Internalized HIV Stigma and Pain among Women with HIV in the United States: The Mediating Role of Depressive Symptoms

Kaylee B Crockett¹, T Alinea Esensoy², Mallory O Johnson³, Torsten B Neilands³, Mirjam-Colette Kempf^{2

4}, Deborah Konkle-Parker⁵, Gina Wingood⁶, Phyllis C Tien⁷, Mardge Cohen⁸, Tracey E Wilson⁹, Carmen H Logie¹⁰, Oluwakemi Sosanya¹¹, Michael Plankey¹², Elizabeth Golub¹³, Adaora A Adimora¹⁴, Carrigan Parish¹⁵, Sheri D Weiser¹⁶, Janet M Turan¹⁷, Bulent Turan¹⁸

Affiliations

¹ Department of Health Care Organization and Policy, School of Public Health, University of Alabama At Birmingham, 1665 University Blvd, Birmingham, AL, 35294-0022, USA. kburnham@uab.edu.
² School of Medicine, University of Alabama At Birmingham, Birmingham, AL, USA.
³ Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.
⁴ Schools of Nursing and Public Health, University of Alabama At Birmingham, Birmingham, AL, USA.
⁵ Department of Medicine/Infectious Diseases, University of Mississippi Medical Center, Jackson, MS, USA.
⁶ Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY, USA.
⁷ Department of Medicine, Department of Veterans Affairs Medical Center, San Francisco and Medical Service, University of California, San Francisco, CA, USA.
⁸ Department of Medicine, Stroger Hospital of Cook County Bureau of Health and Hospital Systems, Chicago, IL, USA.
⁹ Department of Community Health Sciences, School of Public Health, State University of New York, Downstate Health Sciences University, Brooklyn, NY, USA.
¹⁰ Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada.
¹¹ Montefiore Health System, Bronx, NY, USA.
¹² Department of Medicine, Division of Infectious Diseases, Georgetown University Medical Center, Washington, DC, USA.
¹³ Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
¹⁴ Division of Infectious Diseases, Department of Medicine, and Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
¹⁵ Mailman School of Public Health, Department of Sociomedical Sciences, Columbia University Miami Research Center, Miami, FL, USA.
¹⁶ Division of HIV, ID and Global Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.
¹⁷ Department of Health Care Organization and Policy, School of Public Health, University of Alabama At Birmingham, 1665 University Blvd, Birmingham, AL, 35294-0022, USA.
¹⁸ Department of Psychology, University of Alabama At Birmingham, Birmingham, AL, USA.

PMID: 32418165
PMCID: PMC7669722
DOI: 10.1007/s10461-020-02919-w

Internalized HIV Stigma and Pain among Women with HIV in the United States: The Mediating Role of Depressive Symptoms

Kaylee B Crockett et al. AIDS Behav. 2020 Dec.

. 2020 Dec;24(12):3482-3490.

doi: 10.1007/s10461-020-02919-w.

Authors

Affiliations

¹ Department of Health Care Organization and Policy, School of Public Health, University of Alabama At Birmingham, 1665 University Blvd, Birmingham, AL, 35294-0022, USA. kburnham@uab.edu.
² School of Medicine, University of Alabama At Birmingham, Birmingham, AL, USA.
³ Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.
⁴ Schools of Nursing and Public Health, University of Alabama At Birmingham, Birmingham, AL, USA.
⁵ Department of Medicine/Infectious Diseases, University of Mississippi Medical Center, Jackson, MS, USA.
⁶ Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY, USA.
⁷ Department of Medicine, Department of Veterans Affairs Medical Center, San Francisco and Medical Service, University of California, San Francisco, CA, USA.
⁸ Department of Medicine, Stroger Hospital of Cook County Bureau of Health and Hospital Systems, Chicago, IL, USA.
⁹ Department of Community Health Sciences, School of Public Health, State University of New York, Downstate Health Sciences University, Brooklyn, NY, USA.
¹⁰ Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada.
¹¹ Montefiore Health System, Bronx, NY, USA.
¹² Department of Medicine, Division of Infectious Diseases, Georgetown University Medical Center, Washington, DC, USA.
¹³ Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
¹⁴ Division of Infectious Diseases, Department of Medicine, and Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
¹⁵ Mailman School of Public Health, Department of Sociomedical Sciences, Columbia University Miami Research Center, Miami, FL, USA.
¹⁶ Division of HIV, ID and Global Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.
¹⁷ Department of Health Care Organization and Policy, School of Public Health, University of Alabama At Birmingham, 1665 University Blvd, Birmingham, AL, 35294-0022, USA.
¹⁸ Department of Psychology, University of Alabama At Birmingham, Birmingham, AL, USA.

PMID: 32418165
PMCID: PMC7669722
DOI: 10.1007/s10461-020-02919-w

Abstract

Pain is common in women with HIV, though little research has focused on psychosocial experiences contributing to pain in this population. In the present study we examined whether internalized HIV stigma predicts pain, and whether depressive symptoms mediate this relationship among women with HIV. Data were drawn from the Women's Interagency HIV Study (WIHS), for 1,364 women with HIV who completed three study visits between 2015 and 2016. We used a sequential longitudinal design to assess the relationship between internalized HIV stigma at time 1 on pain at time 3 through depressive symptoms at time 2. Analyses revealed internalized HIV stigma was prospectively associated with greater pain, B = 5.30, 95% CI [2.84, 7.60]. The indirect effect through depressive symptoms supported mediation, B = 3.68, 95% CI [2.69, 4.79]. Depression is a modifiable risk factor that can be addressed to improve pain prevention and intervention for women with HIV.

Keywords: Depression; HIV; Internalized stigma; Pain; WIHS; Women.

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Conflict of interest statement

No conflicts of interest were reported by the authors of this paper.

Figures

**Figure 1.**
Longitudinal mediation model showing internalized HIV stigma predicting bodily pain one year later, mediated by depressive symptoms at 6 months. Covariates include age, race, income, recreational drug use, months on ART, and viral load suppression measured at baseline. CES-D: Center for Epidemiological Studies Depression Scale; SF-36: Short Form Health Survey ** p < 0.001, * p < 0.05

See this image and copyright information in PMC

References

1. Hasse B, Ledergerber B, Furrer H, et al. Morbidity and aging in HIV-infected persons: the Swiss HIV cohort study. Clin Infect Dis. 2011;53(11):1130–1139. 10.1093/cid/cir626 - DOI - PubMed
1. Deeks SG, Lewin SR, Havlir DV. The end of AIDS: HIV infection as a chronic disease. The Lancet. 2013;382(9903):1525–1533. 10.1016/S0140-6736(13)61809-7 - DOI - PMC - PubMed
1. Balderson BH, Grothaus L, Harrison RG, McCoy K, Mahoney C, Catz S. Chronic illness burden and quality of life in an aging HIV population. AIDS Care. 2013;25(4):451–458. 10.1080/09540121.2012.712669 - DOI - PMC - PubMed
1. Merlin J Chronic Pain in Patients With HIV Infection: What Clinicians Need To Know. Top Antivir Med. 2015;23(3):120–124. - PMC - PubMed
1. Goodin BR, Owens MA, White DM, et al. Intersectional health-related stigma in persons living with HIV and chronic pain: implications for depressive symptoms. AIDS Care. 2018;30(sup2):66–73. 10.1080/09540121.2018.1468012 - DOI - PMC - PubMed

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Internalized HIV Stigma and Pain among Women with HIV in the United States: The Mediating Role of Depressive Symptoms

Affiliations

Internalized HIV Stigma and Pain among Women with HIV in the United States: The Mediating Role of Depressive Symptoms

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Medical