Social Science & Medicine 64 (2007) 1823–1831 Internalized stigma, discrimination, and depression among men and women living with HIV/AIDS in Cape Town, South Africa Leickness C. Simbayi a , Seth Kalichman b,Ã , Anna Strebel a , Allanise Cloete a , Nomvo Henda a , Ayanda Mqeketo a a Social Aspects of HIV/AIDS and Health, Human Sciences Research Council, P. Bag X9182, Cape Town 8000, South Africa b Department of Psychology, University of Connecticut, 406 Babbidge Rd, Storrs, CT 06269 USA Available online 2 March 2007 Abstract AIDS stigmas interfere with HIV prevention, diagnosis, and treatment and can become internalized by people living with HIV/AIDS. However, the effects of internalized AIDS stigmas have not been investigated in Africa, home to two- thirds of the more than 40 million people living with AIDS in the world. The current study examined the prevalence of discrimination experiences and internalized stigmas among 420 HIV-positive men and 643 HIV-positive women recruited from AIDS services in Cape Town, South Africa. The anonymous surveys found that 40% of persons with HIV/AIDS had experienced discrimination resulting from having HIV infection and one in five had lost a place to stay or a job because of their HIV status. More than one in three participants indicated feeling dirty, ashamed, or guilty because of their HIV status. A hierarchical regression model that included demographic characteristics, health and treatment status, social support, substance use, and internalized stigma significantly predicted cognitive–affective depression. Internalized stigma accounted for 4.8% of the variance in cognitive–affective depression scores over and above the other variables. These results indicate an urgent need for social reform to reduce AIDS stigmas and the design of interventions to assist people living with HIV/AIDS to adjust and adapt to the social conditions of AIDS in South Africa. r 2007 Elsevier Ltd. All rights reserved. Keywords: Internalized stigma; AIDS; Coping; South Africa; Discrimination; Depression Introduction HIV/AIDS is perhaps the most stigmatized medical condition in the world. Research conducted across continents has consistently demonstrated that adversarial views of people living with HIV/ AIDS are common. AIDS stigmatizing beliefs are the product of multiple social influences including attributions of responsibility for HIV infection and beliefs that individuals with HIV/AIDS are con- taminated and tainted. In his classic theory of social stigma, Goffman (1963) identified three aspects of stigma that are characteristic of HIV/AIDS: blemishes of personal character, stained social identity, and physical deformity or defects. AIDS stigmas also reproduce inequalities of class, race, and gender (Parker & Aggleton, 2003). People with HIV infection are often ascribed responsibility for their condition because HIV is contracted from behaviors that are considered avoidable, namely unsafe sex and drug use practices (Herek, 1999). AIDS stigmas are also inextricably enmeshed with other stigmas associated with risk behaviors, such as ARTICLE IN PRESS www.elsevier.com/locate/socscimed 0277-9536/$ - see front matter r 2007 Elsevier Ltd. All rights reserved. doi:10.1016/j.socscimed.2007.01.006 Ã Corresponding author. E-mail address: seth.k@uconn.edu (S. Kalichman).