Article

The Association of Stigma with Self-Reported Access to Medical Care and Antiretroviral Therapy Adherence in Persons Living with HIV/AIDS

Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at University of California-Los Angeles, 911 Broxton Ave., Los Angeles, CA 90024, USA.
Journal of General Internal Medicine (Impact Factor: 3.42). 09/2009; 24(10):1101-8. DOI: 10.1007/s11606-009-1068-8
Source: PubMed

ABSTRACT The stigma of HIV-infection may profoundly affect the lives of persons living with HIV/AIDS (PLHA). However few studies have examined the association of HIV stigma with multiple components of HIV treatment and care.
To estimate the association between HIV stigma and: self-reported access to care, regular source of HIV care, and antiretroviral therapy adherence; and to test whether mental health mediates these associations.
Cross-sectional study.
202 PLHA living in Los Angeles County in 2007.
Participants completed an anonymous survey, assessing internalized HIV stigma (28-items, alpha = 0.93), self-reported access to medical care (six items, alpha = 0.75), regular source of HIV care, and antiretroviral therapy (ART) adherence.
One-third of participants reported high levels of stigma; 77% reported poor access to care; 42.5% reported suboptimal ART adherence; and 10.5% reported no regular source of HIV care. In unadjusted analysis, those reporting a high level of stigma were more likely to report poor access to care (OR = 4.97, 95% CI 2.54-9.72), regular source of HIV care (OR = 2.48, 95% CI 1.00-6.19), and ART adherence (OR = 2.45, 95% CI 1.23-4.91). In adjusted analyses, stigma was significantly associated with poor access to care (OR = 4.42, 95% CI 1.88-10.37), but not regular source of HIV care or ART adherence. Mental health mediated the relationship between stigma and ART adherence, but not poor access to care or regular source of HIV care.
The association of stigma with self-reported access to care and adherence suggests that efforts to improve these components of HIV care will require a better understanding of the possible effects of stigma and its mediators.

Download full-text

Full-text

Available from: David Martins, Jun 20, 2015
1 Follower
 · 
91 Views
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Abstract Objective: HIV-related stigma is a major driver of poor prognosis for the treatment and reduced spread of HIV. The present article provides a qualitative analysis surrounding various themes related to stigma and shame as a result HIV Design: Eight gay men recruited from a community HIV clinic contacted the researchers in response to a study involving participation in a structured, 8-week group intervention for HIV-related stigma. Following this group, three men took part in open-ended interviews about their thoughts and experiences. Methods: IPA (interpretative phenomenological analysis) was used to examine the participants' experiences surrounding shame and stigma related to living with HIV. Results: Three superordinate themes were identified: social support and the disclosure of serostatus, stigma associated with serosorting, and attempts to negotiate a spoiled identity. Conclusion: In San Francisco, a city with a great deal of acceptance surrounding HIV and a large, politically active community of persons living with HIV, gay men continue to struggle with disclosure and stigma. This stigma may be an unexpected result of a high degree of HIV-testing and attempts by both HIV-positive and negative gay men to practice serosorting.
    Psychology & Health 12/2013; DOI:10.1080/08870446.2013.871283 · 1.95 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: While methamphetamine users report high rates of internalized or self-stigma, few studies have examined experiences of stigma (i.e., stigmatization by others) and its correlates. This study identified correlates of stigma experiences in a sample of 438 HIV-positive men who have sex with men (MSM) who were enrolled in a sexual risk reduction intervention in San Diego, CA. Approximately 96% of the sample reported experiences of stigma related to their use of methamphetamine. In multiple regression analysis, experiences of stigma were associated with binge use of methamphetamine, injection drug use, increased anger symptoms, reduced emotional support, and lifetime treatment for methamphetamine use. These findings suggest that experiences of stigma are common among methamphetamine users and that interventions to address this type of stigma and its correlates may offer social, psychological, and health benefits to HIV-positive methamphetamine-using MSM.
    Drug and alcohol dependence 05/2012; 125(1-2):154-9. DOI:10.1016/j.drugalcdep.2012.04.007 · 3.28 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: This study tested the hypothesis that depressive symptoms would mediate the association of HIV-related stigma to medication adherence. We recruited HIV-infected men who have sex with men (MSM; N = 66; 66 % White, 23 % African-American) from an outpatient infectious disease clinic, and asked them to complete self-report measures. Mediational analyses showed that depressive symptoms fully mediated the association between HIV-related stigma and adherence. That is, stigma-related experiences were positively associated with depressive symptoms and negatively associated with adherence, and, in the final model, depressive symptoms remained a significant correlate of adherence while stigma did not. A test of the indirect effect of stigma on adherence through depressive symptoms was also significant (unstandardized b = -0.19; bootstrap 95 % CI -0.45 to -0.01). These results highlight the importance of treating depressive symptoms in interventions aiming to improve medication adherence among HIV-infected MSM.
    AIDS and Behavior 03/2015; DOI:10.1007/s10461-015-1038-6 · 3.49 Impact Factor