Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada.
Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.
J Int AIDS Soc. 2019 Jul;22(7):e25341. doi: 10.1002/jia2.25341.
Women living with HIV (WLHIV) experience stigma and elevated exposure to violence in comparison with HIV-negative women. We examined the mediating role of experiencing recent violence in the relationship between stigma and depression among WLHIV in Canada.
We conducted a cohort study with WLHIV in three Canadian provinces. Recent violence was assessed through self-reported experiences of control, physical, sexual or verbal abuse in the past three months. At Time 1 (2013-2015) three forms of stigma were assessed (HIV-related, racial, gender) and at Time 2 (2015-2017) only HIV-related stigma was assessed. We conducted structural equation modelling (SEM) using the maximum likelihood estimation method with Time 1 data to identify direct and indirect effects of gender discrimination, racial discrimination and HIV-related stigma on depression via recent violence. We then conducted mixed effects regression and SEM using Time 1 and Time 2 data to examine associations between HIV-related stigma, recent violence and depression.
At Time 1 (n = 1296), the direct path from HIV-related stigma (direct effect: β = 0.200, p < 0.001; indirect effect: β = 0.014, p < 0.05) to depression was significant; recent violence accounted for 6.5% of the total effect. Gender discrimination had a significant direct and indirect effect on depression (direct effect: β = 0.167, p < 0.001; indirect effect: β = 0.050, p < 0.001); recent violence explained 23.15% of the total effect. Including Time 1 and Time 2 data (n = 1161), mixed-effects regression results indicate a positive relationship over time between HIV-related stigma and depression (Acoef: 0.04, 95% CI: 0.03, 0.06, p < 0.001), and recent violence and depression (Acoef: 1.95, 95% CI: 0.29, 4.42, p < 0.05), controlling for socio-demographics. There was a significant interaction between HIV-related stigma and recent violence with depression (Acoef: 0.04, 95% CI: 0.01, 0.07, p < 0.05). SEM analyses reveal that HIV-related stigma had a significant direct and indirect effect on depression over time (direct effect: β = 0.178, p < 0.001; indirect effect: β = 0.040, p < 0.001); recent violence experiences accounted for 51% of the total effect.
Our findings suggest that HIV-related stigma is associated with increased experiences of recent violence, and both stigma and violence are associated with increased depression among WLHIV in Canada. There is an urgent need for trauma-informed stigma interventions to address stigma, discrimination and violence.
与 HIV 阴性女性相比，感染 HIV 的女性（WLHIV）经历着污名化和更高程度的暴力风险。我们检验了在加拿大，近期暴力经历在 HIV 相关污名与 WLHIV 抑郁之间的中介作用。
我们在加拿大三个省份开展了一项队列研究。近期暴力通过过去三个月中经历的控制、身体、性或言语虐待的自我报告经验进行评估。在时间 1（2013-2015 年）评估了三种形式的污名（HIV 相关、种族、性别），在时间 2（2015-2017 年）仅评估了 HIV 相关污名。我们使用最大似然估计方法，通过时间 1 数据进行结构方程建模（SEM），以识别性别歧视、种族歧视和 HIV 相关污名通过近期暴力对抑郁的直接和间接影响。然后，我们使用时间 1 和时间 2 数据进行混合效应回归和 SEM，以检验 HIV 相关污名、近期暴力和抑郁之间的关联。
在时间 1（n=1296）中，HIV 相关污名与抑郁之间存在直接路径（直接效应：β=0.200，p<0.001；间接效应：β=0.014，p<0.05），近期暴力占总效应的 6.5%。性别歧视对抑郁有显著的直接和间接影响（直接效应：β=0.167，p<0.001；间接效应：β=0.050，p<0.001）；近期暴力解释了总效应的 23.15%。纳入时间 1 和时间 2 数据（n=1161），混合效应回归结果表明，HIV 相关污名与抑郁之间存在随时间变化的正相关关系（Acoef：0.04，95%CI：0.03，0.06，p<0.001），近期暴力与抑郁之间也存在正相关关系（Acoef：1.95，95%CI：0.29，4.42，p<0.05），控制了社会人口统计学因素。HIV 相关污名和近期暴力与抑郁之间存在显著的交互作用（Acoef：0.04，95%CI：0.01，0.07，p<0.05）。SEM 分析表明，HIV 相关污名对抑郁有显著的直接和间接影响（直接效应：β=0.178，p<0.001；间接效应：β=0.040，p<0.001）；近期暴力经历占总效应的 51%。
我们的研究结果表明，HIV 相关污名与近期暴力经历增加有关，污名和暴力都与加拿大 WLHIV 的抑郁增加有关。迫切需要以创伤为中心的污名干预措施来解决污名、歧视和暴力问题。
