Psychosocial Impact of Stigma by Association on Self-Esteem and Emotional and Psychological Well-Being among Children of Parents Living with HIV/AIDS in Telangana, India: A Quantitative Cross-Sectional Study

Abstract

Background. Children of parents living with HIV/AIDS in India are disproportionately exposed to stigma by association, social exclusion, and psychosocial adversity. However, empirical evidence on the psychological impact of this stigma in the Indian context — particularly in South India — remains limited.

Method. This quantitative cross-sectional study (N = 477) examined stigma by association, self-esteem, and emotional and psychological well-being among children of parents living with HIV/AIDS across three districts of Telangana — Medak, Sangareddy, and Siddipet. The affected group (n = 387) was compared with a non-affected comparison group (n = 90). Data were collected using the adapted HIV/AIDS Stigma Instrument — Children (HASI-C; α = .858), the Rosenberg Self-Esteem Scale (RSES; α = .868), and a researcher-developed Emotional and Psychological Well-Being Scale (EPWBS; α = .923). One-sample t-tests, independent samples t-tests, one-way ANOVA, and Pearson correlation were applied.

Results. Affected children exhibited significantly elevated stigma by association (M = 55.40, SD = 8.78; t[386] = 12.090, p < .001), significantly lower self-esteem (M = 23.86, SD = 3.21 vs. M = 26.07, SD = 3.89; t[475] = 5.632, p < .001), and significantly poorer emotional and psychological well-being (M = 34.41, SD = 5.59 vs. M = 38.62, SD = 4.42; t[475] = 6.669, p < .001) than non-affected peers. Stigma by association was negatively correlated with both self-esteem (r = −.460, p < .001) and well-being (r = −.441, p < .001). District of residence significantly differentiated all three variables, and caste additionally differentiated well-being.

Conclusion. Stigma by association constitutes a measurable psychosocial stressor that erodes self-esteem and emotional well-being in HIV-affected children. District-level variation underscores the need for contextually responsive social work interventions and policy integration of children's psychosocial well-being within India's HIV response.