A Structural Equation Model of HIV-Related Stigma, Racial Discrimination, Housing Insecurity and Wellbeing among African and Caribbean Black Women Living with HIV in Ontario, Canada

Abstract

African and Caribbean Black women in Canada have new HIV infection rates 7 times higher than their white counterparts. This overrepresentation is situated in structural contexts of inequities that result in social, economic and health disparities among African and Caribbean Black populations. Economic insecurity is a distal driver of HIV vulnerability, reducing access to HIV testing, prevention and care. Less is known about how economic insecurity indicators, such as housing security, continue to influence the lives of women living with HIV following HIV-positive diagnoses. The aim of this study was to test a conceptual model of the pathways linking HIV-related stigma, racial discrimination, housing insecurity, and wellbeing (depression, social support, self-rated health). We implemented a cross-sectional survey with African and Caribbean Black women living with HIV in 5 Ontario cities, and included 157 participants with complete data in the analyses. We conducted structural equation modeling using maximum likelihood estimation to evaluate the hypothesized conceptual model. One-fifth (22.5%; n = 39) of participants reported housing insecurity. As hypothesized, racial discrimination had significant direct effects on: HIV-related stigma, depression and social support, and an indirect effect on self-rated health via HIV-related stigma. HIV-related stigma and housing insecurity had direct effects on depression and social support, and HIV-related stigma had a direct effect on self-rated health. The model fit the data well: χ2 (45, n = 154) = 54.28, p = 0.387; CFI = 0.997; TLI = 0.996; RMSEA = 0.016. Findings highlight the need to address housing insecurity and intersecting forms of stigma and discrimination among African and Caribbean Black women living with HIV. Understanding the complex relationships between housing insecurity, HIV-related stigma, racial discrimination, and wellbeing can inform multi-level interventions to reduce stigma and enhance health.

Fig 1. Tested conceptual model of the relationship between HIV-related stigma, racial discrimination, housing insecurity and wellbeing among African and Caribbean women living with HIV in Ontario.

Fig 1 depicts hypothesized relationships between variables analyzed in the model. Solid lines represent hypothesized direct effects. Ovals represent latent variables, and rectangles represent observed variables.

Fig 2. Final model of the relationship between HIV-related stigma, racial discrimination, housing insecurity and wellbeing among African and Caribbean women living with HIV in Ontario (n = 157).

Fig 2 depicts the relationships between the latent variables (depicted as ovals) and observed variables (depicted as rectangles). Solid lines represent statistically significant direct effects and dotted lines represent statistically significant indirect effects. The standardized path coefficients next to each arrow reflect the strength and direction of the effect between variables, and the coefficient is similar to standardized beta weights in regression modeling.