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


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.

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    • "DS , 2014 ) . Among these PLWH , who primar - ily had substance use disorders and extremely low utilization of drug treatment or HIV care prior to incarceration , we found perceptions and experiences of stigma ( 40 . 5 6 19 . 8 ) similar to those found in economically disadvantaged and medically under - served PLWH in the United States ( 41 6 19 ; Sayles et al . , 2009 ) ; and high levels of stigma ( mean score . 50 ) in 33 . 3% of participants , in part reflect - ing the lived experience of a group with high HIV mortality and limited access to effective HIV treat - ments ( Castro & Farmer , 2005 ) . Many participants had lost someone close to HIV , including cellmates , friends , siblings , and spous"
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    ABSTRACT: In Indonesia, the syndemic nature of HIV, drug use, and incarceration may influence experiences of stigma for HIV-infected prisoners. This mixed-method study explores HIV stigma in prisoners living with HIV in Indonesia. Randomly selected male HIV-infected prisoners (n = 102) from two large prisons in Jakarta completed in-depth interviews and a structured HIV stigma survey. Quantitative results found four groups of HIV-infected prisoners with significantly higher HIV stigma levels, including those: (a) with drug-related offenses, (b) seeking help to decrease drug use, (c) diagnosed with HIV before the current incarceration, and (d) who had not disclosed their HIV status to family members or friends. Qualitative results highlighted the prominent role of HIV stigma in decisions to disclose HIV status to family members, partners, and other prisoners. Interventions should address HIV stigma in HIV-infected prisoners in Indonesia to achieve HIV treatment as prevention goals. Copyright © 2015 Association of Nurses in AIDS Care. Published by Elsevier Inc. All rights reserved.
    The Journal of the Association of Nurses in AIDS Care: JANAC 07/2015; DOI:10.1016/j.jana.2015.07.006 · 1.27 Impact Factor
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    • "Our findings are consistent with a recent meta-analysis of patients with various long-term medical conditions, showing that patients’ beliefs have an important influence on medication adherence [223]. Results are also consistent with previous studies showing that substance use, depressive symptoms, and HIV stigma are associated with lower levels of adherence, and trust or satisfaction with the healthcare provider are associated with higher levels of adherence [7,8,180,224]. These results should be encouraging to HIV care providers, as they suggest several avenues for intervention that could result in improved adherence. "
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    • "Negative social norms that are created and maintained at a community level, such as community stigma, are likely to influence the use of HIV services by individuals [3]. For example, poor adherence to HIV treatment tends to be high among patients who think HIV is highly stigmatized in their community [1,15]. Thus, one’s endorsement of community stigma would influence her behavior and attitudes regarding the use of VCT. "
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