Tiffany R Glynn1, Maria M Llabre1, Jasper S Lee1, C Andres Bedoya2, Megan M Pinkston3, Conall O'Cleirigh2, Steven A Safren4. 1. Department of Psychology, University of Miami, Coral Gables, FL, USA. 2. Department of Psychiatry, The Fenway Institute, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA. 3. Department of Psychiatry and Human Behavior, The Miriam Hospital, Clinical Behavioral Medicine Service of the Immunology Center, Warren Alpert Medical School of Brown University, Providence, RI, USA. 4. Department of Psychology, University of Miami, Coral Gables, FL, USA. ssafren@miami.edu.
Abstract
BACKGROUND: Despite antiretroviral treatment (ART) being an efficacious treatment for HIV, essentially making it a chronic non-terminal illness, two related and frequent concerns for many people living with HIV/AIDS (PLWHA) continue to be HIV-related stigma and life stress. These two variables are frequently associated with depression, substance use, and poorer functional health. Studies to date have not fully examined the degree to which these constructs may be associated within one model, which could reveal a more nuanced understanding of how HIV-related stigma and life stress affect functional health in PLWHA. METHODS: The current study employed hybrid structural equation modeling to examine the interconnectedness and potential indirect relationships of HIV-related stigma and life stress to worse health through substance use and depression, controlling for ART adherence and age. Participants were 240 HIV-infected individuals who completed a biopsychosocial assessment battery upon screening for an RCT on treating depression in those infected with HIV. RESULTS: Both HIV-related stigma and stressful life events were directly related to depression, and depression was directly related to health. There were significant indirect effects from stigma and stress to health via depression. There were no significant effects involving substance use. CONCLUSION: It is important to continue to develop ways to address stigma, stressful life events, and their effects on distress in those living with HIV. Expanding our knowledge of disease progression risk factors beyond ART adherence is important to be able to design adjuvant interventions, particularly because treatment means that people living with HIV have markedly improved life expectancy and that successful treatment means that HIV is not transmittable to others.
BACKGROUND: Despite antiretroviral treatment (ART) being an efficacious treatment for HIV, essentially making it a chronic non-terminal illness, two related and frequent concerns for many people living with HIV/AIDS (PLWHA) continue to be HIV-related stigma and life stress. These two variables are frequently associated with depression, substance use, and poorer functional health. Studies to date have not fully examined the degree to which these constructs may be associated within one model, which could reveal a more nuanced understanding of how HIV-related stigma and life stress affect functional health in PLWHA. METHODS: The current study employed hybrid structural equation modeling to examine the interconnectedness and potential indirect relationships of HIV-related stigma and life stress to worse health through substance use and depression, controlling for ART adherence and age. Participants were 240 HIV-infected individuals who completed a biopsychosocial assessment battery upon screening for an RCT on treating depression in those infected with HIV. RESULTS: Both HIV-related stigma and stressful life events were directly related to depression, and depression was directly related to health. There were significant indirect effects from stigma and stress to health via depression. There were no significant effects involving substance use. CONCLUSION: It is important to continue to develop ways to address stigma, stressful life events, and their effects on distress in those living with HIV. Expanding our knowledge of disease progression risk factors beyond ART adherence is important to be able to design adjuvant interventions, particularly because treatment means that people living with HIV have markedly improved life expectancy and that successful treatment means that HIV is not transmittable to others.
Entities:
Keywords:
Depression; HIV; HIV-related stigma; Stressful life events; Substance use
Authors: A C Justice; W Holmes; A L Gifford; L Rabeneck; R Zackin; G Sinclair; S Weissman; J Neidig; C Marcus; M Chesney; S E Cohn; A W Wu Journal: J Clin Epidemiol Date: 2001-12 Impact factor: 6.437
Authors: Kathryn Whetten; Jane Leserman; Kristin Lowe; Dalene Stangl; Nathan Thielman; Marvin Swartz; Laura Hanisch; Lynn Van Scoyoc Journal: Am J Public Health Date: 2006-05-02 Impact factor: 9.308
Authors: Michael H Antoni; Adam W Carrico; Ron E Durán; Susan Spitzer; Frank Penedo; Gail Ironson; Mary Ann Fletcher; Nancy Klimas; Neil Schneiderman Journal: Psychosom Med Date: 2006 Jan-Feb Impact factor: 4.312
Authors: Michael H Antoni; Dean G Cruess; Nancy Klimas; Kevin Maher; Stacy Cruess; Mahendra Kumar; Susan Lutgendorf; Gail Ironson; Neil Schneiderman; Mary Ann Fletcher Journal: Am J Psychiatry Date: 2002-01 Impact factor: 18.112
Authors: Adam W Carrico; Michael H Antoni; Ron E Duran; Gail Ironson; Frank Penedo; Mary Ann Fletcher; Nancy Klimas; Neil Schneiderman Journal: Ann Behav Med Date: 2006-04
Authors: Katherine R Schafer; Amanda E Tanner; Lilli Mann-Jackson; Jorge Alonzo; Eunyoung Y Song; Scott D Rhodes Journal: South Med J Date: 2022-01 Impact factor: 0.954
Authors: Valerie A Earnshaw; Lisa A Eaton; Zachary K Collier; Ryan J Watson; Jessica L Maksut; Katherine B Rucinski; John F Kelly; Seth C Kalichman Journal: AIDS Patient Care STDS Date: 2020-06 Impact factor: 5.078
Authors: Tiffany R Glynn; Noelle A Mendez; Deborah L Jones; Sannisha K Dale; Adam W Carrico; Daniel J Feaster; Allan E Rodriguez; Steven A Safren Journal: J Behav Med Date: 2020-10-24
Authors: Steven Meanley; Seul Ki Choi; Azure B Thompson; Jacquelyn L Meyers; Gypsyamber D'Souza; Adaora A Adimora; Matthew J Mimiaga; Mirjam-Colette Kempf; Deborah Konkle-Parker; Mardge H Cohen; Linda A Teplin; Lynn Murchison; Leah H Rubin; Anna A Rubtsova; Deborah Jones Weiss; Brad Aouizerat; Mackey R Friedman; Michael W Plankey; Tracey E Wilson Journal: Drug Alcohol Depend Date: 2021-12-25 Impact factor: 4.492