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