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

HIV Stigma and Viral Suppression Among People Living With HIV in the Context of Universal Test and Treat: Analysis of Data From the HPTN 071 (PopART) Trial in Zambia and South Africa

“…Four other studies have explored measures of HIV stigma and their association with viral suppression. 18 – 21 Among a cohort of 6448 PLHIV in care in the United States, 88% of whom were virally suppressed, a “modest but significant” association was observed between internalized stigma and concurrent viremia. This followed a smaller study in the United States nested within a randomized trial of an intervention to reduce HIV stigma among 234 African American women in HIV care in 3 cities, in which changes in viral load over time were associated with experiences of stigma.…”

Psychosocial Well-Being and HIV-Related Immune Health Outcomes among HIV-Positive Older Adults: Support for a Biopsychosocial Model of HIV Stigma and Health

“…76,77 However, the notion of a direct link between HIV stigma and physical health has met preliminary support in a limited number of similar, but methodologically diverse studies. 78 For example, Lipira et al 47 found that higher HIV stigma predicted lower odds of VL suppression, independent of ART nonadherence. Relatedly, Kay et al 44 observed that both ART nonadherence and experienced HIV stigma predicted VL nonsuppression; however, the authors concluded that adherence did not mediate the association between HIV stigma and VL.…”

“…Recently published findings from a stigma-reduction intervention have portrayed a similar association between HIV stigma and VL. 46,47 In cross-sectional analyses, 95% of participants endorsed experiencing HIV stigma, and moreover, higher experiences of HIV stigma were significantly associated with lower odds of VL suppression, while hypothesized indirect effects of depression and ART adherence failed to reach significance. 47 In longitudinal analyses, the direct association between higher HIV stigma and lower odds of VL suppression persisted, while the hypothesized mediators of this association (depressive symptoms and social support) remained nonsignificant.…”

HIV-Related Stigma Research as a Priority at the National Institutes of Health

“…NIMH prioritizes theoretically driven bio-behavioral approaches to developing HIV stigma models [ 52 , 53 ] and measurements [ 54 , 55 ] to advance understanding of how HIV-related stigma impacts HIV prevention and treatment outcomes [ 56 ]. Similarly, NIMH prioritizes intervention research that mitigates HIV stigma, improves HIV outcomes and examines mechanisms of change [ 57 , 58 ]. Targeting highly stigmatized communities at substantial risk of HIV, particularly those living in high-incidence counties, and focusing on different types (e.g., internalized or anticipated), levels (e.g., individual or multi-level) of HIV stigma in different contexts (e.g., health care settings, communities/neighborhoods, faith-based institutions) is also priority.…”

“…Clinical trial tests of anti-HIV stigma approaches include a faith-based intervention for Black churches [ 77 – 79 ], a group-level intervention for Black women [ 80 ], and a community-level intervention for young Black men [ 81 , 82 ]. Whereas Rao and colleagues [ 80 ] did not find group differences in stigma reduction, follow-up analyses reveal important impact of HIV stigma on viral load [ 83 ] and engagement in HIV care [ 84 ], and the mediating role of depression and ART non-adherence [ 58 ].…”