Andrea Norcini Pala1, Mirjam-Colette Kempf2, Deborah Konkle-Parker3, Tracey E Wilson4, Phyllis C Tien5, Gina Wingood6, Torsten B Neilands7, Mallory O Johnson8, Sheri D Weiser9, Carmen H Logie10, Janet M Turan11, Bulent Turan12. 1. School of Social Work, Columbia University, New York, New York. 2. Department of Health Behavior, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama. 3. Division of Infectious Diseases, Department of Medicine, School of Nursing, University of Mississippi Medical Center, Jackson, Mississippi. 4. Department of Community Health Sciences, School of Public Health, State University of New York Downstate Health Sciences University, Brooklyn, New York. 5. Department of Medicine, University of California, San Francisco and Medical Service, Department of Veteran Affairs Medical Center, San Francisco, California. 6. Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, New York. 7. Department of Medicine, University of California, San Francisco. 8. Department of Medicine, Center for AIDS Prevention Studies, University of California, San Francisco. 9. Division of HIV, ID and Global Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California, USA. 10. Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada. 11. Department of Healthcare Organization and Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA. 12. Department of Psychology, Koc University, Istanbul, Turkey.
Abstract
OBJECTIVES: To explore the associations between intersectional poverty, HIV, sex, and racial stigma, adherence to antiretroviral therapy (ART), and viral suppression among women with HIV (WHIV). DESIGN: We examined intersectional stigmas, self-report ART adherence, and viral suppression using cross-sectional data. METHODS: Participants were WHIV ( N = 459) in the Women's Adherence and Visit Engagement, a Women's Interagency HIV Study substudy. We used Multidimensional Latent Class Item Response Theory and Bayesian models to analyze intersectional stigmas and viral load adjusting for sociodemographic and clinical covariates. RESULTS: We identified five intersectional stigma-based latent classes. The likelihood of viral suppression was approximately 90% lower among WHIV who experienced higher levels of poverty, sex, and racial stigma or higher levels of all intersectional stigmas compared with WHIV who reported lower experiences of intersectional stigmas. ART adherence accounted for but did not fully mediate some of the associations between latent intersectional stigma classes and viral load. CONCLUSION: The negative impact of intersectional stigmas on viral suppression is likely mediated, but not fully explained, by reduced ART adherence. We discuss the research and clinical implications of our findings.
OBJECTIVES: To explore the associations between intersectional poverty, HIV, sex, and racial stigma, adherence to antiretroviral therapy (ART), and viral suppression among women with HIV (WHIV). DESIGN: We examined intersectional stigmas, self-report ART adherence, and viral suppression using cross-sectional data. METHODS: Participants were WHIV ( N = 459) in the Women's Adherence and Visit Engagement, a Women's Interagency HIV Study substudy. We used Multidimensional Latent Class Item Response Theory and Bayesian models to analyze intersectional stigmas and viral load adjusting for sociodemographic and clinical covariates. RESULTS: We identified five intersectional stigma-based latent classes. The likelihood of viral suppression was approximately 90% lower among WHIV who experienced higher levels of poverty, sex, and racial stigma or higher levels of all intersectional stigmas compared with WHIV who reported lower experiences of intersectional stigmas. ART adherence accounted for but did not fully mediate some of the associations between latent intersectional stigma classes and viral load. CONCLUSION: The negative impact of intersectional stigmas on viral suppression is likely mediated, but not fully explained, by reduced ART adherence. We discuss the research and clinical implications of our findings.
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