HIV-Related Stigma and Viral Suppression Among African-American Women: Exploring the Mediating Roles of Depression and ART Nonadherence

Abstract

We used baseline data from a sample of African-American women living with HIV who were recruited to participate in a stigma-reduction intervention in Chicago and Birmingham (2013-2015) to (1) evaluate the relationship between HIV-related stigma and viral suppression, and (2) assess the role of depression and nonadherence to antiretroviral therapy (ART) as mediators. Data from women were included in this secondary analysis if they were on ART, had viral load data collected within 8-weeks of study entry and had complete covariate data. We used logistic regression to estimate the total effect of HIV-related stigma (14-item Stigma Scale for Chronic Illness) on viral suppression (< 200 copies/mL), and serial mediation analysis to estimate indirect effects mediated by depressive symptoms (8-item Patient Health Questionnaire) and ART nonadherence (number of days with missed doses). Among 100 women who met study inclusion criteria, 95% reported some level of HIV-related stigma. In adjusted models, higher levels of HIV-related stigma were associated with lower odds of being virally suppressed (AOR = 0.93, 95% CI = 0.89-0.98). In mediation analysis, indirect effects through depression and ART nonadherence were not significant. Findings suggest that HIV-related stigma is common among African-American women living with HIV, and those who experience higher levels of stigma are less likely to be virally suppressed. However, the mechanisms remain unclear.

Keywords: ART adherence; African-American women; Depression; HIV stigma; Viral suppression.

Figure 1.

Hypothesized pathway from HIV-related stigma to viral suppression ART – antiretroviral therapy

Figure 2.

Primary and sensitivity study samples: flow of participant study inclusion among African-American women living with HIV enrolled in an HIV-related stigma-reduction intervention (Unity Study) ART – antiretroviral therapy, VL – viral load Covariates of interest include age, number of years living with HIV, and education

Figure 3.

Predicted probability of viral suppression and 95% confidence intervals for different levels of HIV-related stigma (SSCI), by study site, among a sample of African-American women living with HIV enrolled in the Unity Study (N = 100) SSCI – 14-item Stigma Scale for Chronic Illness NU – Northwestern University, CORE – Ruth M. Rothstein CORE Center, UAB – University of Alabama, Birmingham

Figure 4.

Primary serial mediation model with unstandardized path coefficients estimating associations between HIV-related stigma, depressive symptoms, ART nonadherence and viral suppression among a sample of African-American women living with HIV enrolled in the Unity Study (N = 100) ART – antiretroviral therapy