Understanding HIV-Related Stigma Among Women in the Southern United States: A Literature Review

Darlington, Caroline K.; Hutson, Sadie P.

doi:10.1007/s10461-016-1504-9

Cited by 88 publications

(73 citation statements)

References 62 publications

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“…Despite the improvements, the absolute rates of >90% implementation remain low, never exceeding 60% for any medication that we examined. Consistent with our prior research, Blacks, women, younger age groups, patients with substance use and those living in Georgia and Texas were more likely to have lower rates of >90% ART implementation, possibly due to limited resources, restricted access to care and high levels of HIV‐related stigma . Differences between states may also be attributable to differences in Medicaid programme generosity, including Medicaid eligibility criteria, out‐of‐pocket spending, access to providers and limits on the number of reimbursable prescriptions .…”

Section: Discussionsupporting

confidence: 76%

Trends in medication adherence in HIV patients in the US, 2001 to 2012: an observational cohort study

et al. 2019

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Introduction Adherence to antiretroviral therapy ( ART ) is essential to reduce HIV ‐related morbidity and mortality as well as the risk of virological failure and HIV transmission. We determined the trends in ART adherence during the periods of therapeutic advances, wider use of ART and greater attention to ART adherence. To understand the general trends in medication adherence, we compared ART adherence with medications for other common chronic conditions. Methods A retrospective cohort study using Medicaid claims between 2001 and 2012 from 14 US states with the highest HIV prevalence. Medicaid is the largest source of care for HIV patients in the US . We identified Medicaid beneficiaries with HIV who initiated ART between 2001 and 2010 (n=23,343). Comparison groups included (1) HIV ‐ persons who initiated a statin, angiotensin‐converting enzyme inhibitor or angiotensin receptor blocker ( ACEI / ARB ), or metformin and (2) HIV + persons who initiated these control medications while on and not on ART . We estimated adjusted odds of >90% medication implementation during the two years following initiation. Results The proportion of HIV + persons with >90% ART implementation increased from 33.5% in those who initiated in 2001 to 46.4% in 2005 and 52.4% in 2010. ART initiators in 2007 to 2010 had 53% increased odds of >90% implementation compared to those in 2001 to 2003 (adjusted OR 1.53, 99% CI : 1.34 to 1.75). Older age, male, White race, newer ART regimens and absence of substance use indicators were also associated with increased odds of >90% ART implementation. No or minimal improvements were found in the implementation of control medications in HIV ‐ persons. For HIV ‐ persons, the adjusted OR s comparing 2007–2010 to 2001–2003 were 1.06, 1.01 and 1.19 for statins, ACEI / ARB , metformin respectively. HIV + persons who were on ART had, on average, 15.0 ( SD : 4.2) and 16.1 ( SD : 3.4) percentage points higher >90% implementation rates of concurrent statins, ACEI / ARB ...

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Section: Discussionsupporting

confidence: 76%

Trends in medication adherence in HIV patients in the US, 2001 to 2012: an observational cohort study

et al. 2019

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“…Nevertheless, it is important to study the effects of HIV-related stigma in the southern U.S., since this region is now viewed as the epicenter of the domestic HIV epidemic, showing the highest HIV incidence and fatality rates in the U.S. 49 Internalization of stigma may be particularly pervasive in the southern U.S., where the culture of social conservatism may differentiate experiences of HIV-related stigma, as compared to other regions. 50 …”

Section: Discussionmentioning

confidence: 99%

Association Between Internalized HIV-Related Stigma and HIV Care Visit Adherence

Rice

Crockett

Mugavero

et al. 2017

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Background Internalized HIV-related stigma acts as a barrier to antiretroviral therapy (ART) adherence, but its effects on other HIV care continuum outcomes is unclear. Methods Among 196 HIV clinic patients in Birmingham, Alabama, we assessed internalized HIV-related stigma and depressive symptom severity using validated multi-item scales, and assessed ART adherence using a validated single-item measure. HIV visit adherence (attended out of total scheduled visits) was calculated using data from clinic records. Using covariate-adjusted regression analysis, we investigated the association between internalized stigma and visit adherence. Using path analytic methods with bootstrapping, we tested the mediating role of depressive symptoms in the association between internalized stigma and visit adherence, and the mediating role of visit adherence in the association between internalized stigma and ART adherence. Results Higher internalized stigma was associated with lower visit adherence (B=−0.04, p=0.04). Black (versus white) race and depressive symptoms were significant predictors within this model. Mediation analysis yielded no effect by depression in the association between internalized stigma and visit adherence (B = −0.18, SE = .11, 95% CI [−0.44, −0.02]) in the whole sample. Supplemental mediated moderation analyses revealed gender-specific effects. Additionally, the indirect effect of internalized stigma on sub-optimal ART adherence was mediated by lower visit adherence (B = −0.18, SE = .11, 95% CI [−0.44, −0.02]). Conclusion Results highlight the importance of internalized HIV stigma to multiple and sequential HIV care continuum outcomes. Also, findings suggest multiple intervention targets, including addressing internalized stigma directly, reducing depressive symptoms, and promoting consistent engagement in care.

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“…Our literature review identified only one empirical study that documented the (negative) influence of HIV stigma on WLWHs’ pregnancy intentions in the United States(27). Despite the potential detrimental influence of stigma on WLWHs’ reproductive decisions and health access, two recent systematic and literature reviews on stigma and fertility desires/intentions identified gaps in empirical research on the impact of structural drivers, including stigma(28), on WLWHs’ pregnancy decisions(6). The role of stigma and discrimination on WLWH’s reproductive choices are particularly pertinent in criminalized settings, where HIV non-disclosure before a sexual encounter can potentially result in an aggravated sexual assault conviction.…”

Section: Introductionmentioning

confidence: 99%

Realizing Women Living with HIV’s Reproductive Rights in the Era of ART: The Negative Impact of Non-consensual HIV Disclosure on Pregnancy Decisions Amongst Women Living with HIV in a Canadian Setting

et al. 2018

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To better understand the structural drivers of women living with HIV's (WLWH's) reproductive rights and choices, this study examined the structural correlates, including non-consensual HIV disclosure, on WLWH's pregnancy decisions and describes access to preconception care. Analyses drew on data (2014-present) from SHAWNA, a longitudinal community-based cohort with WLWH across Metro-Vancouver, Canada. Multivariable logistic regression was used to model the effect of non-consensual HIV disclosure on WLWH's pregnancy decisions. Of the 218 WLWH included in our analysis, 24.8% had ever felt discouraged from becoming pregnant and 11.5% reported accessing preconception counseling. In multivariable analyses, non-consensual HIV disclosure was positively associated with feeling discouraged from wanting to become pregnant (AOR 3.76; 95% CI 1.82-7.80). Non-consensual HIV disclosure adversely affects WLWH's pregnancy decisions. Supporting the reproductive rights of WLWH will require further training among general practitioners on the reproductive health of WLWH and improved access to women-centred, trauma-informed care, including non-judgmental preconception counseling.

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Understanding HIV-Related Stigma Among Women in the Southern United States: A Literature Review

Cited by 88 publications

References 62 publications

Trends in medication adherence in HIV patients in the US, 2001 to 2012: an observational cohort study

Trends in medication adherence in HIV patients in the US, 2001 to 2012: an observational cohort study

Association Between Internalized HIV-Related Stigma and HIV Care Visit Adherence

Realizing Women Living with HIV’s Reproductive Rights in the Era of ART: The Negative Impact of Non-consensual HIV Disclosure on Pregnancy Decisions Amongst Women Living with HIV in a Canadian Setting

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