Framing Mechanisms Linking HIV-Related Stigma, Adherence to Treatment, and Health Outcomes

Turan, Bülent; Hatcher, Abigail M.; Weiser, Sheri D.; Johnson, Mallory O.; Rice, Whitney S.; Turan, Janet M.

doi:10.2105/ajph.2017.303744

Cited by 366 publications

(389 citation statements)

References 36 publications

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“…is important in predicting different health behaviors that PLWH adopt in response to stigma. 24,50 Perceived stigma and discrimination in healthcare settings may impact health behaviors and outcomes differently than community stigma or stigma from family and friends. Stigma in a healthcare setting has been associated with reduced physician trust and non-suppressed viral load, 51 and the quality of a patients’ relationship with their HIV care provider seems to play an important role in ART adherence.…”

Section: Discussionmentioning

confidence: 99%

“…24,49 In this article, we focused on perceptions of enacted stigma in healthcare settings, which may be a better predictor of health outcomes than actual experiences, and this association may be mediated by internalized stigma. A recently proposed theoretical framework suggests that different dimensions of HIV-related stigma may mediate the effect of other stigma dimensions.…”

Section: Discussionmentioning

confidence: 99%

“…A recently proposed theoretical framework suggests that different dimensions of HIV-related stigma may mediate the effect of other stigma dimensions. 24 Future studies can examine the complex mechanisms through which different dimensions of stigma affect health outcomes for PLWH.…”

Section: Discussionmentioning

confidence: 99%

“…23,24 Research suggests that perceived strength of the provider-patient relationship is associated with ART adherence. 25,26 However, there are few studies from the United States (US) investigating the impact of perceived HIV-related stigma and discrimination from healthcare providers on ART adherence.…”

Section: Introductionmentioning

confidence: 99%

“…Given the importance of consistent ART adherence for maintaining viral load suppression, preventing the development of treatment-resistant HIV strains, and reducing risk of transmission, interventions to reduce risk factors for sub-optimal adherence are crucial. 24 However, interventions to reduce HIV stigma and discrimination from different sources have had mixed success. 30,31 This may be due in part to our lack of understanding about the role of psychosocial factors as mediating mechanisms for the impact of HIV-related stigma and discrimination on health behaviors.…”

Section: Introductionmentioning

confidence: 99%

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Association between Perceived Discrimination in Healthcare Settings and HIV Medication Adherence: Mediating Psychosocial Mechanisms

et al. 2017

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There is insufficient research on the impact of perceived discrimination in healthcare settings on adherence to antiretroviral therapy (ART), particularly among women living with HIV, and even less is known about psychosocial mechanisms that may mediate this association. Cross-sectional analyses were conducted in a sample of 1356 diverse women living with HIV enrolled in the Women’s Interagency HIV Study (WIHS), a multi-center cohort study. Indirect effects analysis with bootstrapping was used to examine the potential mediating roles of internalized stigma and depressive symptoms in the association between perceived discrimination in healthcare settings and ART adherence. Perceived discrimination in healthcare settings was negatively associated with optimal (95% or better) ART adherence (adjusted odds ratio AOR = 0.81, p = .02, 95% confidence interval CI [0.68,0.97]). Furthermore, internalization of stigma and depressive symptoms mediated the perceived discrimination-adherence association: Serial mediation analyses revealed a significant indirect effect of perceived discrimination in healthcare settings on ART adherence, first through internalized HIV stigma, and then through depressive symptoms (B = −0.08, SE = 0.02, 95% CI [−0.12, −0.04]). Perceiving discrimination in healthcare settings may contribute to internalization of HIV-related stigma, which in turn may lead to depressive symptoms, with downstream adverse effects on ART adherence among women. These findings can guide the design of interventions to reduce discrimination in healthcare settings, as well as interventions targeting psychosocial mechanisms that may impact the ability of women living with HIV to adhere to ART regimens.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Association between Perceived Discrimination in Healthcare Settings and HIV Medication Adherence: Mediating Psychosocial Mechanisms

et al. 2017

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How Can the Experiences of Black Women Living With HIV Inform Equitable and Respectful Reproductive Health Care Delivery?

Fletcher

Amutah‐Onukagha

Attys

et al. 2021

AMA Journal of Ethics

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Black women living with HIV (BWLWH) contend with injuries of injustice, which manifest in restricted reproductive autonomy and decision-making power in social and medical settings. Mitigating threats to reproductive autonomy calls for innovations that consider patients' needs and offer insights on how historically situated marginalization influences today's institutional, political, and economic systems and shapes reproductive decision making. In addition to cross-disciplinary expertise and collaboration, integrating structural competency into reproductive health care requires demonstrating respect for the autonomy, lived experiences, and preferences of BWLWH.

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A longitudinal study of associations between HIV‐related stigma, recent violence and depression among women living with HIV in a Canadian cohort study

et al. 2019

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Introduction Women living with HIV (WLHIV) experience stigma and elevated exposure to violence in comparison with HIV‐negative women. We examined the mediating role of experiencing recent violence in the relationship between stigma and depression among WLHIV in Canada. Methods We conducted a cohort study with WLHIV in three Canadian provinces. Recent violence was assessed through self‐reported experiences of control, physical, sexual or verbal abuse in the past three months. At Time 1 (2013‐2015) three forms of stigma were assessed (HIV‐related, racial, gender) and at Time 2 (2015‐2017) only HIV‐related stigma was assessed. We conducted structural equation modelling (SEM) using the maximum likelihood estimation method with Time 1 data to identify direct and indirect effects of gender discrimination, racial discrimination and HIV‐related stigma on depression via recent violence. We then conducted mixed effects regression and SEM using Time 1 and Time 2 data to examine associations between HIV‐related stigma, recent violence and depression. Results At Time 1 (n = 1296), the direct path from HIV‐related stigma (direct effect: β = 0.200, p < 0.001; indirect effect: β = 0.014, p < 0.05) to depression was significant; recent violence accounted for 6.5% of the total effect. Gender discrimination had a significant direct and indirect effect on depression (direct effect: β = 0.167, p < 0.001; indirect effect: β = 0.050, p < 0.001); recent violence explained 23.15% of the total effect. Including Time 1 and Time 2 data (n = 1161), mixed‐effects regression results indicate a positive relationship over time between HIV‐related stigma and depression (Acoef: 0.04, 95% CI: 0.03, 0.06, p < 0.001), and recent violence and depression (Acoef: 1.95, 95% CI: 0.29, 4.42, p < 0.05), controlling for socio‐demographics. There was a significant interaction between HIV‐related stigma and recent violence with depression (Acoef: 0.04, 95% CI: 0.01, 0.07, p < 0.05). SEM analyses reveal that HIV‐related stigma had a significant direct and indirect effect on depression over time (direct effect: β = 0.178, p < 0.001; indirect effect: β = 0.040, p < 0.001); recent violence experiences accounted for 51% of the total effect. Conclusions Our findings suggest that HIV‐related stigma is associated with increased experiences of recent violence, and both stigma and violence are associated with increased depression among WLHIV in Canada. There is an urgent need for trauma‐informed stigma interventions to address stigma, discrimination and violence.

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Framing Mechanisms Linking HIV-Related Stigma, Adherence to Treatment, and Health Outcomes

Cited by 366 publications

References 36 publications

Association between Perceived Discrimination in Healthcare Settings and HIV Medication Adherence: Mediating Psychosocial Mechanisms

Association between Perceived Discrimination in Healthcare Settings and HIV Medication Adherence: Mediating Psychosocial Mechanisms

How Can the Experiences of Black Women Living With HIV Inform Equitable and Respectful Reproductive Health Care Delivery?

A longitudinal study of associations between HIV‐related stigma, recent violence and depression among women living with HIV in a Canadian cohort study

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