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Longitudinal association between internalized HIV stigma and antiretroviral therapy adherence for women living with HIV: the mediating role of depression.
Turan, Bulent; Rice, Whitney S; Crockett, Kaylee B; Johnson, Mallory; Neilands, Torsten B; Ross, Shericia N; Kempf, Mirjam-Colette; Konkle-Parker, Deborah; Wingood, Gina; Tien, Phyllis C; Cohen, Mardge; Wilson, Tracey E; Logie, Carmen H; Sosanya, Oluwakemi; Plankey, Michael; Golub, Elizabeth; Adimora, Adaora A; Parish, Carrigan; Weiser, Sheri D; Turan, Janet M
Journal Title
AIDS (London, England)
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Publication Date
2019-03
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Publication Volume
33
Publication Issue
3
Publication Begin
571
Publication End
576
Number of pages
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Abstract
Objective: We investigated whether internalized HIV-related stigma predicts adherence to antiretroviral therapy (ART) longitudinally in women living with HIV in the United States, and whether depression symptoms mediate the relationship between internalized stigma and suboptimal ART adherence.
Design: Observational longitudinal study utilizing data from the Women's Interagency HIV Study cohort.
Methods: A measure of internalized HIV-related stigma was added to the battery of Women's Interagency HIV Study measures in 2013. For current analyses, participants' first assessment of internalized HIV-related stigma and assessments of other variables at that time were used as baseline measures (Time one or T1, visit occurring in 2013/14), with outcomes measured approximately 2 years later (T3, 2015/16; n = 914). A measure of depression symptoms, assessed approximately 18 months after the baseline (T2, 2014/15), was used in mediation analyses (n = 862).
Results: Higher internalized HIV-related stigma at T1 predicted lower odds of optimal ART adherence at T3 (adjusted odds ratio = 0.61, P = 0.001, 95% confidence interval [0.45, 0.82]). Results were similar when ART adherence at T1 was added as a control variable. Mediation analysis revealed a significant indirect effect of internalized HIV stigma at T1 on ART adherence at T3 through depression symptoms at T2 (while controlling for depression symptoms and ART adherence at T1; B = -0.05, SE = 0.03, 95% confidence interval [-0.11, -0.006]).
Conclusion: These results provide strong longitudinal support for the hypothesis that internalized HIV-related stigma results in suboptimal ART adherence in a large sample of women living with HIV in the United States, working through the pathway of increased depression symptoms.
Design: Observational longitudinal study utilizing data from the Women's Interagency HIV Study cohort.
Methods: A measure of internalized HIV-related stigma was added to the battery of Women's Interagency HIV Study measures in 2013. For current analyses, participants' first assessment of internalized HIV-related stigma and assessments of other variables at that time were used as baseline measures (Time one or T1, visit occurring in 2013/14), with outcomes measured approximately 2 years later (T3, 2015/16; n = 914). A measure of depression symptoms, assessed approximately 18 months after the baseline (T2, 2014/15), was used in mediation analyses (n = 862).
Results: Higher internalized HIV-related stigma at T1 predicted lower odds of optimal ART adherence at T3 (adjusted odds ratio = 0.61, P = 0.001, 95% confidence interval [0.45, 0.82]). Results were similar when ART adherence at T1 was added as a control variable. Mediation analysis revealed a significant indirect effect of internalized HIV stigma at T1 on ART adherence at T3 through depression symptoms at T2 (while controlling for depression symptoms and ART adherence at T1; B = -0.05, SE = 0.03, 95% confidence interval [-0.11, -0.006]).
Conclusion: These results provide strong longitudinal support for the hypothesis that internalized HIV-related stigma results in suboptimal ART adherence in a large sample of women living with HIV in the United States, working through the pathway of increased depression symptoms.
Citation
Turan B, Rice WS, Crockett KB, Johnson M, Neilands TB, Ross SN, Kempf MC, Konkle-Parker D, Wingood G, Tien PC, Cohen M, Wilson TE, Logie CH, Sosanya O, Plankey M, Golub E, Adimora AA, Parish C, Weiser SD, Turan JM. Longitudinal association between internalized HIV stigma and antiretroviral therapy adherence for women living with HIV: the mediating role of depression. AIDS. 2019 Mar 1;33(3):571-576. doi: 10.1097/QAD.0000000000002071. PMID: 30702521; PMCID: PMC6362840.