Associations Between HIV-Related Stigma, Racial Discrimination, Gender Discrimination, and Depression Among HIV-Positive African, Caribbean, and Black Women in Ontario, Canada

Abstract

African, Caribbean, and Black (ACB) women are greatly overrepresented in new HIV infections in comparison with Canada's general population. Social and structural factors such as HIV-related stigma, gender discrimination, and racial discrimination converge to increase vulnerability to HIV infection among ACB women by reducing access to HIV prevention services. Stigma and discrimination also present barriers to treatment, care, and support and may contribute to mental health problems. We administered a cross-sectional survey to HIV-positive ACB women (n=173) across Ontario in order to examine the relationships between HIV-related stigma, gender discrimination, racial discrimination, and depression. One-third of participants reported moderate/severe depression scores using the Beck Depression Inventory Fast-Screen guidelines. Hierarchical block regression, moderation, and mediation analyses were conducted to measure associations between independent (HIV-related stigma, gender discrimination, racial discrimination), moderator/mediator (social support, resilient coping), and dependent (depression) variables. Findings included: (1) HIV-related stigma was associated with increased depression; (2) resilient coping was associated with reduced depression but did not moderate the influence of HIV-related stigma on depression; and (3) the effects of HIV-related stigma on depression were partially mediated through resilient coping. HIV-related stigma, gender discrimination, and racial discrimination were significantly correlated with one another and with depression, highlighting the salience of examining multiple intersecting forms of stigma. Generalizability of findings may be limited due to nonrandom sampling. Findings emphasize the importance of multi-component interventions, including building resilient coping skills, mental health promotion and assessment, and stigma reduction programs.

The Effects of a Mass Media HIV-Risk Reduction Strategy on HIV-Related Stigma and Knowledge Among African American Adolescents

“…15 Moreover, HIV-related stigma conflates with other discrediting attributes experienced by African American populations. For example, Logie et al (2013) found that experiencing HIVrelated stigma and racial discrimination were significantly correlated among black PHA. 16 These interacting stigmas may directly impede HIV-reduction efforts.…”

“…For example, Logie et al (2013) found that experiencing HIVrelated stigma and racial discrimination were significantly correlated among black PHA. 16 These interacting stigmas may directly impede HIV-reduction efforts. As noted by Gardezi et al (2008), black PHA accessing medical care report cultural insensitivity among service providers (i.e., negative remarks about one's ethnic/racial group, discourteous service) thus undermining quality of healthcare among this group.…”

Insights on GRACE (Gender, Race, And Clinical Experience) from the Patient's Perspective: GRACE Participant Survey

“…3 Women of color have been particularly under-represented, despite the fact that they comprise a large portion of new infections. 4,5 In addition to HIV-related stigma, women of color may face both sex-based and race-based discrimination, culminating in increased rates of mental health issues. 4 Challenges to recruitment and retention have been observed and exist for studies in other therapeutic areas as well.…”

“…4,5 In addition to HIV-related stigma, women of color may face both sex-based and race-based discrimination, culminating in increased rates of mental health issues. 4 Challenges to recruitment and retention have been observed and exist for studies in other therapeutic areas as well. 6,7 Sex-based statistical analyses and conclusions are limited when female enrollment is low; therefore, female enrollment in HIV clinical trials should be representative of the infected population.…”

The Association Between Depressive Symptoms, Anger, and Perceived Support Resources Among Underserved Older HIV Positive Black/African American Adults

“…First, the present study did not examine other stressors such as perceived discrimination, stigma, and medical mistrust, which have been shown to influence mental health outcomes. [40][41][42] These constructs were beyond the scope of the present study, and are important areas of future research with this population. Second, although the current study data is cross sectional and causation cannot be determined, these findings provide a closer examination of factors influencing the perception of support resources in this population.…”