Longitudinal association between internalized HIV stigma and antiretroviral therapy adherence for women living with HIV

the mediating role of depression

Bulent Turan, Whitney S. Rice, Kaylee B. Crockett, Mallory Johnson, Torsten B. Neilands, Shericia N. Ross, Mirjam Colette Kempf, Deborah Konkle-Parker, Gina Wingood, Phyllis C. Tien, Mardge Cohen, Tracey E. Wilson, Carmen H. Logie, Oluwakemi Sosanya, Michael Plankey, Elizabeth Golub, Adaora A. Adimora, Carrigan Parish, Sheri D. Weiser, Janet M. Turan

Research output: Contribution to journalArticle

Abstract

OBJECTIVE: We investigated whether internalized HIV-related stigma predicts adherence to antiretroviral therapy (ART) longitudinally in women living with HIV in the United States, and whether depression symptoms mediate the relationship between internalized stigma and suboptimal ART adherence. DESIGN: Observational longitudinal study utilizing data from the Women's Interagency HIV Study cohort. METHODS: A measure of internalized HIV-related stigma was added to the battery of Women's Interagency HIV Study measures in 2013. For current analyses, participants' first assessment of internalized HIV-related stigma and assessments of other variables at that time were used as baseline measures (Time one or T1, visit occurring in 2013/14), with outcomes measured approximately 2 years later (T3, 2015/16; n = 914). A measure of depression symptoms, assessed approximately 18 months after the baseline (T2, 2014/15), was used in mediation analyses (n = 862). RESULTS: Higher internalized HIV-related stigma at T1 predicted lower odds of optimal ART adherence at T3 (adjusted odds ratio = 0.61, P = 0.001, 95% confidence interval [0.45, 0.82]). Results were similar when ART adherence at T1 was added as a control variable. Mediation analysis revealed a significant indirect effect of internalized HIV stigma at T1 on ART adherence at T3 through depression symptoms at T2 (while controlling for depression symptoms and ART adherence at T1; B = -0.05, SE = 0.03, 95% confidence interval [-0.11, -0.006]). CONCLUSION: These results provide strong longitudinal support for the hypothesis that internalized HIV-related stigma results in suboptimal ART adherence in a large sample of women living with HIV in the United States, working through the pathway of increased depression symptoms.

Original languageEnglish (US)
Pages (from-to)571-576
Number of pages6
JournalAIDS (London, England)
Volume33
Issue number3
DOIs
StatePublished - Mar 1 2019

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HIV
Therapeutics
Confidence Intervals
Observational Studies
Longitudinal Studies
Cohort Studies
Odds Ratio

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology
  • Infectious Diseases

Cite this

Longitudinal association between internalized HIV stigma and antiretroviral therapy adherence for women living with HIV : the mediating role of depression. / Turan, Bulent; Rice, Whitney S.; Crockett, Kaylee B.; Johnson, Mallory; Neilands, Torsten B.; Ross, Shericia N.; Kempf, Mirjam Colette; Konkle-Parker, Deborah; Wingood, Gina; Tien, Phyllis C.; Cohen, Mardge; Wilson, Tracey E.; Logie, Carmen H.; Sosanya, Oluwakemi; Plankey, Michael; Golub, Elizabeth; Adimora, Adaora A.; Parish, Carrigan; Weiser, Sheri D.; Turan, Janet M.

In: AIDS (London, England), Vol. 33, No. 3, 01.03.2019, p. 571-576.

Research output: Contribution to journalArticle

Turan, B, Rice, WS, Crockett, KB, Johnson, M, Neilands, TB, Ross, SN, Kempf, MC, Konkle-Parker, D, Wingood, G, Tien, PC, Cohen, M, Wilson, TE, Logie, CH, Sosanya, O, Plankey, M, Golub, E, Adimora, AA, Parish, C, Weiser, SD & Turan, JM 2019, 'Longitudinal association between internalized HIV stigma and antiretroviral therapy adherence for women living with HIV: the mediating role of depression', AIDS (London, England), vol. 33, no. 3, pp. 571-576. https://doi.org/10.1097/QAD.0000000000002071
Turan, Bulent ; Rice, Whitney S. ; Crockett, Kaylee B. ; Johnson, Mallory ; Neilands, Torsten B. ; Ross, Shericia N. ; Kempf, Mirjam Colette ; Konkle-Parker, Deborah ; Wingood, Gina ; Tien, Phyllis C. ; Cohen, Mardge ; Wilson, Tracey E. ; Logie, Carmen H. ; Sosanya, Oluwakemi ; Plankey, Michael ; Golub, Elizabeth ; Adimora, Adaora A. ; Parish, Carrigan ; Weiser, Sheri D. ; Turan, Janet M. / Longitudinal association between internalized HIV stigma and antiretroviral therapy adherence for women living with HIV : the mediating role of depression. In: AIDS (London, England). 2019 ; Vol. 33, No. 3. pp. 571-576.
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abstract = "OBJECTIVE: We investigated whether internalized HIV-related stigma predicts adherence to antiretroviral therapy (ART) longitudinally in women living with HIV in the United States, and whether depression symptoms mediate the relationship between internalized stigma and suboptimal ART adherence. DESIGN: Observational longitudinal study utilizing data from the Women's Interagency HIV Study cohort. METHODS: A measure of internalized HIV-related stigma was added to the battery of Women's Interagency HIV Study measures in 2013. For current analyses, participants' first assessment of internalized HIV-related stigma and assessments of other variables at that time were used as baseline measures (Time one or T1, visit occurring in 2013/14), with outcomes measured approximately 2 years later (T3, 2015/16; n = 914). A measure of depression symptoms, assessed approximately 18 months after the baseline (T2, 2014/15), was used in mediation analyses (n = 862). RESULTS: Higher internalized HIV-related stigma at T1 predicted lower odds of optimal ART adherence at T3 (adjusted odds ratio = 0.61, P = 0.001, 95{\%} confidence interval [0.45, 0.82]). Results were similar when ART adherence at T1 was added as a control variable. Mediation analysis revealed a significant indirect effect of internalized HIV stigma at T1 on ART adherence at T3 through depression symptoms at T2 (while controlling for depression symptoms and ART adherence at T1; B = -0.05, SE = 0.03, 95{\%} confidence interval [-0.11, -0.006]). CONCLUSION: These results provide strong longitudinal support for the hypothesis that internalized HIV-related stigma results in suboptimal ART adherence in a large sample of women living with HIV in the United States, working through the pathway of increased depression symptoms.",
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T1 - Longitudinal association between internalized HIV stigma and antiretroviral therapy adherence for women living with HIV

T2 - the mediating role of depression

AU - Turan, Bulent

AU - Rice, Whitney S.

AU - Crockett, Kaylee B.

AU - Johnson, Mallory

AU - Neilands, Torsten B.

AU - Ross, Shericia N.

AU - Kempf, Mirjam Colette

AU - Konkle-Parker, Deborah

AU - Wingood, Gina

AU - Tien, Phyllis C.

AU - Cohen, Mardge

AU - Wilson, Tracey E.

AU - Logie, Carmen H.

AU - Sosanya, Oluwakemi

AU - Plankey, Michael

AU - Golub, Elizabeth

AU - Adimora, Adaora A.

AU - Parish, Carrigan

AU - Weiser, Sheri D.

AU - Turan, Janet M.

PY - 2019/3/1

Y1 - 2019/3/1

N2 - OBJECTIVE: We investigated whether internalized HIV-related stigma predicts adherence to antiretroviral therapy (ART) longitudinally in women living with HIV in the United States, and whether depression symptoms mediate the relationship between internalized stigma and suboptimal ART adherence. DESIGN: Observational longitudinal study utilizing data from the Women's Interagency HIV Study cohort. METHODS: A measure of internalized HIV-related stigma was added to the battery of Women's Interagency HIV Study measures in 2013. For current analyses, participants' first assessment of internalized HIV-related stigma and assessments of other variables at that time were used as baseline measures (Time one or T1, visit occurring in 2013/14), with outcomes measured approximately 2 years later (T3, 2015/16; n = 914). A measure of depression symptoms, assessed approximately 18 months after the baseline (T2, 2014/15), was used in mediation analyses (n = 862). RESULTS: Higher internalized HIV-related stigma at T1 predicted lower odds of optimal ART adherence at T3 (adjusted odds ratio = 0.61, P = 0.001, 95% confidence interval [0.45, 0.82]). Results were similar when ART adherence at T1 was added as a control variable. Mediation analysis revealed a significant indirect effect of internalized HIV stigma at T1 on ART adherence at T3 through depression symptoms at T2 (while controlling for depression symptoms and ART adherence at T1; B = -0.05, SE = 0.03, 95% confidence interval [-0.11, -0.006]). CONCLUSION: These results provide strong longitudinal support for the hypothesis that internalized HIV-related stigma results in suboptimal ART adherence in a large sample of women living with HIV in the United States, working through the pathway of increased depression symptoms.

AB - OBJECTIVE: We investigated whether internalized HIV-related stigma predicts adherence to antiretroviral therapy (ART) longitudinally in women living with HIV in the United States, and whether depression symptoms mediate the relationship between internalized stigma and suboptimal ART adherence. DESIGN: Observational longitudinal study utilizing data from the Women's Interagency HIV Study cohort. METHODS: A measure of internalized HIV-related stigma was added to the battery of Women's Interagency HIV Study measures in 2013. For current analyses, participants' first assessment of internalized HIV-related stigma and assessments of other variables at that time were used as baseline measures (Time one or T1, visit occurring in 2013/14), with outcomes measured approximately 2 years later (T3, 2015/16; n = 914). A measure of depression symptoms, assessed approximately 18 months after the baseline (T2, 2014/15), was used in mediation analyses (n = 862). RESULTS: Higher internalized HIV-related stigma at T1 predicted lower odds of optimal ART adherence at T3 (adjusted odds ratio = 0.61, P = 0.001, 95% confidence interval [0.45, 0.82]). Results were similar when ART adherence at T1 was added as a control variable. Mediation analysis revealed a significant indirect effect of internalized HIV stigma at T1 on ART adherence at T3 through depression symptoms at T2 (while controlling for depression symptoms and ART adherence at T1; B = -0.05, SE = 0.03, 95% confidence interval [-0.11, -0.006]). CONCLUSION: These results provide strong longitudinal support for the hypothesis that internalized HIV-related stigma results in suboptimal ART adherence in a large sample of women living with HIV in the United States, working through the pathway of increased depression symptoms.

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