Discrimination, Medical Distrust, Stigma, Depressive Symptoms, Antiretroviral Medication Adherence, Engagement in Care, and Quality of Life Among Women Living With HIV in North Carolina: A Mediated Structural Equation Model

J Acquir Immune Defic Syndr. 2019 Jul 1;81(3):328-335. doi: 10.1097/QAI.0000000000002033.


Background: Women represent 23% of all Americans living with HIV. By 2020, more than 70% of Americans living with HIV are expected to be 50 years and older.

Setting: This study was conducted in the Southern United States-a geographic region with the highest number of new HIV infections and deaths.

Objective: To explore the moderating effect of age on everyday discrimination (EVD); group-based medical (GBM) distrust; enacted, anticipated, internalized HIV stigma; depressive symptoms; HIV disclosure; engagement in care; antiretroviral medication adherence; and quality of life (QOL) among women living with HIV.

Methods: We used multigroup structural equation modeling to analyze baseline data from 123 participants enrolled at the University of North Carolina at Chapel Hill site of the Women's Interagency HIV Study during October 2013-May 2015.

Results: Although age did not moderate the pathways hypothesized, age had a direct effect on internalized stigma and QOL. EVD had a direct effect on anticipated stigma and depressive symptoms. GBM distrust had a direct effect on depressive symptoms and a mediated effect through internalized stigma. Internalized stigma was the only form of stigma directly related to disclosure. Depressive symptoms were a significant mediator between GBM, EVD, and internalized stigma reducing antiretroviral therapy medication adherence, engagement in care, and QOL.

Conclusions: EVD, GBM, and internalized stigma adversely affect depressive symptoms, antiretroviral therapy medication adherence, and engagement in care, which collectively influence the QOL of women living with HIV.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Depression*
  • Discrimination, Psychological*
  • Female
  • HIV Infections / psychology*
  • Humans
  • Interpersonal Relations*
  • Medication Adherence / psychology*
  • Middle Aged
  • North Carolina
  • Patient Compliance / psychology
  • Quality of Life*
  • Social Stigma*
  • Social Support