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HIV stigma and viral load among African-American women receiving treatment for HIV

Kemp, Christopher G.a; Lipira, Laurenb; Huh, Davidc; Nevin, Paul E.a; Turan, Janet M.e; Simoni, Jane M.a,d; Cohn, Susan E.f; Bahk, Mieoakg; Berzins, Baibaf; Andrasik, Michelea; Mugavero, Michael J.h; Rao, Deepaa,i

doi: 10.1097/QAD.0000000000002212
EPIDEMIOLOGY AND SOCIAL
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Objective: African-American women are more likely than other women in the United States to experience poor HIV-related health; HIV stigma may contribute to these outcomes. This study assessed the relationship between HIV stigma and viral load, over time, among a sample of African-American women receiving treatment for HIV, and explored social support and depressive symptoms as mediators.

Design: Secondary analysis of longitudinal data.

Methods: Data came from a randomized trial of an intervention to reduce HIV stigma among African-American women in HIV care in Chicago, Illinois and Birmingham, Alabama. Sociodemographic and psychosocial data were collected at up to six study visits over 14 months. Viral loads were extracted from medical records during the study period. Generalized linear mixed effects models were used to estimate associations among overall, internalized, and enacted HIV stigma and viral load over time. Mediation analyses were used to estimate indirect effects via social support and depressive symptoms.

Results: Data from 234 women were analyzed. Overall HIV stigma was significantly associated with subsequent viral load (adjusted β = 0.24, P = 0.005). Both between-subject (adjusted β = 0.74, P < 0.001) and within-subject (adjusted β = 0.34, P = 0.005) differences in enacted stigma were associated with viral load. Neither social support nor depressive symptoms were statistically significant mediators.

Conclusion: Ongoing experiences of HIV stigmatization may contribute to increased viral load among African-American women in primary HIV care. Interventions should aim to alleviate the consequences of stigma experienced by patients and prevent future stigmatization.

aDepartment of Global Health

bDepartment of Health Services

cSchool of Social Work

dDepartment of Psychology, University of Washington, Seattle, Washington

eSchool of Public Health, University of Alabama at Birmingham, Birmingham, Alabama

fDivision of Infectious Diseases, Northwestern University Feinberg School of Medicine

gRuth M. Rothstein CORE Center, Chicago, Illinois

hDepartment of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama

iDepartment of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA.

Correspondence to Christopher G. Kemp, MPH, PhDc, Department of Global Health, University of Washington, Ninth and Jefferson Building, 13th Floor, Box 359932, 908 Jefferson Street, Seattle, WA 98104, USA. Tel: +1 206 765 0989; e-mail: kempc@uw.edu

Received 4 August, 2018

Revised 5 February, 2019

Accepted 22 February, 2019

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website (http://www.AIDSonline.com).

Copyright © 2019 Wolters Kluwer Health, Inc.