Department of Psychology, Ankara Medipol University, Altindağ, Turkey.
Department of Psychology, University of Alabama at Birmingham, Birmingham, AL.
J Acquir Immune Defic Syndr. 2021 Apr 1;86(4):406-412. doi: 10.1097/QAI.0000000000002593.
Research on how disclosure concerns affect health outcomes for people living with HIV (PLWH) has yielded inconsistent results. Theoretically, disclosure concerns could predict either poorer antiretroviral therapy (ART) adherence (PLWH worried about disclosure may not want to take their medication in front of others) or better ART adherence (stronger concerns may enhance treatment adherence to avoid unintentional disclosure). Furthermore, internalized stigma (which is positively associated with disclosure concerns) predicts worse ART adherence (an effect potentially in the opposite direction of the direct effect of disclosure concerns).
SETTING/METHODS: One hundred eighty-six PLWH initiating HIV care at 4 US clinics completed measures of disclosure concerns, internalized stigma, and ART adherence. Viral load data were obtained from medical records. We examined the indirect effect of disclosure concerns on outcomes, adjusting for the suppressor effect of internalized stigma. That is, we examined whether the association between disclosure concerns and ART adherence/viral suppression is stronger and positive when controlling for the effect of internalized stigma.
Disclosure concerns were more strongly associated with better viral suppression and ART adherence when internalized stigma was in the model, suggesting that internalized stigma suppressed this association. Similarly, internalized stigma led to higher disclosure concerns, which in turn led to better ART adherence and higher likelihood of viral suppression. However, internalized stigma also had a direct effect in the opposite direction of this indirect effect.
Findings highlight the importance of addressing effects of internalized stigma and disclosure concerns jointly when attempting to understand effects on health outcomes among new-to-care PLWH.
研究披露顾虑如何影响艾滋病毒感染者（PLWH）的健康结果得出的结果不一致。从理论上讲，披露顾虑可能会预测抗逆转录病毒治疗（ART）的依从性更差（担心披露的 PLWH 可能不想在别人面前服药），或者更好的 ART 依从性（更强的顾虑可能会增强治疗依从性以避免无意披露）。此外，内化的耻辱感（与披露顾虑呈正相关）预测 ART 依从性更差（这一效应可能与披露顾虑的直接效应相反）。
地点/方法：186 名在美国 4 家诊所开始接受 HIV 护理的 PLWH 完成了披露顾虑、内化耻辱感和 ART 依从性的测量。病毒载量数据来自病历。我们检查了披露顾虑对结果的间接影响，同时调整了内化耻辱感的抑制作用。也就是说，我们检查了当控制内化耻辱感的影响时，披露顾虑与 ART 依从性/病毒抑制之间的关联是否更强且呈阳性。
当内化耻辱感存在于模型中时，披露顾虑与更好的病毒抑制和 ART 依从性的关联更强，这表明内化耻辱感抑制了这种关联。同样，内化耻辱感导致更高的披露顾虑，进而导致更好的 ART 依从性和更高的病毒抑制可能性。然而，内化耻辱感也有一个与这种间接效应相反的直接效应。
研究结果强调了在试图理解新接受护理的 PLWH 的健康结果时，共同解决内化耻辱感和披露顾虑的影响的重要性。
