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. 2024 Mar 1;95(3):231-237.
doi: 10.1097/QAI.0000000000003360.

Longitudinal Associations of Experienced and Perceived Community Stigma With Antiretroviral Therapy Adherence and Viral Suppression in New-to-Care People With HIV: Mediating Roles of Internalized Stigma and Depression Symptoms

Ibrahim Yigit  1 , Bulent Turan  2   3 , Gülşah Kurt  4 , Sheri D Weiser  5 , Mallory O Johnson  6 , Michael J Mugavero  7 , Janet M Turan  8   9
Affiliations

Longitudinal Associations of Experienced and Perceived Community Stigma With Antiretroviral Therapy Adherence and Viral Suppression in New-to-Care People With HIV: Mediating Roles of Internalized Stigma and Depression Symptoms

Ibrahim Yigit et al. J Acquir Immune Defic Syndr. .

Abstract

Background: Although cross-sectional studies have suggested that HIV-related stigma and depression symptoms may result in poor HIV treatment and health outcomes, few studies have investigated potential longitudinal mechanisms in these relationships. Furthermore, longitudinal effects of HIV-related stigma on health outcomes have not been examined in people with HIV (PWH) newly initiating HIV clinical care. We examined longitudinal associations between experienced and perceived community stigma and health outcomes (antiretroviral therapy [ART] adherence and viral load), mediated by internalized stigma and depression symptoms among new-to-care PWH in the United States.

Setting/methods: Data were obtained from 371 PWH who initiated HIV medical care at 4 HIV sites at baseline and 48 weeks later between December 2013 and 2018. Validated measures were used to assess experienced stigma, perceived community stigma, internalized stigma, depression symptoms, and ART adherence, and viral load was obtained from medical records at the final study visit.

Results: Serial mediation models revealed significant indirect effects of experienced stigma and perceived community stigma on ART adherence and on viral suppression, first through internalized stigma and then through depression symptoms.

Conclusions: These results suggest that PWH may tend to internalize HIV-related stigma when they experience acts of stigmatization or perceive negative attitudes in society, which in turn may result in negative effects on psychological and physical well-being. These findings about how stigma in society may be an antecedent mechanism for PWH to develop internalized stigma, which in turn affects individual health outcomes, can be used to tailor both individual-level and community-level interventions.

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Conflict of interest statement

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

Figures

Figure 1.
Figure 1.
Serial mediation model in the association between experienced stigma and ART adherence. aWhen internalized stigma and depression symptoms are in the model. *p < 0.05; ***p < 0.001.
Figure 2.
Figure 2.
Serial mediation model in the association between perceived community stigma and ART adherence. aWhen internalized stigma and depression symptoms are in the model. **p < 0.01; ***p < 0.001.
Figure 3.
Figure 3.
Serial mediation model in the association between experienced stigma and viral suppression. aWhen internalized stigma and depression symptoms are in the model. *p < 0.05; ***p < 0.001.
Figure 4.
Figure 4.
Serial mediation model in the association between perceived community stigma and viral suppression. aWhen internalized stigma and depression symptoms are in the model. *p < 0.05; ***p < 0.001.
See this image and copyright information in PMC

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References

    1. Gardner EM, McLees MP, Steiner JF, Del Rio C, Burman WJ. The spectrum of engagement in HIV care and its relevance to test-and-treat strategies for prevention of HIV infection. Clinical infectious diseases. 2011;52(6):793–800. - PMC - PubMed
    1. Mugavero MJ, Amico KR, Horn T, Thompson MA. The state of engagement in HIV care in the United States: from cascade to continuum to control. Clinical infectious diseases. 2013;57(8):1164–1171. - PubMed
    1. Kitahata MM, Gange SJ, Abraham AG, et al. Effect of early versus deferred antiretroviral therapy for HIV on survival. New England Journal of Medicine. 2009;360(18):1815–1826. - PMC - PubMed
    1. Nwangwu‐Ike N, Saduvala N, Watson M, Panneer N, Oster AM. HIV diagnoses and viral suppression among US women in rural and nonrural areas, 2010–2017. The Journal of Rural Health. 2020;36(2):217–223. - PubMed
    1. Sackoff JE, Hanna DB, Pfeiffer MR, Torian LV. Causes of death among persons with AIDS in the era of highly active antiretroviral therapy: New York City. Annals of internal medicine. 2006;145(6):397–406. - PubMed

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