Division of Prevention Science, Department of Medicine, University of California, San Francisco, San Francisco, California.
Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama.
AIDS. 2019 Jul 1;33(8):1379-1384. doi: 10.1097/QAD.0000000000002189.
To examine whether experienced poverty stigma is associated with worse HIV care and treatment outcomes.
We analyzed cross-sectional data from 433 women living with HIV enrolled in the Women's Adherence and Visit Engagement substudy of the Women's Interagency HIV Study.
Exposure was experienced poverty stigma, measured using the Perceived Stigma of Poverty Scale. Outcomes were viral suppression, CD4 cell count at least 350 cells/μl, and attending all HIV care visits in the past 6 months. Multivariable logistic regression models adjusted for income, age, race/ethnicity, education, substance use, months taking antiretroviral therapy (ART), number of antiretroviral pills in ART regimen, unstable housing, relationship status, and exchanging sex for money, drugs, or shelter. We also explored whether self-reported at least 95% ART adherence mediated the relationship between poverty stigma and viral suppression and CD4 cell count at least 350 cells/μl.
Experienced poverty stigma was associated with lower adjusted odds of viral suppression [adjusted odds ratio (aOR) 0.76; 95% confidence interval (CI) 0.61-0.96], CD4 cell count at least 350 cells/μl (aOR 0.69; 95% CI 0.52-0.91), and attending all HIV care visits (aOR 0.73; 95% CI: 0.54-0.98). Exploratory mediation analysis suggests that at least 95% ART adherence significantly mediates the relationship between experienced poverty stigma and viral suppression and CD4 cell count at least 350 cells/μl.
Longitudinal research should assess these relationships over time. Findings support interventions and policies that seek to reduce poverty stigma among people living with HIV.
探讨是否有经验的贫困污名与更差的艾滋病毒护理和治疗结局相关。
我们分析了来自参加妇女机构间艾滋病毒研究的妇女依从性和就诊参与子研究的 433 名艾滋病毒感染者的横断面数据。
暴露因素是经历贫困污名，使用贫困污名感知量表来衡量。结局是病毒抑制、CD4 细胞计数至少 350 个/μl，以及在过去 6 个月内参加所有艾滋病毒护理就诊。多变量逻辑回归模型调整了收入、年龄、种族/民族、教育程度、物质使用、接受抗逆转录病毒治疗（ART）的月数、ART 方案中的抗逆转录病毒药物数量、不稳定住房、关系状况以及为换取金钱、毒品或住所进行性交易。我们还探讨了自我报告的至少 95%ART 依从性是否介导了贫困污名与病毒抑制和 CD4 细胞计数至少 350 个/μl 之间的关系。
经历贫困污名与较低的调整后病毒抑制几率相关[调整后的优势比（aOR）0.76；95%置信区间（CI）0.61-0.96]、CD4 细胞计数至少 350 个/μl（aOR 0.69；95%CI 0.52-0.91）和参加所有艾滋病毒护理就诊（aOR 0.73；95%CI：0.54-0.98）。探索性中介分析表明，至少 95%ART 依从性显著中介了经历贫困污名与病毒抑制和 CD4 细胞计数至少 350 个/μl 之间的关系。
纵向研究应随着时间的推移评估这些关系。研究结果支持旨在减少艾滋病毒感染者中贫困污名的干预措施和政策。
