HIV stigma and viral load among African-American women receiving treatment for HIV

Kemp, Christopher G.; Lipira, Lauren; Huh, David; Nevin, Paul E.; Turan, Janet M.; Simoni, Jane M.; Cohn, Susan E.; Bahk, Mieoak; Berzins, Baiba; Andrasik, Michele P.; Mugavero, Michael J.; Rao, Deepa

doi:10.1097/qad.0000000000002212

Cited by 54 publications

(47 citation statements)

References 58 publications

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“…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. 19 In another US study, among 92 young Black men who have sex with men, those who reported higher levels of total stigma and personalized stigma were less likely to be virally suppressed. 21 These studies build on a wealth of evidence from multiple settings that suggest that stigma is a barrier to the continuum of care for PLHIV.…”

Section: Discussionmentioning

confidence: 99%

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

Hargreaves

Pliakas

Hoddinott

et al. 2020

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Section: Discussionmentioning

confidence: 99%

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

Hargreaves

Pliakas

Hoddinott

et al. 2020

JAIDS Journal of Acquired Immune Deficiency Syndromes

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“…Evidence continues to grow of the negative relationship of stigma to pre‐exposure prophylaxis [1], HIV testing [2‐4], linkage and retention in care [5‐7], medication adherence [8‐13] and viral load suppression [2,14,15]. More visible global recognition of stigma in fuelling the HIV epidemic and in undermining the HIV response has been forthcoming through recent global declarations [29,35,71].…”

Section: Discussionmentioning

confidence: 99%

“…The rationale for addressing stigma for an effective HIV response and to achieve national and global targets is clearly underscored by the evidence of the negative link between stigma and testing [2,3], treatment [10‐13] and viral load suppression [2,14,15]. The importance and urgency of responding to stigma in a consistent and scaled manner is visible in recent global calls for stigma‐reduction initiatives [29,35,71,72].…”

Section: Discussionmentioning

confidence: 99%

“…Mounting evidence documents that stigma undermines HIV prevention strategies such as pre‐exposure prophylaxis [1], HIV testing [2‐4], linkage to and retention in care [5‐7], medication adherence [8‐13] and ultimately viral load suppression [2,14,15]. Increasingly recognized as a key determinant of health and health inequity [16], stigma is a powerful social process characterized by labelling (distinguishing differences), stereotyping (attributing negative characteristics to the distinguished differences), separation (through physical and social isolation), leading to status loss (social and economic) and discrimination, all occurring in the context of power [17].…”

Section: Introductionmentioning

confidence: 99%

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Results from a difference‐in‐differences evaluation of health facility HIV and key population stigma‐reduction interventions in Ghana

Nyblade

Addo²,

Atuahene

et al. 2020

J Intern AIDS Soc

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Introduction: Stigma undermines all aspects of a comprehensive HIV response, as reflected in recent global initiatives for stigma-reduction. Yet a commensurate response to systematically tackle stigma within country responses has not yet occurred, which may be due to the lack of sufficient evidence documenting evaluated stigma-reduction interventions. With stigma present in all life spheres, health facilities offer a logical starting point for developing and expanding stigma reduction interventions. This study evaluates the impact of a "total facility" stigma-reduction intervention on the drivers and manifestations of stigma and discrimination among health facility staff in Ghana. Methods: We evaluated the impact of a total facility stigma-reduction intervention by comparing five intervention to five comparable non-intervention health facilities in Ghana. Interventions began in September 2017. Data collection was in June 2017 and April 2018. The primary outcomes were composite indicators for three stigma drivers, self-reported stigmatizing avoidance behaviour, and observed discrimination. The principal intervention variable was whether the respondent worked at an intervention or comparison facility. We estimated intervention effects as differences-in-differences in each outcome, further adjusted using inverse probability of treatment weighting (IPTW). Results: We observed favourable intervention effects for all outcome domains except for stigmatizing attitudes. Preferring not to provide services to people living with HIV (PLHIV) or a key population member improved 11.1% more in intervention than comparison facility respondents (95% CI 3.2 to 19.0). Other significant improvements included knowledge of policies to protect against discrimination (difference-in-differences = 20.4%; 95% CI 12.7 to 28.0); belief that discrimination would be punished (11.2%; 95% CI 0.2 to 22.3); and knowledge of and belief in the adequacy of infection control policies (17.6%; 95% CI 8.3 to 26.9). Reported observation of stigma and discrimination incidents fell by 7.4 percentage points more among intervention than comparison facility respondents, though only marginally significant in the IPTW-adjusted model (p = 0.06). Respondents at intervention facilities were 19.0% (95% CI 12.2 to 25.8) more likely to report that staff behaviour towards PLHIV had improved over the last year than those at comparison facilities. Conclusions: These results provide a foundation for scaling up health facility stigma-reduction within national HIV responses, though they should be accompanied by rigorous implementation science to ensure ongoing learning and adaptation for maximum effectiveness and long-term impact.

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“…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. 46 Taken together, these intriguing findings suggest an inverse relationship between HIV stigma and HIV-related health—wherein higher degrees of subjective experiences of HIV-related stigma directly associate with objective measures of HIV VL. However, the potential psychosocial and behavioral mediators of this emergent association remain unclear, and to date, the possibility of a direct relationship between HIV stigma and HIV-related health outcomes has yet to be examined in a sample of OALWH.…”

Section: Introductionmentioning

confidence: 93%

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

Rendina

Weaver

Millar

et al. 2019

J Int Assoc Provid AIDS Care

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Evidence suggests that psychosocial stress negatively impacts immunological health in HIV-positive individuals. However, few studies have explored this association in substance-using older adults living with HIV (OALWH). We evaluated the effect of depression, loneliness, substance use problems, and HIV stigma on primary markers of immune function in a sample of 120 OALWH with substance-related issues. HIV stigma correlated with the greatest number of factors, including depression, loneliness, and substance use problems. Older age and antiretroviral adherence were associated with viral suppression, which was in turn associated with higher percentage of CD4 count. Multivariate path analyses demonstrated that lower HIV stigma and viral suppression were the only factors independently associated with higher percentage of CD4 count, with a significant indirect effect of adherence on CD4 through viral suppression. HIV stigma emerged as the most salient factor associated with both psychosocial well-being and immune health in the current study, suggesting that it is a critical factor to consider in future interventions for the rapidly growing population of OALWH.

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HIV stigma and viral load among African-American women receiving treatment for HIV

Cited by 54 publications

References 58 publications

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

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

Results from a difference‐in‐differences evaluation of health facility HIV and key population stigma‐reduction interventions in Ghana

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

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