运用多维潜在转变项目反应分析，探讨感染艾滋病毒女性的交叉污名、抗逆转录病毒疗法依从性与病毒载量之间的纵向关联。
Longitudinal associations between intersectional stigmas, antiretroviral therapy adherence, and viral load among women living with HIV using multidimensional latent transition item response analysis.
作者信息
Norcini-Pala Andrea, Stringer Kristi L, Kempf Mirjam-Colette, Konkle-Parker Deborah, Wilson Tracey E, Tien Phyllis C, Wingood Gina, Neilands Torsten B, Johnson Mallory O, Weiser Sheri D, Logie Carmen H, Topper Elizabeth F, Turan Janet M, Turan Bulent
机构信息
Department of Community Health Sciences, School of Public Health, State University of New York Downstate Health Sciences University, Brooklyn, NY, USA.
Community and Public Health, Middle Tennessee State University, Murfreesboro, TN, USA.
出版信息
Soc Sci Med. 2025 Feb;366:117643. doi: 10.1016/j.socscimed.2024.117643. Epub 2024 Dec 19.
BACKGROUND
In the US, Women, especially Black and Latina women living in disadvantaged environments, are disproportionally affected by HIV. Women living with HIV (WLHIV) have higher rates of suboptimal antiretroviral therapy (ART) adherence, and detectable viral load (VL). Experiences of intersectional poverty, HIV, gender, and racial stigmas may increase the rates of detectable VL through suboptimal ART adherence.
AIMS
To explore longitudinal associations between intersectional stigmas, ART adherence, and detectable VL using multidimensional latent transition item response analysis.
PARTICIPANTS
WLHIV (N = 459) in the [masked] sub-study of the [masked], from sites in Birmingham, AL, Jackson, MS, Atlanta, GA, and San Francisco, CA.
ASSESSMENT
Experienced poverty, HIV, gender, and racial stigma, self-report ART adherence, and VL were assessed at four yearly follow-ups between 2016 and 2020.
RESULTS
We identified five classes of WLHIV with different combinations of experienced intersectional stigmas. Longitudinally, WLHIV with higher levels of poverty, gender, and racial stigma had higher odds of suboptimal ART adherence (<90%) (OR = 3.59, p < 0.001) and detectable VL (OR = 2.08, p = 0.028) compared to WLHIV with lower/moderately low stigmas levels. WLHIV in the highest stigma classes had higher odds of detectable VL, independently of ART adherence (Class 3: OR = 1.38, p = 0.016; Class 5: OR = 1.31, p = 0.046). These findings underscore the compounded effects of intersectional stigmas on HIV treatment outcomes.
CONCLUSION
Intersecting experiences of HIV, racial, gender, and poverty stigmas can increase detectable VL risk through suboptimal ART adherence, although other mechanisms may also be involved. Recognizing the complexity of intersectional stigmas is essential for developing approaches to improve WLHIV's HIV treatment outcomes.
背景
在美国，女性，尤其是生活在弱势环境中的黑人及拉丁裔女性，受艾滋病毒影响的比例过高。感染艾滋病毒的女性（WLHIV）接受抗逆转录病毒疗法（ART）的依从性欠佳及病毒载量（VL）可检测到的比例较高。交叉贫困、艾滋病毒、性别及种族耻辱感等经历可能会通过欠佳的ART依从性导致可检测到的VL比例增加。
目的
使用多维潜在转变项目反应分析，探讨交叉耻辱感、ART依从性及可检测到的VL之间的纵向关联。
参与者
参与[项目名称]的[子项目名称]的感染艾滋病毒的女性（N = 459），来自阿拉巴马州伯明翰、密西西比州杰克逊、佐治亚州亚特兰大及加利福尼亚州旧金山的研究地点。
评估
在2016年至2020年期间的四次年度随访中，对经历的贫困、艾滋病毒、性别及种族耻辱感、自我报告的ART依从性及VL进行评估。
结果
我们确定了五类感染艾滋病毒的女性，她们经历的交叉耻辱感组合各不相同。从纵向来看，与耻辱感水平较低/中度较低的感染艾滋病毒的女性相比，贫困、性别及种族耻辱感水平较高的感染艾滋病毒的女性ART依从性欠佳（<90%）（比值比[OR]=3.59，p<0.001）及病毒载量可检测到的几率更高（OR = 2.08，p = 0.028）。处于最高耻辱感类别的感染艾滋病毒的女性，无论ART依从性如何，病毒载量可检测到的几率更高（第3类：OR = 1.38，p = 0.016；第5类：OR = 1.31，p = 0.046）。这些发现强调了交叉耻辱感对艾滋病毒治疗结果的复合影响。
结论
艾滋病毒、种族、性别及贫困耻辱感的交叉经历可能会通过欠佳的ART依从性增加病毒载量可检测到的风险，尽管可能还涉及其他机制。认识到交叉耻辱感的复杂性对于制定改善感染艾滋病毒的女性艾滋病毒治疗结果的方法至关重要。
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