Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada.
Centre for Outcomes Research and Evaluation, McGill University, Montréal, Canada.
J Acquir Immune Defic Syndr. 2023 Oct 1;94(2):116-123. doi: 10.1097/QAI.0000000000003241.
HIV-related stigma, gender discrimination, and racial discrimination harm mental health and hamper HIV treatment access for women living with HIV. Maladaptive coping strategies, such as substance use, can further worsen HIV treatment outcomes, whereas resilience can improve HIV outcomes. We examined resilience and depression as mediators of the relationship between multiple stigmas and HIV treatment outcomes among women living with HIV.
Ontario, British Columbia, and Quebec, Canada.
We conducted a longitudinal study with 3 waves at 18-month intervals. We used structural equation modeling to test the associations of multiple stigmas (HIV-related stigma, racial discrimination, and gender discrimination) or an intersectional construct of all 3 stigmas at wave 1 on self-reported HIV treatment cascade outcomes (≥95% antiretroviral treatment [ART] adherence, undetectable viral load) at wave 3. We tested depression and resilience at wave 2 as potential mediators and adjusted for sociodemographic factors.
There were 1422 participants at wave 1, half of whom were Black (29%) or Indigenous (20%). Most participants reported high ART adherence (74%) and viral suppression (93%). Racial discrimination was directly associated with having a detectable viral load, while intersectional stigma was directly associated with lower ART adherence. Resilience mediated associations between individual and intersectional stigmas and HIV treatment cascade outcomes, but depression did not. Racial discrimination was associated with increased resilience, while intersectional and other individual stigmas were associated with reduced resilience.
Race, gender and HIV-related stigma reduction interventions are required to address intersectional stigma among women living with HIV. Including resilience-building activities in these interventions may improve HIV treatment outcomes.
艾滋病毒相关耻辱感、性别歧视和种族歧视会损害妇女的心理健康，并阻碍艾滋病毒感染者获得治疗。适应不良的应对策略，如物质使用，可能会进一步恶化艾滋病毒治疗效果，而韧性则可以改善艾滋病毒治疗效果。我们研究了韧性和抑郁作为多种耻辱感与艾滋病毒感染者治疗效果之间关系的中介因素。
加拿大安大略省、不列颠哥伦比亚省和魁北克省。
我们进行了一项纵向研究，每隔 18 个月进行 3 次随访。我们使用结构方程模型来检验第 1 波时的多种耻辱感（艾滋病毒相关耻辱感、种族歧视和性别歧视）或所有 3 种耻辱感的交叉结构对第 3 波时自我报告的艾滋病毒治疗阶梯结局（≥95%抗逆转录病毒治疗[ART]依从性、不可检测的病毒载量）的关联。我们在第 2 波时测试了抑郁和韧性作为潜在的中介因素，并调整了社会人口因素。
第 1 波有 1422 名参与者，其中一半为黑人（29%）或原住民（20%）。大多数参与者报告了较高的 ART 依从性（74%）和病毒抑制（93%）。种族歧视与病毒载量可检测直接相关，而交叉耻辱感与较低的 ART 依从性直接相关。韧性中介了个体和交叉耻辱感与艾滋病毒治疗阶梯结局之间的关联，但抑郁没有。种族歧视与韧性增加有关，而交叉和其他个体耻辱感与韧性降低有关。
需要针对艾滋病毒感染者的种族、性别和艾滋病毒相关耻辱感减少干预措施来解决交叉耻辱感问题。在这些干预措施中纳入增强韧性的活动可能会改善艾滋病毒治疗效果。
