Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Sep 1;34(11):1665-1671.
doi: 10.1097/QAD.0000000000002595.

Internalized HIV stigma predicts subsequent viremia in US HIV patients through depressive symptoms and antiretroviral therapy adherence

Katerina A Christopoulos  1 , Torsten B Neilands  2 , Samantha Dilworth  2 , Nadra Lisha  3 , John Sauceda  2 , Michael J Mugavero  4 , Heidi M Crane  5 , Rob J Fredericksen  5 , William C Mathews  6 , Richard D Moore  7 , Kenneth H Mayer  8 , Sonia Napravnik  9 , Mallory O Johnson  2
Affiliations

Internalized HIV stigma predicts subsequent viremia in US HIV patients through depressive symptoms and antiretroviral therapy adherence

Katerina A Christopoulos et al. AIDS. .

Abstract

Objective: We sought to examine the prospective association between internalized HIV stigma and unsuppressed viral load and to investigate whether this relationship was sequentially mediated by depressive symptoms and antiretroviral therapy (ART) adherence.

Design: Longitudinal study in a multisite observational clinical cohort.

Methods: The Center for AIDS Research Network of Integrated Clinical Systems patient-reported outcomes survey measures internalized HIV stigma yearly using a four-item assessment (response scale 1 = strongly disagree to 5 = strongly agree). We obtained patient-reported outcome, lab, and appointment data from six center for AIDS research network of integrated clinical systems sites. We used multivariable logistic regression to examine the association between mean stigma and subsequent viremia. We then used Bayesian sequential mediation to fit a longitudinal sequential path model spanning four time points to test if depressive symptoms at T1 and ART adherence at T2 mediated the effect of stigma at T0 on viral load at T3, adjusting for baseline covariates.

Results: Between February 2016 and November 2018, 6859 patients underwent stigma assessment and were 81% cis-men, 38% Black, 16% Latinx, 32% heterosexual-identified, and 49% at least 50 years of age. Mean stigma level was 2.00 (SD 1.08). Stigma was significantly associated with subsequent viremia (adjusted odds ratio = 1.16, 95% confidence interval: 1.05-1.28, P = 0.004), as were younger age and Black race. The chained indirect effect from stigma to unsuppressed viral load through depressive symptoms and then adherence was significant (standardized β = 0.002; SD = 0.001).

Conclusion: Internalized HIV stigma positively predicts subsequent viremia through depressive symptoms and ART adherence. Addressing the link between stigma and depressive symptoms could help improve viral suppression.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
Measurement Time Points for Internalized HIV Stigma, Depressive Symptoms, Antiretroviral Adherence and Viral Load
Figure 2.
Figure 2.
Longitudinal Sequential Path Model of the Association between Internalized HIV Stigma and Unsuppressed Viral Load through the Mediators of Depressive Symptoms and Antiretroviral Adherence
See this image and copyright information in PMC

References

    1. Katz IT, Ryu AE, Onuegbu AG, et al. Impact of HIV-related stigma on treatment adherence: systematic review and meta-synthesis. J Int AIDS Soc. 2013;16(3 Suppl 2):18640. - PMC - PubMed
    1. Sweeney SM, Vanable PA. The Association of HIV-Related Stigma to HIV Medication Adherence: A Systematic Review and Synthesis of the Literature. AIDS Behav. 2016;20(1):29–50. - PubMed
    1. Reif S, Wilson E, McAllaster C, Pence B. The Relationship of HIV-related Stigma and Health Care Outcomes in the US Deep South. AIDS Behav. 2019;23(Suppl 3):242–250. - PubMed
    1. Rao D, Feldman BJ, Fredericksen RJ, et al. A structural equation model of HIV-related stigma, depressive symptoms, and medication adherence. AIDS Behav. 2012;16(3):711–716. - PMC - PubMed
    1. Kipp AM, Audet CM, Earnshaw VA, Owens J, McGowan CC, Wallston KA. Re-validation of the Van Rie HIV/AIDS-related stigma scale for use with people living with HIV in the United States. PLoS One. 2015;10(3):e0118836. - PMC - PubMed

Publication types