Sue & Bill Gross School of Nursing, University of California Irvine, 252D Berk Hall, Irvine, CA, 92697, USA.
Department of Epidemiology, University of California Los Angeles, Los Angeles, USA.
AIDS Behav. 2018 Dec;22(12):3897-3904. doi: 10.1007/s10461-018-2193-3.
Internalized HIV stigma can affect health outcomes, but the mechanism underlying this relationship is poorly understood. We investigated the potential pathways for the association between internalized stigma and opportunistic infections (OIs) among women living with HIV in rural India. We conducted a cross-sectional study involving in-person interviews with 600 participants. We modeled two outcome variables, total number of OIs and fungal dermatoses, which was the most frequently reported OI. Causal mediation analysis was performed to estimate the total effect, direct effect, and indirect effect through mediators while controlling for confounders. Food insecurity was a strong mediator of the association between internalized stigma and the number of OIs (70% of the total effect) and fungal dermatoses (83% of the total effect), while the indirect effect of stigma through adherence was minimal for both outcomes. Household food insecurity may be an important mediator of the impact of HIV-related stigma on opportunistic infections.
内在 HIV 耻辱感可能会影响健康结果，但这种关系的机制尚不清楚。我们调查了内在耻辱感与印度农村地区 HIV 感染者机会性感染（OI）之间关联的潜在途径。我们进行了一项横断面研究，涉及 600 名参与者的面对面访谈。我们构建了两个因变量，即 OI 的总数和真菌感染性皮肤病，这是最常报告的 OI。在控制混杂因素的同时，进行因果中介分析以估计总效应、直接效应和通过中介的间接效应。粮食不安全是内在耻辱感与 OI 总数（总效应的 70%）和真菌感染性皮肤病（总效应的 83%）之间关联的一个强有力的中介，而耻辱感通过依从性对这两种结果的间接效应则微乎其微。家庭粮食不安全可能是 HIV 相关耻辱感对机会性感染影响的一个重要中介。
