Internalized HIV Stigma Is Associated With Concurrent Viremia and Poor Retention in a Cohort of US Patients in HIV Care

Katerina A. Christopoulos, Torsten B. Neilands, Wendy Hartogensis, Elvin H. Geng, John Sauceda, Michael J. Mugavero, Heidi M. Crane, Rob J. Fredericksen, Richard D Moore, William Christopher Mathews, Kenneth H. Mayer, Geetanjali Chander, Christopher B. Hurt, Mallory O. Johnson

Research output: Contribution to journalArticle

Abstract

BACKGROUND: The relationship of internalized HIV stigma to key care cascade metrics in the United States is not well established using large-scale, geographically diverse data. SETTING: Center for AIDS Research Network of Integrated Clinical Systems (CNICS) cohort study. METHODS: Beginning in February 2016, we administered a yearly, validated 4-item internalized HIV stigma scale (response scale 1 = strongly disagree to 5 = strongly agree, Cronbach's alpha 0.91) at 7 CNICS sites and obtained cohort data through November 2017. We compared mean stigma levels by sociodemographic characteristics and used multivariable logistic regression, controlling for the same sociodemographic covariates, to evaluate the association between mean stigma and (1) concurrent viremia; (2) missed visits; and (3) poor visit constancy. We used inverse probability weighting (IPW) to account for differences between patients who did and did not undergo stigma assessment. RESULTS: Of 13,183 CNICS patients, 6448 (49%) underwent stigma assessment. Mean stigma was 1.99 (SD 1.07), and 28.6% agreed/strongly agreed with at least 1 stigma question. Patients younger than 50 years, racial/ethnic minorities, cis-women, and heterosexuals had higher mean stigma. Mean stigma score was associated with concurrent viremia [adjusted odds ratio (AOR) 1.13, 95% confidence interval (CI): 1.02 to 1.25, P 0.02], missed visits (AOR 1.10, 95% CI: 1.02 to 1.19, P 0.01), and poor visit constancy, although the effect on visit constancy was attenuated in the IPW model (AOR 1.05, 95% CI: 0.98 to 1.13, P 0.17). CONCLUSIONS: Higher internalized HIV stigma had a modest but statistically significant association with concurrent viremia and poor retention in care. Further inquiry with prospective analyses is warranted.

Original languageEnglish (US)
Pages (from-to)116-123
Number of pages8
JournalJournal of acquired immune deficiency syndromes (1999)
Volume82
Issue number2
DOIs
StatePublished - Oct 1 2019

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Viremia
Odds Ratio
HIV
Confidence Intervals
Heterosexuality
Acquired Immunodeficiency Syndrome
Cohort Studies
Logistic Models
Research

ASJC Scopus subject areas

  • Infectious Diseases
  • Pharmacology (medical)

Cite this

Christopoulos, K. A., Neilands, T. B., Hartogensis, W., Geng, E. H., Sauceda, J., Mugavero, M. J., ... Johnson, M. O. (2019). Internalized HIV Stigma Is Associated With Concurrent Viremia and Poor Retention in a Cohort of US Patients in HIV Care. Journal of acquired immune deficiency syndromes (1999), 82(2), 116-123. https://doi.org/10.1097/QAI.0000000000002117

Internalized HIV Stigma Is Associated With Concurrent Viremia and Poor Retention in a Cohort of US Patients in HIV Care. / Christopoulos, Katerina A.; Neilands, Torsten B.; Hartogensis, Wendy; Geng, Elvin H.; Sauceda, John; Mugavero, Michael J.; Crane, Heidi M.; Fredericksen, Rob J.; Moore, Richard D; Mathews, William Christopher; Mayer, Kenneth H.; Chander, Geetanjali; Hurt, Christopher B.; Johnson, Mallory O.

In: Journal of acquired immune deficiency syndromes (1999), Vol. 82, No. 2, 01.10.2019, p. 116-123.

Research output: Contribution to journalArticle

Christopoulos, KA, Neilands, TB, Hartogensis, W, Geng, EH, Sauceda, J, Mugavero, MJ, Crane, HM, Fredericksen, RJ, Moore, RD, Mathews, WC, Mayer, KH, Chander, G, Hurt, CB & Johnson, MO 2019, 'Internalized HIV Stigma Is Associated With Concurrent Viremia and Poor Retention in a Cohort of US Patients in HIV Care', Journal of acquired immune deficiency syndromes (1999), vol. 82, no. 2, pp. 116-123. https://doi.org/10.1097/QAI.0000000000002117
Christopoulos, Katerina A. ; Neilands, Torsten B. ; Hartogensis, Wendy ; Geng, Elvin H. ; Sauceda, John ; Mugavero, Michael J. ; Crane, Heidi M. ; Fredericksen, Rob J. ; Moore, Richard D ; Mathews, William Christopher ; Mayer, Kenneth H. ; Chander, Geetanjali ; Hurt, Christopher B. ; Johnson, Mallory O. / Internalized HIV Stigma Is Associated With Concurrent Viremia and Poor Retention in a Cohort of US Patients in HIV Care. In: Journal of acquired immune deficiency syndromes (1999). 2019 ; Vol. 82, No. 2. pp. 116-123.
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abstract = "BACKGROUND: The relationship of internalized HIV stigma to key care cascade metrics in the United States is not well established using large-scale, geographically diverse data. SETTING: Center for AIDS Research Network of Integrated Clinical Systems (CNICS) cohort study. METHODS: Beginning in February 2016, we administered a yearly, validated 4-item internalized HIV stigma scale (response scale 1 = strongly disagree to 5 = strongly agree, Cronbach's alpha 0.91) at 7 CNICS sites and obtained cohort data through November 2017. We compared mean stigma levels by sociodemographic characteristics and used multivariable logistic regression, controlling for the same sociodemographic covariates, to evaluate the association between mean stigma and (1) concurrent viremia; (2) missed visits; and (3) poor visit constancy. We used inverse probability weighting (IPW) to account for differences between patients who did and did not undergo stigma assessment. RESULTS: Of 13,183 CNICS patients, 6448 (49{\%}) underwent stigma assessment. Mean stigma was 1.99 (SD 1.07), and 28.6{\%} agreed/strongly agreed with at least 1 stigma question. Patients younger than 50 years, racial/ethnic minorities, cis-women, and heterosexuals had higher mean stigma. Mean stigma score was associated with concurrent viremia [adjusted odds ratio (AOR) 1.13, 95{\%} confidence interval (CI): 1.02 to 1.25, P 0.02], missed visits (AOR 1.10, 95{\%} CI: 1.02 to 1.19, P 0.01), and poor visit constancy, although the effect on visit constancy was attenuated in the IPW model (AOR 1.05, 95{\%} CI: 0.98 to 1.13, P 0.17). CONCLUSIONS: Higher internalized HIV stigma had a modest but statistically significant association with concurrent viremia and poor retention in care. Further inquiry with prospective analyses is warranted.",
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AU - Christopoulos, Katerina A.

AU - Neilands, Torsten B.

AU - Hartogensis, Wendy

AU - Geng, Elvin H.

AU - Sauceda, John

AU - Mugavero, Michael J.

AU - Crane, Heidi M.

AU - Fredericksen, Rob J.

AU - Moore, Richard D

AU - Mathews, William Christopher

AU - Mayer, Kenneth H.

AU - Chander, Geetanjali

AU - Hurt, Christopher B.

AU - Johnson, Mallory O.

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N2 - BACKGROUND: The relationship of internalized HIV stigma to key care cascade metrics in the United States is not well established using large-scale, geographically diverse data. SETTING: Center for AIDS Research Network of Integrated Clinical Systems (CNICS) cohort study. METHODS: Beginning in February 2016, we administered a yearly, validated 4-item internalized HIV stigma scale (response scale 1 = strongly disagree to 5 = strongly agree, Cronbach's alpha 0.91) at 7 CNICS sites and obtained cohort data through November 2017. We compared mean stigma levels by sociodemographic characteristics and used multivariable logistic regression, controlling for the same sociodemographic covariates, to evaluate the association between mean stigma and (1) concurrent viremia; (2) missed visits; and (3) poor visit constancy. We used inverse probability weighting (IPW) to account for differences between patients who did and did not undergo stigma assessment. RESULTS: Of 13,183 CNICS patients, 6448 (49%) underwent stigma assessment. Mean stigma was 1.99 (SD 1.07), and 28.6% agreed/strongly agreed with at least 1 stigma question. Patients younger than 50 years, racial/ethnic minorities, cis-women, and heterosexuals had higher mean stigma. Mean stigma score was associated with concurrent viremia [adjusted odds ratio (AOR) 1.13, 95% confidence interval (CI): 1.02 to 1.25, P 0.02], missed visits (AOR 1.10, 95% CI: 1.02 to 1.19, P 0.01), and poor visit constancy, although the effect on visit constancy was attenuated in the IPW model (AOR 1.05, 95% CI: 0.98 to 1.13, P 0.17). CONCLUSIONS: Higher internalized HIV stigma had a modest but statistically significant association with concurrent viremia and poor retention in care. Further inquiry with prospective analyses is warranted.

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