Everyday discrimination and HIV self-management: the role of coping among people living with HIV

Self-management is central to long-term HIV care and is influenced by psychosocial as well as clinical factors. Everyday discrimination may represent a persistent social stressor for people living with HIV (PLWH), but its association with overall HIV self-management and the role of coping remain unclear. This study examined everyday discrimination in relation to HIV self-management and evaluated parallel indirect associations through positive and negative coping. In this multicenter cross-sectional study, 253 PLWH were recruited from outpatient clinics at eight specialist infectious disease hospitals in Jiangsu Province, Shanghai, and Beijing, China, between October and December 2025. Participants completed validated measures of everyday discrimination, coping, HIV-related stress, family functioning, and HIV self-management. Pearson correlation analysis was used to examine associations among the main variables. Parallel indirect effects through positive and negative coping were tested using PROCESS Model 4 with 5,000 bootstrap resamples and HC3 robust standard errors, followed by hierarchical multiple linear regression to identify factors independently associated with HIV self-management. Sensitivity analyses used hospital-clustered CR2 standard errors and an exploratory hospital-level bootstrap. Less frequent everyday discrimination, indicated by higher Everyday Discrimination Scale scores, was correlated with better HIV self-management (r = 0.472, P < 0.01). The adjusted indirect association through positive coping was statistically supported (B = 0.146, 95% CI 0.029 to 0.287), whereas the interval for negative coping included zero (B = 0.021, 95% CI −0.025 to 0.114). The final hierarchical regression model explained 38.7% of the variance in self-management. Higher discrimination scores, positive coping, and family functioning were associated with better self-management using conventional standard errors. With hospital-clustered inference, the associations with discrimination scores ( P = 0.021) and positive coping ( P < 0.001) remained statistically supported, whereas that with family functioning did not ( P = 0.132). The hospital-level bootstrap interval for the indirect association through positive coping excluded zero (95% CI 0.048 to 0.267), although inference was limited by the inclusion of only eight hospitals. Less frequent everyday discrimination and greater positive coping were associated with better HIV self-management. Positive coping may partly account for this association, but the cross-sectional design and small number of hospitals limit interpretation. Longitudinal studies involving more hospitals are needed to clarify these relationships and inform the development of psychosocial support strategies.