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艾滋病毒相关耻辱感和病毒抑制与非裔美国妇女:探索抑郁和抗逆转录病毒治疗不依从的中介作用。

HIV-Related Stigma and Viral Suppression Among African-American Women: Exploring the Mediating Roles of Depression and ART Nonadherence.

机构信息

Department of Health Services, University of Washington, Seattle, WA, USA.

Department of Health Services, University of Washington, 1959 NE Pacific St, Magnuson Health Sciences Center, Room H-680, Box 357660, Seattle, WA, 98195-7660, USA.

出版信息

AIDS Behav. 2019 Aug;23(8):2025-2036. doi: 10.1007/s10461-018-2301-4.


DOI:10.1007/s10461-018-2301-4
PMID:30343422
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6815932/
Abstract

We used baseline data from a sample of African-American women living with HIV who were recruited to participate in a stigma-reduction intervention in Chicago and Birmingham (2013-2015) to (1) evaluate the relationship between HIV-related stigma and viral suppression, and (2) assess the role of depression and nonadherence to antiretroviral therapy (ART) as mediators. Data from women were included in this secondary analysis if they were on ART, had viral load data collected within 8-weeks of study entry and had complete covariate data. We used logistic regression to estimate the total effect of HIV-related stigma (14-item Stigma Scale for Chronic Illness) on viral suppression (< 200 copies/mL), and serial mediation analysis to estimate indirect effects mediated by depressive symptoms (8-item Patient Health Questionnaire) and ART nonadherence (number of days with missed doses). Among 100 women who met study inclusion criteria, 95% reported some level of HIV-related stigma. In adjusted models, higher levels of HIV-related stigma were associated with lower odds of being virally suppressed (AOR = 0.93, 95% CI = 0.89-0.98). In mediation analysis, indirect effects through depression and ART nonadherence were not significant. Findings suggest that HIV-related stigma is common among African-American women living with HIV, and those who experience higher levels of stigma are less likely to be virally suppressed. However, the mechanisms remain unclear.

摘要

我们使用了一组生活在 HIV 中的非裔美国女性的基线数据,这些女性是在芝加哥和伯明翰(2013-2015 年)招募来参加一项减少耻辱感干预的研究。这些数据被用于(1)评估 HIV 相关耻辱感与病毒抑制之间的关系,(2)评估抑郁和不遵守抗逆转录病毒治疗(ART)作为中介的作用。如果女性正在接受 ART 治疗,在研究开始后的 8 周内有病毒载量数据,并且有完整的协变量数据,则将其数据纳入这项二次分析。我们使用逻辑回归来估计 HIV 相关耻辱感(慢性疾病 14 项耻辱感量表)对病毒抑制(<200 拷贝/毫升)的总效应,并使用序列中介分析来估计由抑郁症状(8 项患者健康问卷)和 ART 不遵医行为(错过剂量的天数)介导的间接效应。在符合研究纳入标准的 100 名女性中,95%的女性报告了某种程度的 HIV 相关耻辱感。在调整后的模型中,HIV 相关耻辱感水平越高,病毒抑制的可能性就越低(AOR=0.93,95%CI=0.89-0.98)。在中介分析中,通过抑郁和 ART 不遵医行为的间接效应不显著。研究结果表明,HIV 相关耻辱感在生活在 HIV 中的非裔美国女性中很常见,那些经历更高水平耻辱感的人更不可能实现病毒抑制。然而,其机制仍不清楚。

相似文献

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HIV-Related Stigma and Viral Suppression Among African-American Women: Exploring the Mediating Roles of Depression and ART Nonadherence.

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[3]
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J Racial Ethn Health Disparities. 2025-3-3

[4]
Impact of HIV-Related Stigma on Antiretroviral Therapy Adherence, Engagement and Retention in HIV Care, and Transition to Adult HIV Care in Pediatric and Young Adult Populations Living With HIV: A Literature Review.

AIDS Behav. 2025-2

[5]
The Role of Dimensions of Social Support in the Relationship Between Stigma and Mental Health: A Moderation Analysis.

AIDS Behav. 2025-1

[6]
The prevalence of internalized stigma and its association with HIV viral suppression among fully disclosed adolescents and young adults living with HIV (AYLHIV) receiving HIV care in an HIV clinic in Plateau State, Nigeria.

PLoS One. 2024

[7]
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AIDS Patient Care STDS. 2024-1

[8]
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[9]
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[10]
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本文引用的文献

[1]
Stigma Reduction Among African American Women With HIV: UNITY Health Study.

J Acquir Immune Defic Syndr. 2018-7-1

[2]
HIV Stigma Among Black Women in the United States: Intersectionality, Support, Resilience.

Am J Public Health. 2018-4

[3]
Framing Mechanisms Linking HIV-Related Stigma, Adherence to Treatment, and Health Outcomes.

Am J Public Health. 2017-6

[4]
Prevalence of Internalized HIV-Related Stigma Among HIV-Infected Adults in Care, United States, 2011-2013.

AIDS Behav. 2017-9

[5]
Assessing Stigma among African Americans Living with HIV.

Stigma Health. 2016-8

[6]
"She Told Them, Oh That Bitch Got AIDS": Experiences of Multilevel HIV/AIDS-Related Stigma Among African American Women Living with HIV/AIDS in the South.

AIDS Patient Care STDS. 2016-7

[7]
Trends in Racial and Ethnic Disparities in Antiretroviral Therapy Prescription and Viral Suppression in the United States, 2009-2013.

J Acquir Immune Defic Syndr. 2016-12-1

[8]
Predictive validity of clinical AUDIT-C alcohol screening scores and changes in scores for three objective alcohol-related outcomes in a Veterans Affairs population.

Addiction. 2016-11

[9]
Understanding Cross-Sectional Racial, Ethnic, and Gender Disparities in Antiretroviral Use and Viral Suppression Among HIV Patients in the United States.

Medicine (Baltimore). 2016-3

[10]
Mechanisms for the Negative Effects of Internalized HIV-Related Stigma on Antiretroviral Therapy Adherence in Women: The Mediating Roles of Social Isolation and Depression.

J Acquir Immune Defic Syndr. 2016-6-1

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