Crawford Timothy N, Neilands Torsten B, Drumright Lydia N, Fredericksen Rob J, Johnson Mallory O, Mayer Kenneth H, Bamford Laura, Batchelder Abigail W, Crane Heidi M, Elopre Latesha, Moore Richard D, Rosengren A Lina, Christopoulos Katerina A
Wright State University, Dayton, Ohio.
University of California, San Francisco, California.
AIDS. 2024 Dec 1;38(15):2064-2072. doi: 10.1097/QAD.0000000000003999. Epub 2024 Aug 28.
The aim of this study was to examine the effects of internalized HIV stigma on viral nonsuppression via depressive symptoms, alcohol use, illicit drug use, and medication adherence and investigate whether social support moderates these effects.
Longitudinal observational clinical cohort of patients in HIV care in the US.Methods: Data from the CFAR Network for Integrated Clinical Systems (2016-2019) were used to conduct structural equation models (SEM) to test the indirect effects of internalized HIV stigma on viral nonsuppression through depressive symptoms, illicit drug use, alcohol use, and medication adherence. Moderated mediation with an interaction between social support and internalized HIV stigma was examined.
Among 9574 individuals included in the study sample, 81.1% were men and 41.4% were black, non-Hispanic. The model demonstrated good fit (root mean square error of approximation = 0.028; standardized root means square residual = 0.067). The overall indirect effect was significant [b = 0.058; se = 0.020; β = 0.048; 95% confidence interval (95% CI) = 0.019-0.098], indicating that internalized HIV stigma's impact on viral nonsuppression was mediated by depressive symptoms, illicit drug use, and medication adherence. An interaction was observed between internalized HIV stigma and social support on alcohol use; however, there was no moderated mediation for any of the mediators.
Internalized HIV stigma indirectly impacts viral nonsuppression through its effects on depressive symptoms, illicit drug use, and medication adherence. Social support may buffer the impact, but more research is needed. Understanding the pathways through which internalized stigma impacts viral suppression is key to improving health of people with HIV.
本研究旨在探讨内化的艾滋病病毒污名通过抑郁症状、饮酒、使用非法药物和药物依从性对病毒抑制不佳的影响，并调查社会支持是否会调节这些影响。
美国接受艾滋病病毒治疗患者的纵向观察性临床队列研究。方法：使用综合临床系统CFAR网络（2016 - 2019年）的数据进行结构方程模型（SEM），以测试内化的艾滋病病毒污名通过抑郁症状、使用非法药物、饮酒和药物依从性对病毒抑制不佳的间接影响。研究了社会支持与内化的艾滋病病毒污名之间的相互作用的调节中介作用。
在纳入研究样本的9574名个体中，81.1%为男性，41.4%为非西班牙裔黑人。该模型显示拟合良好（近似均方根误差 = 0.028；标准化均方根残差 = 0.067）。总体间接效应显著[b = 0.058；标准误 = 0.020；β = 0.048；95%置信区间（95%CI）= 0.019 - 0.098]，表明内化的艾滋病病毒污名对病毒抑制不佳的影响是由抑郁症状、使用非法药物和药物依从性介导的。在内化的艾滋病病毒污名与社会支持对饮酒的影响之间观察到相互作用；然而，对于任何中介变量均未发现调节中介作用。
内化的艾滋病病毒污名通过对抑郁症状、使用非法药物和药物依从性的影响间接影响病毒抑制不佳。社会支持可能会缓冲这种影响，但还需要更多研究。了解内化污名影响病毒抑制的途径是改善艾滋病病毒感染者健康的关键。
