School of Social Work, Columbia University, New York, New York.
Department of Health Behavior, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama.
AIDS. 2022 Nov 1;36(13):1769-1776. doi: 10.1097/QAD.0000000000003342. Epub 2022 Jul 25.
OBJECTIVES: To explore the associations between intersectional poverty, HIV, sex, and racial stigma, adherence to antiretroviral therapy (ART), and viral suppression among women with HIV (WHIV). DESIGN: We examined intersectional stigmas, self-report ART adherence, and viral suppression using cross-sectional data. METHODS: Participants were WHIV ( N = 459) in the Women's Adherence and Visit Engagement, a Women's Interagency HIV Study substudy. We used Multidimensional Latent Class Item Response Theory and Bayesian models to analyze intersectional stigmas and viral load adjusting for sociodemographic and clinical covariates. RESULTS: We identified five intersectional stigma-based latent classes. The likelihood of viral suppression was approximately 90% lower among WHIV who experienced higher levels of poverty, sex, and racial stigma or higher levels of all intersectional stigmas compared with WHIV who reported lower experiences of intersectional stigmas. ART adherence accounted for but did not fully mediate some of the associations between latent intersectional stigma classes and viral load. CONCLUSION: The negative impact of intersectional stigmas on viral suppression is likely mediated, but not fully explained, by reduced ART adherence. We discuss the research and clinical implications of our findings.
目的:探索多重贫困、艾滋病毒、性别和种族污名与艾滋病毒女性感染者(WHIV)的抗逆转录病毒治疗(ART)依从性和病毒抑制之间的关联。 设计:我们使用横断面数据检查了交叉污名、自我报告的 ART 依从性和病毒抑制情况。 方法:参与者为 Women's Adherence and Visit Engagement 研究中的 WHIV(N=459),这是 Women's Interagency HIV Study 的一个子研究。我们使用多维潜在类别项目反应理论和贝叶斯模型,分析了调整社会人口统计学和临床协变量后的交叉污名和病毒载量。 结果:我们确定了五个基于交叉污名的潜在类别。与报告交叉污名体验较低的 WHIV 相比,经历较高水平的贫困、性别和种族污名或所有交叉污名的 WHIV,其病毒抑制的可能性大约低 90%。ART 依从性解释了但并未完全解释潜在交叉污名类别与病毒载量之间的一些关联。 结论:交叉污名对病毒抑制的负面影响可能通过降低 ART 依从性来介导,但并不能完全解释。我们讨论了我们研究结果的研究和临床意义。
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