Format

Send to

Choose Destination
AIDS Behav. 2019 Aug;23(8):2025-2036. doi: 10.1007/s10461-018-2301-4.

HIV-Related Stigma and Viral Suppression Among African-American Women: Exploring the Mediating Roles of Depression and ART Nonadherence.

Author information

1
Department of Health Services, University of Washington, Seattle, WA, USA. llipira@uw.edu.
2
Department of Health Services, University of Washington, 1959 NE Pacific St, Magnuson Health Sciences Center, Room H-680, Box 357660, Seattle, WA, 98195-7660, USA. llipira@uw.edu.
3
Department of Health Services, University of Washington, Seattle, WA, USA.
4
VA Puget Sound Health Care System, Seattle, WA, USA.
5
School of Social Work, University of Washington, Seattle, WA, USA.
6
Department of Global Health, University of Washington, Seattle, WA, USA.
7
Fred Hutch, Seattle, WA, USA.
8
Department of Biostatistics, University of Washington, Seattle, WA, USA.
9
Stroger Hospital of Cook County and Ruth M. Rothstein CORE Center, Chicago, IL, USA.
10
Division of Infectious Diseases, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
11
Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, USA.
12
Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, USA.
13
Department of Psychology, University of Washington, Seattle, WA, USA.

Abstract

We used baseline data from a sample of African-American women living with HIV who were recruited to participate in a stigma-reduction intervention in Chicago and Birmingham (2013-2015) to (1) evaluate the relationship between HIV-related stigma and viral suppression, and (2) assess the role of depression and nonadherence to antiretroviral therapy (ART) as mediators. Data from women were included in this secondary analysis if they were on ART, had viral load data collected within 8-weeks of study entry and had complete covariate data. We used logistic regression to estimate the total effect of HIV-related stigma (14-item Stigma Scale for Chronic Illness) on viral suppression (< 200 copies/mL), and serial mediation analysis to estimate indirect effects mediated by depressive symptoms (8-item Patient Health Questionnaire) and ART nonadherence (number of days with missed doses). Among 100 women who met study inclusion criteria, 95% reported some level of HIV-related stigma. In adjusted models, higher levels of HIV-related stigma were associated with lower odds of being virally suppressed (AOR = 0.93, 95% CI = 0.89-0.98). In mediation analysis, indirect effects through depression and ART nonadherence were not significant. Findings suggest that HIV-related stigma is common among African-American women living with HIV, and those who experience higher levels of stigma are less likely to be virally suppressed. However, the mechanisms remain unclear.

KEYWORDS:

ART adherence; African-American women; Depression; HIV stigma; Viral suppression

PMID:
30343422
DOI:
10.1007/s10461-018-2301-4
[Indexed for MEDLINE]

Supplemental Content

Full text links

Icon for Springer
Loading ...
Support Center