Food Insecurity, Internalized Stigma, and Depressive Symptoms Among Women Living with HIV in the United States

doi:10.1007/s10461-018-2164-8

. 2018 Dec;22(12):3869-3878.

doi: 10.1007/s10461-018-2164-8.

Food Insecurity, Internalized Stigma, and Depressive Symptoms Among Women Living with HIV in the United States

Kartika Palar¹, Edward A Frongillo², Jessica Escobar², Lila A Sheira³, Tracey E Wilson⁴, Adebola Adedimeji⁵, Daniel Merenstein⁶, Mardge H Cohen⁷, Eryka L Wentz⁸, Adaora A Adimora⁹, Ighovwerha Ofotokun^{10

11}, Lisa Metsch¹², Phyllis C Tien^{13

14}, Janet M Turan¹⁵, Sheri D Weiser^{3

16}

Affiliations

¹ Division of HIV, Infectious Disease and Global Medicine, Department of Medicine, San Francisco General Hospital, University of California, San Francisco (UCSF), 995 Potrero Avenue, Bldg 80, Ward 84, Campus Box 0874, San Francisco, CA, 94110, USA. Kartika.Palar@ucsf.edu.
² Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, SC, USA.
³ Division of HIV, Infectious Disease and Global Medicine, Department of Medicine, San Francisco General Hospital, University of California, San Francisco (UCSF), 995 Potrero Avenue, Bldg 80, Ward 84, Campus Box 0874, San Francisco, CA, 94110, USA.
⁴ Department of Community Health Sciences, School of Public Health, State University of New York Downstate Medical Center, Brooklyn, NY, USA.
⁵ Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA.
⁶ Department of Family Medicine, Georgetown University Medical Center, Washington, DC, USA.
⁷ Department of Medicine, Stroger Hospital, Chicago, IL, USA.
⁸ Bloomberg School of Public Health, Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA.
⁹ School of Medicine and UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
¹⁰ School of Medicine, Emory University, Atlanta, GA, USA.
¹¹ Grady Healthcare System, Atlanta, GA, USA.
¹² Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA.
¹³ Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.
¹⁴ Medical Service, Department of Veteran Affairs Medical Center, San Francisco, CA, USA.
¹⁵ Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA.
¹⁶ Center for AIDS Prevention Studies, UCSF, San Francisco, CA, USA.

PMID: 29948333
PMCID: PMC6209540
DOI: 10.1007/s10461-018-2164-8

Food Insecurity, Internalized Stigma, and Depressive Symptoms Among Women Living with HIV in the United States

Kartika Palar et al. AIDS Behav. 2018 Dec.

. 2018 Dec;22(12):3869-3878.

doi: 10.1007/s10461-018-2164-8.

Authors

Affiliations

¹ Division of HIV, Infectious Disease and Global Medicine, Department of Medicine, San Francisco General Hospital, University of California, San Francisco (UCSF), 995 Potrero Avenue, Bldg 80, Ward 84, Campus Box 0874, San Francisco, CA, 94110, USA. Kartika.Palar@ucsf.edu.
² Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, SC, USA.
³ Division of HIV, Infectious Disease and Global Medicine, Department of Medicine, San Francisco General Hospital, University of California, San Francisco (UCSF), 995 Potrero Avenue, Bldg 80, Ward 84, Campus Box 0874, San Francisco, CA, 94110, USA.
⁴ Department of Community Health Sciences, School of Public Health, State University of New York Downstate Medical Center, Brooklyn, NY, USA.
⁵ Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA.
⁶ Department of Family Medicine, Georgetown University Medical Center, Washington, DC, USA.
⁷ Department of Medicine, Stroger Hospital, Chicago, IL, USA.
⁸ Bloomberg School of Public Health, Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA.
⁹ School of Medicine and UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
¹⁰ School of Medicine, Emory University, Atlanta, GA, USA.
¹¹ Grady Healthcare System, Atlanta, GA, USA.
¹² Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA.
¹³ Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.
¹⁴ Medical Service, Department of Veteran Affairs Medical Center, San Francisco, CA, USA.
¹⁵ Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA.
¹⁶ Center for AIDS Prevention Studies, UCSF, San Francisco, CA, USA.

PMID: 29948333
PMCID: PMC6209540
DOI: 10.1007/s10461-018-2164-8

Abstract

Food insecurity, internalized HIV stigma, and depressive symptoms are independently associated with poor HIV outcomes. Food insecurity, stigma, and depression may be interrelated among women living with HIV (WLHIV). We hypothesized that food insecurity would be independently associated with internalized stigma and depressive symptoms among WLHIV in the United States (US), and would partially account for associations between stigma and depressive symptoms. We tested hypotheses using regression models and partial correlation analysis with cross-sectional data among 1317 WLHIV from the Women's Interagency HIV Study. In adjusted models, greater food insecurity was associated with internalized HIV stigma and depressive symptoms (all p < 0.05), exhibiting dose-response relationships. Food insecurity accounted for 23.2% of the total shared variance between depressive symptoms and internalized stigma. Food insecurity is associated with depressive symptoms and internalized HIV stigma among US WLHIV, and may play a role in the negative cycle of depression and internalized stigma.

Keywords: Depression; Food insecurity; HIV; Internalized stigma; United States; Women.

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References

1. Katz IT, Ryu AE, Onuegbu AG, et al. Impact of HIV-related stigma on treatment adherence: systematic review and meta-synthesis. Journal of the International AIDS Society. 2013;16(3 Suppl 2) - PMC - PubMed
1. Turan B, Smith W, Cohen MH, et al. Mechanisms For The Negative Effects Of Internalized Hiv-Related Stigma On Art Adherence In Women: The Mediating Roles Of Social Isolation And Depression. Journal of acquired immune deficiency syndromes (1999) 2016 - PMC - PubMed
1. Kinsler JJ, Wong MD, Sayles JN, Davis C, Cunningham WE. The effect of perceived stigma from a health care provider on access to care among a low-income HIV-positive population. AIDS patient care and STDs. 2007;21(8):584–592. - PubMed
1. Allen H, Wright BJ, Harding K, Broffman L. The role of stigma in access to health care for the poor. Milbank Quarterly. 2014;92(2):289–318. - PMC - PubMed
1. Sumari-de Boer IM, Sprangers MA, Prins JM, Nieuwkerk PT. HIV stigma and depressive symptoms are related to adherence and virological response to antiretroviral treatment among immigrant and indigenous HIV infected patients. AIDS and Behavior. 2012;16(6):1681–1689. - PMC - PubMed

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[1] Katz IT, Ryu AE, Onuegbu AG, et al. Impact of HIV-related stigma on treatment adherence: systematic review and meta-synthesis. Journal of the International AIDS Society. 2013;16(3 Suppl 2) - PMC - PubMed

[2] Katz IT, Ryu AE, Onuegbu AG, et al. Impact of HIV-related stigma on treatment adherence: systematic review and meta-synthesis. Journal of the International AIDS Society. 2013;16(3 Suppl 2) - PMC - PubMed

[3] Turan B, Smith W, Cohen MH, et al. Mechanisms For The Negative Effects Of Internalized Hiv-Related Stigma On Art Adherence In Women: The Mediating Roles Of Social Isolation And Depression. Journal of acquired immune deficiency syndromes (1999) 2016 - PMC - PubMed

[4] Turan B, Smith W, Cohen MH, et al. Mechanisms For The Negative Effects Of Internalized Hiv-Related Stigma On Art Adherence In Women: The Mediating Roles Of Social Isolation And Depression. Journal of acquired immune deficiency syndromes (1999) 2016 - PMC - PubMed

[5] Kinsler JJ, Wong MD, Sayles JN, Davis C, Cunningham WE. The effect of perceived stigma from a health care provider on access to care among a low-income HIV-positive population. AIDS patient care and STDs. 2007;21(8):584–592. - PubMed

[6] Kinsler JJ, Wong MD, Sayles JN, Davis C, Cunningham WE. The effect of perceived stigma from a health care provider on access to care among a low-income HIV-positive population. AIDS patient care and STDs. 2007;21(8):584–592. - PubMed

[7] Allen H, Wright BJ, Harding K, Broffman L. The role of stigma in access to health care for the poor. Milbank Quarterly. 2014;92(2):289–318. - PMC - PubMed

[8] Allen H, Wright BJ, Harding K, Broffman L. The role of stigma in access to health care for the poor. Milbank Quarterly. 2014;92(2):289–318. - PMC - PubMed

[9] Sumari-de Boer IM, Sprangers MA, Prins JM, Nieuwkerk PT. HIV stigma and depressive symptoms are related to adherence and virological response to antiretroviral treatment among immigrant and indigenous HIV infected patients. AIDS and Behavior. 2012;16(6):1681–1689. - PMC - PubMed

[10] Sumari-de Boer IM, Sprangers MA, Prins JM, Nieuwkerk PT. HIV stigma and depressive symptoms are related to adherence and virological response to antiretroviral treatment among immigrant and indigenous HIV infected patients. AIDS and Behavior. 2012;16(6):1681–1689. - PMC - PubMed

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Food Insecurity, Internalized Stigma, and Depressive Symptoms Among Women Living with HIV in the United States

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Food Insecurity, Internalized Stigma, and Depressive Symptoms Among Women Living with HIV in the United States

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