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. 2019 Jun;26(3):286-296.
doi: 10.1007/s12529-019-09786-3.

Pathways to Health: an Examination of HIV-Related Stigma, Life Stressors, Depression, and Substance Use

Tiffany R Glynn  1 , Maria M Llabre  1 , Jasper S Lee  1 , C Andres Bedoya  2 , Megan M Pinkston  3 , Conall O'Cleirigh  2 , Steven A Safren  4
Affiliations

Pathways to Health: an Examination of HIV-Related Stigma, Life Stressors, Depression, and Substance Use

Tiffany R Glynn et al. Int J Behav Med. 2019 Jun.

Abstract

Background: Despite antiretroviral treatment (ART) being an efficacious treatment for HIV, essentially making it a chronic non-terminal illness, two related and frequent concerns for many people living with HIV/AIDS (PLWHA) continue to be HIV-related stigma and life stress. These two variables are frequently associated with depression, substance use, and poorer functional health. Studies to date have not fully examined the degree to which these constructs may be associated within one model, which could reveal a more nuanced understanding of how HIV-related stigma and life stress affect functional health in PLWHA.

Methods: The current study employed hybrid structural equation modeling to examine the interconnectedness and potential indirect relationships of HIV-related stigma and life stress to worse health through substance use and depression, controlling for ART adherence and age. Participants were 240 HIV-infected individuals who completed a biopsychosocial assessment battery upon screening for an RCT on treating depression in those infected with HIV.

Results: Both HIV-related stigma and stressful life events were directly related to depression, and depression was directly related to health. There were significant indirect effects from stigma and stress to health via depression. There were no significant effects involving substance use.

Conclusion: It is important to continue to develop ways to address stigma, stressful life events, and their effects on distress in those living with HIV. Expanding our knowledge of disease progression risk factors beyond ART adherence is important to be able to design adjuvant interventions, particularly because treatment means that people living with HIV have markedly improved life expectancy and that successful treatment means that HIV is not transmittable to others.

Keywords: Depression; HIV; HIV-related stigma; Stressful life events; Substance use.

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Conflict of interest statement

Conflict of Interest The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Proposed and initially tested model examining how life stressors and HIV-related stigma affect the health of HIV-infected individuals via substance use and depression
Fig. 2
Fig. 2
Final hybrid structural equation model tested examining how life stressors and HIV-related stigma affect the health of HIV-infected individuals via substance use and depression
Fig. 3
Fig. 3
Significant direct and indirect pathways from life stress and HIV-related stigma to functional health via depression
See this image and copyright information in PMC

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