Abstract

Background: Adolescents living with HIV may be at elevated risk of psychological problems, which are correlated
with negative health outcomes. In cross-sectional research with HIV-affected adolescents, bullying victimisation
and internalised HIV stigma have been associated with poorer psychological health. We extended these
findings and tested longitudinal associations between bullying victimisation, internalised stigma, and mental
health among adolescents living with HIV. We also tested whether relationships between bullying victimisation
and psychological symptoms were mediated by internalised stigma.
Method: Adolescents living with HIV (n = 1060, 10–19 years, 55% female), who had ever initiated HIV
treatment in 53 public health facilities in the Eastern Cape, South Africa, were interviewed and followed up 18
months later (n = 995, 94% retention). Participants completed well-validated measures of depression, anxiety,
posttraumatic stress, bullying victimisation, and internalised stigma.
Results: After adjusting for baseline mental health and sociodemographic characteristics, baseline internalised
stigma prospectively predicted poorer outcomes on all psychological measures. Bullying victimisation at baseline
was not directly associated with any psychological measures at follow up; however, it was indirectly associated
with all psychological measures via internalised stigma.
Limitations: Reliance on self-report measures and poor reliability of the depression scale.
Conclusions: Bullying victimisation is associated with internalised stigma, which in turn predicts psychological
symptoms over time. Interventions reducing internalised stigma and associated psychological distress are
needed, and these should be integrated into HIV care to ensure optimal HIV management. The implementation of
bullying prevention programs may reduce internalised stigma and promote mental health among adolescents
living with HIV.

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