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Religiosity, Social Support, and Ethnic Identity

Exploring “Resilience Resources” for African-American Women Experiencing HIV-Related Stigma

Lipira, Lauren, PhD, MSWa; Williams, Emily C., PhD, MPHb,c; Nevin, Paul E., MPHd; Kemp, Christopher G., MPHd; Cohn, Susan E., MD, MPHe; Turan, Janet M., PhDf; Simoni, Jane M., PhD, MAg; Andrasik, Michele P., PhDh; French, Audrey L., MDi; Unger, Joseph M., PhD, MSj; Heagerty, Patrick, PhDk; Rao, Deepa, PhDd,l

JAIDS Journal of Acquired Immune Deficiency Syndromes: June 1, 2019 - Volume 81 - Issue 2 - p 175–183
doi: 10.1097/QAI.0000000000002006
Prevention Research

Introduction: African-American women living with HIV report substantial HIV-related stigma and depression. Resilience resources are strength-based resources that may moderate the effects of HIV-related stigma on poor psychosocial outcomes such as depression.

Objective: To evaluate whether religiosity, social support, and ethnic identity moderate the effects of HIV-related stigma on depression among African-American women living with HIV.

Methods: We used baseline data (May 2013–October 2015) from a randomized controlled trial testing the efficacy of an HIV-related stigma-reduction intervention among African-American women living with HIV in Chicago, IL, and Birmingham, AL, who were older than 18 years and currently receiving HIV services. To assess whether religiosity (7-item Religious Beliefs and Behaviors survey), social support (select subscales from the Medical Outcomes Study Social Support Survey), and ethnic identity (Commitment subscale from the Multigroup Ethnic Identity Measure) modified the relationship between HIV-related stigma (Stigma Scale for Chronic Illness) and depression (8-item Patient Health Questionnaire), we conducted 3 separate moderation analyses using linear regression with interactions between HIV-related stigma and each moderator of interest, adjusted for study site, age, time since diagnosis, and education.

Results: Among 226 African-American women living with HIV, greater levels of HIV-related stigma were associated with greater depression in all 3 models (P < 0.05). Only religiosity modified this association (P = 0.04), with a weaker association among women reporting higher levels of religiosity.

Conclusions: The protective effects of religiosity may be leveraged in interventions for African-American women living with HIV struggling with HIV-related stigma.

aDepartment of Health Services, Department of Global Health, University of Washington, Seattle, WA;

bDepartment of Health Services, University of Washington, Seattle, WA;

cSeattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Health Services Research and Development, Seattle, WA;

dDepartment of Global Health, University of Washington, Seattle, WA;

eDepartment of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL;

fDepartment of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, AL;

gDepartment of Psychology, University of Washington, Seattle, WA;

hVaccine and Infectious Disease Division, Fred Hutch, Seattle, WA;

iStroger Hospital of Cook County, Ruth M. Rothstein CORE Center, Chicago, IL;

jPublic Health Sciences Division, Fred Hutch, Seattle, WA;

kDepartment of Biostatistics, University of Washington, Seattle, WA; and

lDepartment of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA.

Correspondence to: Lauren Lipira, PhD, MSW, Department of Global Health, University of Washington, Harris Hydraulics Building, 1705 NE Pacific Street, UW Campus Mailbox 357965, Seattle, WA 98195-7175 (e-mail:

Supported by the National Institute of Mental Health (NIMH) under grant R01-MH98675 (PI: D.R.) with additional support from Ms. Lipira's Agency for Healthcare Research and Quality Health Services Training Award (T32 HS013853-13) and Dr. Williams' VA Health Services Research & Development Career Development Award (CDA 12-276).

Presented at AIDS Impact 14th International Conference; July 29–31, 2017; Cape Town, South Africa.

The authors have no conflicts of interests to disclose.

Received September 26, 2018

Accepted February 04, 2019

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