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. 2018 Feb 1;77(2):144-153.
doi: 10.1097/QAI.0000000000001589.

Pathways From HIV-Related Stigma to Antiretroviral Therapy Measures in the HIV Care Cascade for Women Living With HIV in Canada

Carmen H Logie  1   2 , Ashley Lacombe-Duncan  1 , Ying Wang  1 , Angela Kaida  3 , Tracey Conway  2 , Kath Webster  3 , Alexandra de Pokomandy  4   5 , Mona R Loutfy  2   6 , Aranka Anema, Denise Becker, Lori Brotto, Allison Carter, Claudette Cardinal, Guillaume Colley, Erin Ding, Janice Duddy, Nada Gataric, Robert S Hogg, Terry Hosward, Shahab Jabbari, Evin Jones, Mary Kestler, Andrea Langlois, Viviane Lima, Elisa Lloyd-Smith, Melissa Medjuck, Cari Miller, Deborah Money, Valerie Nicholson, Gina Ogilvie, Sophie Patterson, Neora Pick, Eric Roth, Kate Salters, Margarite Sanchez, Jacquie Sas, Paul Sereda, Marcie Summers, Christina Tom, Lu Wang, Kath Webster, Wendy Zhang, Rahma Abdul-Noor, Jonathan Angel, Fatimatou Barry, Greta Bauer, Kerrigan Beaver, Anita Benoit, Breklyn Bertozzi, Sheila Borton, Tammy Bourque, Jason Brophy, Ann Burchell, Allison Carlson, Lynne Cioppa, Jeffrey Cohen, Tracey Conway, Curtis Cooper, Jasmine Cotnam, Janette Cousineau, Annette Fraleigh, Brenda Gagnier, Claudine Gasingirwa, Saara Greene, Trevor Hart, Shazia Islam, Charu Kaushic, Logan Kennedy, Desiree Kerr, Maxime Kiboyogo, Gladys Kwaramba, Lynne Leonard, Johanna Lewis, Carmen Logie, Shari Margolese, Marvelous Muchenje, Mary Ndungʼu, Kelly OʼBrien, Charlene Ouellette, Jeff Powis, Corinna Quan, Janet Raboud, Anita Rachlis, Edward Ralph, Sean Rourke, Sergio Rueda, Roger Sandre, Fiona Smaill, Stephanie Smith, Tsitsi Tigere, Wangari Tharao, Sharon Walmsley, Wendy Wobeser, Jessica Yee, Mark Yudin, Jean-Guy Baril, Nora Butler Burke, Pierrette Clément, Janice Dayle, Danièle Dubuc, Mylène Fernet, Danielle Groleau, Aurélie Hot, Marina Klein, Carrie Martin, Lyne Massie, Brigitte Ménard, Nadia OʼBrien, Joanne Otis, Doris Peltier, Alie Pierre, Karène Proulx-Boucher, Danielle Rouleau, Édénia Savoie, Cécile Tremblay, Benoit Trottier, Sylvie Trottier, Christos Tsoukas, Jacqueline Gahagan, Catherine Hankins, Renee Masching, Susanna Ogunnaike-Cooke
Affiliations

Pathways From HIV-Related Stigma to Antiretroviral Therapy Measures in the HIV Care Cascade for Women Living With HIV in Canada

Carmen H Logie et al. J Acquir Immune Defic Syndr. .

Abstract

Background: Associations between HIV-related stigma and reduced antiretroviral therapy (ART) adherence are widely established, yet the mechanisms accounting for this relationship are underexplored. There has been less attention to HIV-related stigma and its associations with ART initiation and current ART use. We examined pathways from HIV-related stigma to ART initiation, current ART use, and ART adherence among women living with HIV in Canada.

Methods: We used baseline survey data from a national cohort of women living with HIV in Canada (n = 1425). Structural equation modeling using weighted least squares estimation methods was conducted to test the direct effects of HIV-related stigma dimensions (personalized, negative self-image, and public attitudes) on ART initiation, current ART use, and 90% ART adherence, and indirect effects through depression and HIV disclosure concerns, adjusting for sociodemographic factors.

Results: In the final model, the direct paths from personalized stigma to ART initiation (β = -0.104, P < 0.05) and current ART use (β = -0.142, P < 0.01), and negative self-image to ART initiation (β = -0.113, P < 0.01) were significant, accounting for the mediation effects of depression and HIV disclosure concerns. Depression mediated the pathways from personalized stigma to ART adherence, and negative self-image to current ART use and ART adherence. Final model fit indices suggest that the model fit the data well [χ(25) = 90.251, P < 0.001; comparative fit index = 0.945; root-mean-square error of approximation = 0.044].

Conclusions: HIV-related stigma is associated with reduced likelihood of ART initiation and current ART use, and suboptimal ART adherence. To optimize the benefit of ART among women living with HIV, interventions should reduce HIV-related stigma and address depression.

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Conflict of interest statement

The authors have no funding or conflicts of interest to disclose.

Figures

FIGURE 1.
FIGURE 1.
Conceptualized pathways from HIV-related stigma to ART initiation, current ART use, and >90% ART adherence.
FIGURE 2.
FIGURE 2.
Final path analysis results for HIV-related stigma on ART initiation, current ART use, and ART adherence >90%. Standard coefficients are reported with the standard errors in parentheses. Statistical significance is noted with the following notations; *P < 0.05, **P < 0.01, ***P < 0.001. Covariates include age, ethnicity, immigration status, relationship status, education level, and years with HIV.
See this image and copyright information in PMC

References

    1. Mugavero MJ, Amico KR, Horn T, et al. The state of engagement in HIV care in the United States: from cascade to continuum to control. Clin Infect Dis. 2013;57:1164–1171. - PubMed
    1. UNAIDS. 90–90–90-An ambitious treatment target to help end the AIDS epidemic. 2014;1–33.
    1. Giordano TP, Gifford AL, White AC, et al. Retention in care: a challenge to survival with HIV infection. Clin Infect Dis. 2007;44:1493–1499. - PubMed
    1. Horstmann E, Brown J, Islam F, et al. Retaining HIV-infected patients in care: where are we? Where do we go from here? Clin Infect Dis. 2010;50:752–761. - PubMed
    1. Mugavero MJ, Lin HY, Allison JJ, et al. Racial disparities in HIV virologic failure: do missed visits matter? J Acquir Immun Defic Syndr. 2009;50:100–108. - PMC - PubMed

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