Mechanisms For The Negative Effects Of Internalized Hiv-Related Stigma On Art Adherence In Women

The Mediating Roles Of Social Isolation And Depression

Bulent Turan, Whitney Smith, Mardge H. Cohen, Tracey E. Wilson, Adaora A. Adimora, Daniel Merenstein, Adebola A. Adedimeji, Eryka L. Wentz, Antonina G. Foster, Lisa Metsch, Phyllis C. Tien, Sheri D. Weiser, Janet M. Turan

Research output: Contribution to journalArticle

45 Citations (Scopus)

Abstract

: Abstract 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 sub-optimal 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 multi-center cohort study. Women living with HIV complete interviewer-administered questionnaires semi-annually. 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 sub-optimal ART adherence was significant for those in racial/ethnic minority groups (AOR = 0.69, p = .009, CI [0.52,0.91]), but not for non-Hispanic whites (AOR = 2.15, p = .19, CI [0.69,6.73]). Depressive symptoms, loneliness, and low perceived social support mediated the association between internalized stigma and sub-optimal 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 sub-optimal medication adherence. CONCLUSIONS:: Findings suggest that interconnected psychosocial mechanisms affect ART adherence, and that improvements in adherence may require multi-faceted interventions addressing both mental health and interpersonal factors, especially for minority women.

Original languageEnglish (US)
JournalJournal of Acquired Immune Deficiency Syndromes
DOIs
StateAccepted/In press - Feb 16 2016

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Social Isolation
Art
Depression
HIV
Loneliness
Medication Adherence
Social Support
Therapeutics
Minority Groups
Aptitude
Ethnic Groups
Mental Health
Cohort Studies
Cross-Sectional Studies
Interviews
Research

ASJC Scopus subject areas

  • Infectious Diseases
  • Pharmacology (medical)

Cite this

Mechanisms For The Negative Effects Of Internalized Hiv-Related Stigma On Art Adherence In Women : The Mediating Roles Of Social Isolation And Depression. / Turan, Bulent; Smith, Whitney; Cohen, Mardge H.; Wilson, Tracey E.; Adimora, Adaora A.; Merenstein, Daniel; Adedimeji, Adebola A.; Wentz, Eryka L.; Foster, Antonina G.; Metsch, Lisa; Tien, Phyllis C.; Weiser, Sheri D.; Turan, Janet M.

In: Journal of Acquired Immune Deficiency Syndromes, 16.02.2016.

Research output: Contribution to journalArticle

Turan, Bulent ; Smith, Whitney ; Cohen, Mardge H. ; Wilson, Tracey E. ; Adimora, Adaora A. ; Merenstein, Daniel ; Adedimeji, Adebola A. ; Wentz, Eryka L. ; Foster, Antonina G. ; Metsch, Lisa ; Tien, Phyllis C. ; Weiser, Sheri D. ; Turan, Janet M. / Mechanisms For The Negative Effects Of Internalized Hiv-Related Stigma On Art Adherence In Women : The Mediating Roles Of Social Isolation And Depression. In: Journal of Acquired Immune Deficiency Syndromes. 2016.
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abstract = ": Abstract 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 sub-optimal 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 multi-center cohort study. Women living with HIV complete interviewer-administered questionnaires semi-annually. 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 sub-optimal ART adherence was significant for those in racial/ethnic minority groups (AOR = 0.69, p = .009, CI [0.52,0.91]), but not for non-Hispanic whites (AOR = 2.15, p = .19, CI [0.69,6.73]). Depressive symptoms, loneliness, and low perceived social support mediated the association between internalized stigma and sub-optimal 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 sub-optimal medication adherence. CONCLUSIONS:: Findings suggest that interconnected psychosocial mechanisms affect ART adherence, and that improvements in adherence may require multi-faceted interventions addressing both mental health and interpersonal factors, especially for minority women.",
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T1 - Mechanisms For The Negative Effects Of Internalized Hiv-Related Stigma On Art Adherence In Women

T2 - The Mediating Roles Of Social Isolation And Depression

AU - Turan, Bulent

AU - Smith, Whitney

AU - Cohen, Mardge H.

AU - Wilson, Tracey E.

AU - Adimora, Adaora A.

AU - Merenstein, Daniel

AU - Adedimeji, Adebola A.

AU - Wentz, Eryka L.

AU - Foster, Antonina G.

AU - Metsch, Lisa

AU - Tien, Phyllis C.

AU - Weiser, Sheri D.

AU - Turan, Janet M.

PY - 2016/2/16

Y1 - 2016/2/16

N2 - : Abstract 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 sub-optimal 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 multi-center cohort study. Women living with HIV complete interviewer-administered questionnaires semi-annually. 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 sub-optimal ART adherence was significant for those in racial/ethnic minority groups (AOR = 0.69, p = .009, CI [0.52,0.91]), but not for non-Hispanic whites (AOR = 2.15, p = .19, CI [0.69,6.73]). Depressive symptoms, loneliness, and low perceived social support mediated the association between internalized stigma and sub-optimal 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 sub-optimal medication adherence. CONCLUSIONS:: Findings suggest that interconnected psychosocial mechanisms affect ART adherence, and that improvements in adherence may require multi-faceted interventions addressing both mental health and interpersonal factors, especially for minority women.

AB - : Abstract 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 sub-optimal 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 multi-center cohort study. Women living with HIV complete interviewer-administered questionnaires semi-annually. 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 sub-optimal ART adherence was significant for those in racial/ethnic minority groups (AOR = 0.69, p = .009, CI [0.52,0.91]), but not for non-Hispanic whites (AOR = 2.15, p = .19, CI [0.69,6.73]). Depressive symptoms, loneliness, and low perceived social support mediated the association between internalized stigma and sub-optimal 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 sub-optimal medication adherence. CONCLUSIONS:: Findings suggest that interconnected psychosocial mechanisms affect ART adherence, and that improvements in adherence may require multi-faceted interventions addressing both mental health and interpersonal factors, especially for minority women.

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