Intersectional stigmas are associated with lower viral suppression rates and antiretroviral therapy adherence among women living with HIV

Abstract

Objectives:To explore the associations between intersectional poverty, HIV, sex, and racial stigma, adherence to antiretroviral therapy (ART), and viral suppression among women with HIV (WHIV).Design:We examined intersectional stigmas, self-report ART adherence, and viral suppression using cross-sectional data.Methods:Participants were WHIV (N = 459) in the Women's Adherence and Visit Engagement, a Women's Interagency HIV Study substudy. We used Multidimensional Latent Class Item Response Theory and Bayesian models to analyze intersectional stigmas and viral load adjusting for sociodemographic and clinical covariates.Results:We identified five intersectional stigma-based latent classes. The likelihood of viral suppression was approximately 90% lower among WHIV who experienced higher levels of poverty, sex, and racial stigma or higher levels of all intersectional stigmas compared with WHIV who reported lower experiences of intersectional stigmas. ART adherence accounted for but did not fully mediate some of the associations between latent intersectional stigma classes and viral load.Conclusion:The negative impact of intersectional stigmas on viral suppression is likely mediated, but not fully explained, by reduced ART adherence. We discuss the research and clinical implications of our findings.

Factors associated with sex differences in viral non‐suppression in the Swedish InfCareHIV cohort: An observational real‐world study

“…In Sweden, the majority of women living with HIV were born abroad. They may experience intersectional stigma which is associated with impaired adherence and viral non‐suppression [18, 29]. In men, homo‐/bisexual transmission was associated with significantly lower relative risk of viral non‐suppression, and adjustment for route of transmission reduced the difference in viral non‐suppression between women and men to non‐significance.…”

Brief Report: Social Factors Associated With Trajectories of HIV-Related Stigma and Everyday Discrimination Among Women Living With HIV in Vancouver, Canada: Longitudinal Cohort Findings

“…17 Poverty stigma was linked with poorer HIV care outcomes among WLWHIV in the United States, 18 as was experiencing combinations of poverty, sex, and racial stigma. 19 In sum, these studies signal that HIV-related stigma drivers, and other forms of day-to-day mistreatment—referred to as “everyday” discrimination 20 —warrant further investigation among WLHIV who disproportionately experience poverty, 13–15 violence, 10,12 and discrimination based on race, 21–23 gender, 6,7 and sexual orientation, 9,24,25 among other socially devalued identities. 1,3…”

“…17 Poverty stigma was linked with poorer HIV care outcomes among WLWHIV in the United States, 18 as was experiencing combinations of poverty, sex, and racial stigma. 19 In sum, these studies signal that HIV-related stigma drivers, and other forms of dayto-day mistreatment-referred to as "everyday" discrimination 20 -warrant further investigation among WLHIV who disproportionately experience poverty, [13][14][15] violence, 10,12 and discrimination based on race, [21][22][23] gender, 6,7 and sexual orientation, 9,24,25 among other socially devalued identities. 1,3 To address knowledge gaps regarding drivers of stigma and discrimination, this study aimed to estimate the associations between food and housing insecurity, violence, and sociodemographic characteristics with trajectories of HIVrelated stigma and Everyday Discrimination among a cohort of WLHIV in Vancouver, Canada.…”

Associations between social determinants of health and comorbidity and multimorbidity in people of black ethnicities with HIV

“…People with HIV experience a disproportionate level of intersecting social disadvantages including lower socioeconomic status [8], poor mental health [9], substance misuse [10], structural racism [11], sex-based violence [12], and in particular, HIV-related stigma including selfstigma [13]. The impact of SDH on engagement with HIV care and virological suppression is well recognized; nonwhite ethnicity, low education level, low health literacy, poverty, food insecurity, homelessness, criminal justice involvement, and intimate partner violence have all been associated with suboptimal engagement with care, poor adherence to antiretroviral therapy (ART) and/ or viral rebound [14][15][16][17][18].…”