Mechanisms for the Negative Effects of Internalized HIV-Related Stigma on Antiretroviral Therapy Adherence in Women: The Mediating Roles of Social Isolation and Depression
| Autor: | Bulent Turan, Daniel Merenstein, Whitney Smith, Janet M. Turan, Lisa R. Metsch, Phyllis C. Tien, Adaora A. Adimora, Mardge H. Cohen, Sheri D. Weiser, Eryka L. Wentz, Adebola Adedimeji, Antonina Foster, Tracey E. Wilson |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2016 |
| Předmět: |
medicine.medical_specialty
Social stigma Anti-HIV Agents Social Stigma Psychological intervention Stigma (botany) HIV Infections Medication Adherence 03 medical and health sciences Social support 0302 clinical medicine Discrimination Psychological Surveys and Questionnaires medicine loneliness Humans Pharmacology (medical) 030212 general & internal medicine adherence Social isolation 10. No inequality Psychiatry 030505 public health business.industry Depression Epidemiology and Prevention Social Support Loneliness Middle Aged Mental health United States 3. Good health Infectious Diseases Cross-Sectional Studies Social Isolation stigma ComputingMethodologies_DOCUMENTANDTEXTPROCESSING Female medicine.symptom 0305 other medical science business Psychosocial |
| Zdroj: | Journal of Acquired Immune Deficiency Syndromes (1999) |
| ISSN: | 1944-7884 1525-4135 |
| Popis: | Supplemental Digital Content is Available in the Text. Background: Internalization of HIV-related stigma may inhibit a person's ability to manage HIV disease through adherence to treatment regimens. Studies, mainly with white men, have suggested an association between internalized stigma and suboptimal adherence to antiretroviral therapy (ART). However, there is a scarcity of research with women of different racial/ethnic backgrounds and on mediating mechanisms in the association between internalized stigma and ART adherence. Methods: The Women's Interagency HIV Study (WIHS) is a multicenter cohort study. Women living with HIV complete interviewer-administered questionnaires semiannually. Cross-sectional analyses for the current article included 1168 women on ART for whom data on medication adherence were available from their last study visit between April 2013 and March 2014, when the internalized stigma measure was initially introduced. Results: The association between internalized stigma and self-reported suboptimal ART adherence was significant for those in racial/ethnic minority groups (AOR = 0.69, P = 0.009, 95% CI: 0.52 to 0.91), but not for non-Hispanic whites (AOR = 2.15, P = 0.19, 95% CI: 0.69 to 6.73). Depressive symptoms, loneliness, and low perceived social support mediated the association between internalized stigma and suboptimal adherence in the whole sample, as well as in the subsample of minority participants. In serial mediation models, internalized stigma predicted less-perceived social support (or higher loneliness), which in turn predicted more depressive symptoms, which in turn predicted suboptimal medication adherence. Conclusions: Findings suggest that interconnected psychosocial mechanisms affect ART adherence, and that improvements in adherence may require multifaceted interventions addressing both mental health and interpersonal factors, especially for minority women. |
| Databáze: | OpenAIRE |
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