Department of Epidemiology, Florida International University, Miami, Florida, USA.
Center for Research on US Latino HIV/AIDS and Drug Abuse (CRUSADA), and Florida International University, Miami, Florida, USA.
AIDS Patient Care STDS. 2020 Jul;34(7):316-326. doi: 10.1089/apc.2020.0031.
Among people living with HIV (PLWH) in Florida, <2/3 are virally suppressed (viral load <200 copies/mL). Previous theoretical frameworks have pointed to HIV-related stigma as an important factor for viral suppression; an important outcome related to the HIV continuum of care. This study aims to analyze the association between enacted HIV-related stigma and antiretroviral therapy (ART) adherence and viral suppression among a sample of PLWH in Florida. The overall sample ( = 932) was male (66.0%), majority greater than 45 years of age (63.5%), black (58.1%), and non-Hispanic (79.7%). Adjusted odds ratios (AOR) and 95% confidence intervals (CI) were estimated using logistic regression models. The odds of nonadherence to ART was not significantly greater for those reporting low/moderate or high levels of general enacted HIV-related stigma (vs. no stigma) [AOR = 1.30, CI: (0.87-1.95), = 0.198; AOR = 1.17, CI: (0.65-2.11), = 0.600, respectively]. Moreover, the odds of nonviral suppression were not significantly greater for those reporting low/moderate or high levels of general enacted HIV-related stigma (vs. no stigma) [AOR = 0.92, CI: (0.60-1.42), = 0.702; AOR = 1.16, CI: (0.64-2.13), = 0.622, respectively]. However, ever experiencing health care-specific enacted HIV-related stigma was associated with both nonadherence [AOR = 2.29, CI: (1.25-4.20), = 0.008] and nonsuppression [AOR = 2.16, CI: (1.19-3.92), = 0.011]. Despite limitations, the results suggest that the perpetuation of stigma by health care workers may have a larger impact on continuum of care outcomes of PLWH than other sources of enacted stigma. Based on the results, there is a need to develop and evaluate interventions for health care workers intended to reduce experienced stigma among PLWH and improve health outcomes.
在佛罗里达州的 HIV 感染者(PLWH)中,不到 2/3 的人病毒得到抑制(病毒载量<200 拷贝/毫升)。以前的理论框架指出,HIV 相关耻辱感是病毒抑制的一个重要因素;这是与 HIV 护理连续体相关的一个重要结果。本研究旨在分析佛罗里达州 PLWH 样本中实施的 HIV 相关耻辱感与抗逆转录病毒治疗(ART)依从性和病毒抑制之间的关联。总体样本(n=932)中,男性占 66.0%,年龄大于 45 岁的占 63.5%,黑人占 58.1%,非西班牙裔占 79.7%。使用逻辑回归模型估计调整后的优势比(AOR)和 95%置信区间(CI)。报告低度/中度或高度普遍实施的 HIV 相关耻辱感(与无耻辱感相比)的个体,ART 不依从的可能性没有显著增加(AOR=1.30,CI:(0.87-1.95),p=0.198;AOR=1.17,CI:(0.65-2.11),p=0.600)。此外,报告低度/中度或高度普遍实施的 HIV 相关耻辱感(与无耻辱感相比)的个体,病毒未抑制的可能性没有显著增加(AOR=0.92,CI:(0.60-1.42),p=0.702;AOR=1.16,CI:(0.64-2.13),p=0.622)。然而,曾经经历过医疗保健特定的实施性 HIV 相关耻辱感与不依从(AOR=2.29,CI:(1.25-4.20),p=0.008)和未抑制(AOR=2.16,CI:(1.19-3.92),p=0.011)均相关。尽管存在局限性,但结果表明,医疗保健工作者实施的耻辱感可能比其他来源的耻辱感对 PLWH 的护理连续体结果产生更大的影响。基于结果,需要为医疗保健工作者制定和评估旨在减少 PLWH 经历的耻辱感并改善健康结果的干预措施。
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