Anna M Leddy1, Janet M Turan2, Mallory O Johnson1, Torsten B Neilands1, Mirjam-Colette Kempf3, Deborah Konkle-Parker4, Gina Wingood5, Phyllis C Tien6,7, Tracey E Wilson8, Carmen H Logie9, Sheri D Weiser10, Bulent Turan11. 1. Division of Prevention Science, Department of Medicine, University of California, San Francisco, San Francisco, California. 2. Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama. 3. Schools of Nursing, Public Health and Medicine, University of Alabama at Birmingham, Birmingham, Alabama. 4. Department of Medicine and School of Nursing, University of Mississippi Medical Center, Jackson, Mississippi. 5. Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, New York. 6. Department of Medicine, University of California, San Francisco. 7. Department of Veterans Affairs Medical Center, Medical Service, San Francisco, California. 8. Department of Community Health Sciences, State University of New York, Downstate Medical Center, School of Public Health, Brooklyn, New York, USA. 9. Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada. 10. Division of HIV, ID and Global Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California. 11. Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama, USA.
Abstract
OBJECTIVE: To examine whether experienced poverty stigma is associated with worse HIV care and treatment outcomes. DESIGN: We analyzed cross-sectional data from 433 women living with HIV enrolled in the Women's Adherence and Visit Engagement substudy of the Women's Interagency HIV Study. METHODS: Exposure was experienced poverty stigma, measured using the Perceived Stigma of Poverty Scale. Outcomes were viral suppression, CD4 cell count at least 350 cells/μl, and attending all HIV care visits in the past 6 months. Multivariable logistic regression models adjusted for income, age, race/ethnicity, education, substance use, months taking antiretroviral therapy (ART), number of antiretroviral pills in ART regimen, unstable housing, relationship status, and exchanging sex for money, drugs, or shelter. We also explored whether self-reported at least 95% ART adherence mediated the relationship between poverty stigma and viral suppression and CD4 cell count at least 350 cells/μl. RESULTS: Experienced poverty stigma was associated with lower adjusted odds of viral suppression [adjusted odds ratio (aOR) 0.76; 95% confidence interval (CI) 0.61-0.96], CD4 cell count at least 350 cells/μl (aOR 0.69; 95% CI 0.52-0.91), and attending all HIV care visits (aOR 0.73; 95% CI: 0.54-0.98). Exploratory mediation analysis suggests that at least 95% ART adherence significantly mediates the relationship between experienced poverty stigma and viral suppression and CD4 cell count at least 350 cells/μl. CONCLUSION: Longitudinal research should assess these relationships over time. Findings support interventions and policies that seek to reduce poverty stigma among people living with HIV.
OBJECTIVE: To examine whether experienced poverty stigma is associated with worse HIV care and treatment outcomes. DESIGN: We analyzed cross-sectional data from 433 women living with HIV enrolled in the Women's Adherence and Visit Engagement substudy of the Women's Interagency HIV Study. METHODS: Exposure was experienced poverty stigma, measured using the Perceived Stigma of Poverty Scale. Outcomes were viral suppression, CD4 cell count at least 350 cells/μl, and attending all HIV care visits in the past 6 months. Multivariable logistic regression models adjusted for income, age, race/ethnicity, education, substance use, months taking antiretroviral therapy (ART), number of antiretroviral pills in ART regimen, unstable housing, relationship status, and exchanging sex for money, drugs, or shelter. We also explored whether self-reported at least 95% ART adherence mediated the relationship between poverty stigma and viral suppression and CD4 cell count at least 350 cells/μl. RESULTS: Experienced poverty stigma was associated with lower adjusted odds of viral suppression [adjusted odds ratio (aOR) 0.76; 95% confidence interval (CI) 0.61-0.96], CD4 cell count at least 350 cells/μl (aOR 0.69; 95% CI 0.52-0.91), and attending all HIV care visits (aOR 0.73; 95% CI: 0.54-0.98). Exploratory mediation analysis suggests that at least 95% ART adherence significantly mediates the relationship between experienced poverty stigma and viral suppression and CD4 cell count at least 350 cells/μl. CONCLUSION: Longitudinal research should assess these relationships over time. Findings support interventions and policies that seek to reduce poverty stigma among people living with HIV.
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