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
  • Source
    • "Estimation was limited to HIV-positive women enrolled in a long-term HIV cohort. Given the myriad ways in which HIV stigma undermines treatment uptake747576, it is likely that theirs was a fairly unique population that had overcome substantial barriers to remain engaged in care[77,78]. (In contrast, in our sample, less than twothirds of the HIV-positive women had re-engaged in HIV care following childbirth[68].) "
    [Show abstract] [Hide abstract]
    ABSTRACT: Violence against women by intimate partners remains unacceptably common worldwide. The evidence base for the assumed psychological impacts of intimate partner violence (IPV) is derived primarily from studies conducted in high-income countries. A recently published systematic review identified 13 studies linking IPV to incident depression, none of which were conducted in sub-Saharan Africa. To address this gap in the literature, we analyzed longitudinal data collected during the course of a 3-y cluster-randomized trial with the aim of estimating the association between IPV and depression symptom severity.
    Full-text · Article · Jan 2016 · PLoS Medicine
  • Source
    • "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"
    [Show abstract] [Hide abstract]
    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.
    Full-text · Article · Jul 2015 · The Journal of the Association of Nurses in AIDS Care: JANAC
  • Source
    • "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. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Adherence to combination antiretroviral therapy (ART) is a key predictor of the success of human immunodeficiency virus (HIV) treatment, and is potentially amenable to intervention. Insight into predictors or correlates of non-adherence to ART may help guide targets for the development of adherence-enhancing interventions. Our objective was to review evidence on predictors/correlates of adherence to ART, and to aggregate findings into quantitative estimates of their impact on adherence. We searched PubMed for original English-language papers, published between 1996 and June 2014, and the reference lists of all relevant articles found. Studies reporting on predictors/correlates of adherence of adults prescribed ART for chronic HIV infection were included without restriction to adherence assessment method, study design or geographical location. Two researchers independently extracted the data from the same papers. Random effects models with inverse variance weights were used to aggregate findings into pooled effects estimates with 95% confidence intervals. The standardized mean difference (SMD) was used as the common effect size. The impact of study design features (adherence assessment method, study design, and the United Nations Human Development Index (HDI) of the country in which the study was set) was investigated using categorical mixed effects meta-regression. In total, 207 studies were included. The following predictors/correlates were most strongly associated with adherence: adherence self-efficacy (SMD = 0.603, P = 0.001), current substance use (SMD = −0.395, P = 0.001), concerns about ART (SMD = −0.388, P = 0.001), beliefs about the necessity/utility of ART (SMD = 0.357, P = 0.001), trust/satisfaction with the HIV care provider (SMD = 0.377, P = 0.001), depressive symptoms (SMD = −0.305, P = 0.001), stigma about HIV (SMD = −0.282, P = 0.001), and social support (SMD = 0.237, P = 0.001). Smaller but significant associations were observed for the following being prescribed a protease inhibitor-containing regimen (SMD = −0.196, P = 0.001), daily dosing frequency (SMD = −0.193, P = 0.001), financial constraints (SMD −0.187, P = 0.001) and pill burden (SMD = −0.124, P = 0.001). Higher trust/satisfaction with the HIV care provider, a lower daily dosing frequency, and fewer depressive symptoms were more strongly related with higher adherence in low and medium HDI countries than in high HDI countries. These findings suggest that adherence-enhancing interventions should particularly target psychological factors such as self-efficacy and concerns/beliefs about the efficacy and safety of ART. Moreover, these findings suggest that simplification of regimens might have smaller but significant effects.
    Full-text · Article · Aug 2014 · BMC Medicine
Show more