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101. Global Action to reduce HIV stigma and discrimination

Author

Stangl, Anne L, Grossman, Cynthia I, Sidibé, Michel, Goosby, Eric P, Katz, Ingrid T, Ryu, Annemarie E, Onuegbu, Afiachukwu G, Psaros, Christina, Weiser, Sheri D, Bangsberg, David R, Tsai, Alexander C, Lloyd, Jennifer K, Brady, Laura M, Holland, Claire E, Baral, Stefan, Mburu, Gitau, Ram, Mala, Skovdal, Morten, Bitira, David, Hodgson, Ian, Mwai, Grace W, Stegling, Christine, Seeley, Janet, Jain, Aparna, Nuankaew, Ratana, Mongkholwiboolphol, Nungruthai, Banpabuth, Arunee, Tuvinun, Rachada, Ayuthaya, Pakprim Oranop na, Richter, Kerry, Li, Li, Lin, Chunqing, Guan, Jihui, Wu, Zunyou, Varas-Díaz, Nelson, Neilands, Torsten B, Cintrón-Bou, Francheska, Marzán-Rodríguez, Melissa, Santos-Figueroa, Axel, Santiago-Negrón, Salvador, Marques, Domingo, Rodríguez-Madera, Sheilla, Nyblade, Laura, Benkirane, Manal, Lohiniva, Anna-Leena, McLean, Roger, Turan, Janet M, Kwena, Zachary, Thomas, Wendell, Gruskin, Sofia, Safreed-Harmon, Kelly, Ezer, Tamar, Gathumbi, Anne, Cohen, Jonathan, Kameri-Mbote, Patricia, Ekstrand, Maria L, Ramakrishna, Jayashree, Bharat, Shalini, Heylen, Elsa, Berkley-Patton, Jannette Y, Moore, Erin, Berman, Marcie, Simon, Stephen D, Thompson, Carole Bowe, Schleicher, Thomas, Hawes, Starlyn M, Christensen, John L, Miller, Lynn Carol, Appleby, Paul Robert, Corsbie-Massay, Charisse, Godoy, Carlos Gustavo, Marsella, Stacy C, Read, Stephen J, Risher, Kathryn, Adams, Darrin, Sithole, Bhekie, Ketende, Sosthenes, Kennedy, Caitlin, Mnisi, Zandile, Mabusa, Xolile, Baral, Stefan D, Lim, Travis, Zelaya, Carla, Latkin, Carl, Quan, Vu Minh, Frangakis, Constantine, Ha, Tran Viet, Le Minh, Nguyen, and Go, Vivian

Subjects
Clinical Sciences, Public Health and Health Services, Other Medical and Health Sciences
Published
2013

102. Global Action to reduce HIV stigma and discrimination

Author

Sidibé, Michel, Goosby, Eric P, Grossman, Cynthia I, Stangl, Anne L, Katz, Ingrid T, Ryu, Annemarie E, Onuegbu, Afiachukwu G, Psaros, Christina, Weiser, Sheri D, Bangsberg, David R, Tsai, Alexander C, Lloyd, Jennifer K, Brady, Laura M, Holland, Claire E, Baral, Stefan, Mburu, Gitau, Ram, Mala, Skovdal, Morten, Bitira, David, Hodgson, Ian, Mwai, Grace W, Stegling, Christine, Seeley, Janet, Jain, Aparna, Nuankaew, Ratana, Mongkholwiboolphol, Nungruthai, Banpabuth, Arunee, Tuvinun, Rachada, Ayuthaya, Pakprim Oranop na, Richter, Kerry, Li, Li, Lin, Chunqing, Guan, Jihui, Wu, Zunyou, Varas‐Díaz, Nelson, Neilands, Torsten B, Cintrón‐Bou, Francheska, Marzán‐Rodríguez, Melissa, Santos‐Figueroa, Axel, Santiago‐Negrón, Salvador, Marques, Domingo, Rodríguez‐Madera, Sheilla, Nyblade, Laura, Benkirane, Manal, Lohiniva, Anna‐Leena, McLean, Roger, Turan, Janet M, Kwena, Zachary, Thomas, Wendell, Gruskin, Sofia, Safreed‐Harmon, Kelly, Ezer, Tamar, Gathumbi, Anne, Cohen, Jonathan, Kameri‐Mbote, Patricia, Ekstrand, Maria L, Ramakrishna, Jayashree, Bharat, Shalini, Heylen, Elsa, Berkley‐Patton, Jannette Y, Moore, Erin, Berman, Marcie, Simon, Stephen D, Thompson, Carole Bowe, Schleicher, Thomas, Hawes, Starlyn M, Christensen, John L, Miller, Lynn Carol, Appleby, Paul Robert, Corsbie‐Massay, Charisse, Godoy, Carlos Gustavo, Marsella, Stacy C, Read, Stephen J, Risher, Kathryn, Adams, Darrin, Sithole, Bhekie, Ketende, Sosthenes, Kennedy, Caitlin, Mnisi, Zandile, Mabusa, Xolile, Baral, Stefan D, Lim, Travis, Zelaya, Carla, Latkin, Carl, Quan, Vu Minh, Frangakis, Constantine, Ha, Tran Viet, Le Minh, Nguyen, and Go, Vivian

Subjects
Health Services and Systems, Public Health, Health Sciences, Mental Health, Pediatric, HIV/AIDS, Pediatric AIDS, Prevention, Basic Behavioral and Social Science, Behavioral and Social Science, Health Services, Clinical Research, Substance Misuse, Infectious Diseases, Drug Abuse (NIDA only), Mind and Body, Prevention of disease and conditions, and promotion of well-being, 3.1 Primary prevention interventions to modify behaviours or promote wellbeing, Management of diseases and conditions, 7.1 Individual care needs, Infection, Good Health and Well Being, Reduced Inequalities, Clinical Sciences, Public Health and Health Services, Other Medical and Health Sciences, Clinical sciences, Epidemiology, Public health
Published
2013

107. The Study of HIV and Antenatal Care Integration in Pregnancy in Kenya: Design, Methods, and Baseline Results of a Cluster-Randomized Controlled Trial

Author

Turan, Janet M, Steinfeld, Rachel L, Onono, Maricianah, Bukusi, Elizabeth A, Woods, Meghan, Shade, Starley B, Washington, Sierra, Marima, Reson, Penner, Jeremy, Ackers, Marta L, Mbori-Ngacha, Dorothy, and Cohen, Craig R

Subjects
Biomedical and Clinical Sciences, Public Health, Health Sciences, Human Society, Social Work, Pediatric AIDS, HIV/AIDS, Behavioral and Social Science, Health Services, Clinical Trials and Supportive Activities, Perinatal Period - Conditions Originating in Perinatal Period, Clinical Research, Women's Health, Infectious Diseases, Pregnancy, Pediatric, Sexually Transmitted Infections, Prevention, Maternal Health, 6.1 Pharmaceuticals, Evaluation of treatments and therapeutic interventions, Infection, Reproductive health and childbirth, Good Health and Well Being, Adult, Cluster Analysis, Female, Geography, HIV Infections, Health Plan Implementation, Humans, Kenya, Male, Prenatal Care, Research Design, General Science & Technology
Abstract

BackgroundDespite strong evidence for the effectiveness of anti-retroviral therapy for improving the health of women living with HIV and for the prevention of mother-to-child transmission (PMTCT), HIV persists as a major maternal and child health problem in sub-Saharan Africa. In most settings antenatal care (ANC) services and HIV treatment services are offered in separate clinics. Integrating these services may result in better uptake of services, reduction of the time to treatment initiation, better adherence, and reduction of stigma.Methodology/principal findingsA prospective cluster randomized controlled trial design was used to evaluate the effects of integrating HIV treatment into ANC clinics at government health facilities in rural Kenya. Twelve facilities were randomized to provide either fully integrated services (ANC, PMTCT, and HIV treatment services all delivered in the ANC clinic) or non-integrated services (ANC clinics provided ANC and basic PMTCT services and referred clients to a separate HIV clinic for HIV treatment). During June 2009- March 2011, 1,172 HIV-positive pregnant women were enrolled in the study. The main study outcomes are rates of maternal enrollment in HIV care and treatment, infant HIV testing uptake, and HIV-free infant survival. Baseline results revealed that the intervention and control cohorts were similar with respect to socio-demographics, male partner HIV testing, sero-discordance of the couple, obstetric history, baseline CD4 count, and WHO Stage. Challenges faced while conducting this trial at low-resource rural health facilities included frequent staff turnover, stock-outs of essential supplies, transportation challenges, and changes in national guidelines.Conclusions/significanceThis is the first randomized trial of ANC and HIV service integration to be conducted in rural Africa. It is expected that the study will provide critical evidence regarding the implementation and effectiveness of this service delivery strategy, with important implications for programs striving to eliminate vertical transmission of HIV and improve maternal health.Trial registrationClinicalTrials.gov NCT00931216 http://clinicaltrials.gov/ct2/show/NCT00931216.

Published
2012

108. Nonatonic Obstetric Haemorrhage: Effectiveness of the Nonpneumatic Antishock Garment in Egypt

Author

Fathalla, Mohamed MF, Youssif, Mohammed Mourad, Meyer, Carinne, Camlin, Carol, Turan, Janet, Morris, Jessica, Butrick, Elizabeth, and Miller, Suellen

Subjects
Reproductive Medicine, Biomedical and Clinical Sciences, Health Sciences, Clinical Research, Clinical Trials and Supportive Activities, Reproductive health and childbirth, Good Health and Well Being
Abstract

The study aims to determine if the nonpneumatic antishock garment (NASG), a first aid compression device, decreases severe adverse outcomes from nonatonic obstetric haemorrhage. Women with nonatonic aetiologies (434), blood loss > 1000 mL, and signs of shock were eligible. Women received standard care during the preintervention phase (226) and standard care plus application of the garment in the NASG phase (208). Blood loss and extreme adverse outcomes (EAO-mortality and severe morbidity) were measured. Women who used the NASG had more estimated blood loss on admission. Mean measured blood loss was 370 mL in the preintervention phase and 258 mL in the NASG phase (P < 0.0001). EAO decreased with use of the garment (2.9% versus 4.4%, (OR 0.65, 95% CI 0.24-1.76)). In conclusion, using the NASG improved maternal outcomes despite the worse condition on study entry. These findings should be tested in larger studies.

Published
2011

109. HIV/AIDS Stigma and Refusal of HIV Testing Among Pregnant Women in Rural Kenya: Results from the MAMAS Study

Author

Turan, Janet M, Bukusi, Elizabeth A, Onono, Maricianah, Holzemer, William L, Miller, Suellen, and Cohen, Craig R

Subjects
Public Health, Health Sciences, Sexually Transmitted Infections, Mental Health, Women's Health, Infectious Diseases, HIV/AIDS, Prevention, Clinical Research, Behavioral and Social Science, Infection, Gender Equality, AIDS Serodiagnosis, Adolescent, Adult, Cross-Sectional Studies, Female, HIV Infections, Health Knowledge, Attitudes, Practice, Humans, Infectious Disease Transmission, Vertical, Kenya, Patient Acceptance of Health Care, Pregnancy, Pregnancy Complications, Infectious, Prenatal Care, Risk Factors, Rural Population, Socioeconomic Factors, Stereotyping, Young Adult, Stigma, Intimate partner violence, Public Health and Health Services, Social Work, Public health
Abstract

HIV/AIDS stigma is a common thread in the narratives of pregnant women affected by HIV/AIDS globally and may be associated with refusal of HIV testing. We conducted a cross-sectional study of women attending antenatal clinics in Kenya (N = 1525). Women completed an interview with measures of HIV/AIDS stigma and subsequently information on their acceptance of HIV testing was obtained from medical records. Associations of stigma measures with HIV testing refusal were examined using multivariate logistic regression. Rates of anticipated HIV/AIDS stigma were high-32% anticipated break-up of their relationship, and 45% anticipated losing their friends. Women who anticipated male partner stigma were more than twice as likely to refuse HIV testing, after adjusting for other individual-level predictors (OR = 2.10, 95% CI: 1.15-3.85). This study demonstrated quantitatively that anticipations of HIV/AIDS stigma can be barriers to acceptance of HIV testing by pregnant women and highlights the need to develop interventions that address pregnant women's fears of HIV/AIDS stigma and violence from male partners.

Published
2011

110. Obstetric Hemorrhage and Shock Management: Using the Low Technology Non-pneumatic Anti-Shock Garment in Nigerian and Egyptian Tertiary Care Facilities

Author

Miller, Suellen, Fathalla, Mohamed MF, Ojengbede, Oladosu A, Camlin, Carol, Mourad-Youssif, Mohammed, Morhason-Bello, Imran O, Galadanci, Hadiza, Nsima, David, Butrick, Elizabeth, al Hussaini, Tarek, Turan, Janet, Meyer, Carinne, Martin, Hilarie, and Mohammed, Aminu I

Abstract

Abstract Background Obstetric hemorrhage is the leading cause of maternal mortality globally. The Non-pneumatic Anti-Shock Garment (NASG) is a low-technology, first-aid compression device which, when added to standard hypovolemic shock protocols, may improve outcomes for women with hypovolemic shock secondary to obstetric hemorrhage in tertiary facilities in low-resource settings. Methods This study employed a pre-intervention/intervention design in four facilities in Nigeria and two in Egypt. Primary outcomes were measured mean and median blood loss, severe end-organ failure morbidity (renal failure, pulmonary failure, cardiac failure, or CNS dysfunctions), mortality, and emergency hysterectomy for 1442 women with ≥750 mL blood loss and at least one sign of hemodynamic instability. Comparisons of outcomes by study phase were assessed with rank sum tests, relative risks (RR), number needed to treat for benefit (NNTb), and multiple logistic regression. Results Women in the NASG phase (n = 835) were in worse condition on study entry, 38.5% with mean arterial pressure

Published
2010

129. The role of social support on cognitive function among midlife and older adult MSM

Author

Henderson, Emmett R., primary, Haberlen, Sabina A., additional, Coulter, Robert W.S., additional, Weinstein, Andrea M., additional, Meanley, Steven, additional, Brennan-Ing, Mark, additional, Mimiaga, Matthew J., additional, Turan, Janet M., additional, Turan, Bulent, additional, Teplin, Linda A., additional, Egan, James E., additional, Plankey, Michael W., additional, and Friedman, M. Reuel, additional

Published
2022
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133. HIV-related stigma, couple relationship quality, and mental health among HIV-status discordant couples in Kenya

Author

Turan, Janet, Buyukcan-Tetik, Asuman, Turan, Bulent, Darbes, Lynae, Kwena, Zachary, and Owuor, Kevin

Subjects
Medicine and Health Sciences, Social and Behavioral Sciences
Abstract

This analysis will examine how couple relationship quality moderates the effects of HIV-related stigma on mental health in HIV-status discordant married couples in Kenya.

Published
2022
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134. T-cell activation state differentially contributes to neuropsychiatric complications in women with HIV

Author

Williams, Dionna W., primary, Flores, Bianca R., additional, Xu, Yanxun, additional, Wang, Yuezhe, additional, Yu, Danyang, additional, Peters, Brandilyn A., additional, Adedimeji, Adebola, additional, Wilson, Tracey E., additional, Merenstein, Daniel, additional, Tien, Phyllis C., additional, Cohen, Mardge H., additional, Weber, Kathleen M., additional, Adimora, Adaora A., additional, Ofotokun, Igho, additional, Fischl, Margaret, additional, Turan, Janet, additional, Turan, Bülent, additional, Laumet, Geoffroy, additional, Landay, Alan L., additional, Dastgheyb, Raha M., additional, Gange, Stephen J., additional, Weiser, Sheri D., additional, and Rubin, Leah H., additional

Published
2022
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135. Recent Stressful Life Events, Lifetime Traumatic Events, Missed Visits, and Antiretroviral Adherence Among Black Women With HIV in the Southeastern United States: A Cross-sectional Study

Author

Chapman Lambert, Crystal, primary, Wright, Nicole C., additional, Elopre, Latesha, additional, Fazeli, Pariya, additional, King, Kiko, additional, Raper, James L., additional, Holstad, Marcia M., additional, Azuero, Andres, additional, Turan, Janet M., additional, and Mugavero, Michael J., additional

Published
2022
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136. Impact of harm reduction care in HIV clinical settings on stigma and health outcomes for people with HIV who use drugs: study protocol for a mixed-methods, multisite, observational study

Author

Kay, Emma Sophia, primary, Creasy, Stephanie, additional, Batey, D Scott, additional, Coulter, Robert, additional, Egan, James E, additional, Fisk, Stuart, additional, Friedman, Mackey Reuel, additional, Kinsky, Suzanne, additional, Krier, Sarah, additional, Noble, Victor, additional, Turan, Bulent, additional, Turan, Janet M, additional, Yu, Lan, additional, and Hawk, Mary, additional

Published
2022
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141. Intersectional stigmas are associated with lower viral suppression rates and antiretroviral therapy adherence among women living with HIV

Author

Norcini Pala, Andrea, primary, Kempf, Mirjam-Colette, additional, Konkle-Parker, Deborah, additional, Wilson, Tracey E., additional, Tien, Phyllis C., additional, Wingood, Gina, additional, Neilands, Torsten B., additional, Johnson, Mallory O., additional, Weiser, Sheri D., additional, Logie, Carmen H., additional, Turan, Janet M., additional, and Turan, Bulent, additional

Published
2022
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142. Adapting a Motivational Interviewing Intervention to Improve HIV Prevention Among Young, Black, Sexual Minority Men in Alabama: Protocol for the Development of the Kings Digital Health Intervention

Author

Budhwani, Henna, primary, Kiszla, B Matthew, additional, Outlaw, Angulique Y, additional, Oster, Robert A, additional, Mugavero, Michael J, additional, Johnson, Mallory O, additional, Hightow-Weidman, Lisa B, additional, Naar, Sylvie, additional, and Turan, Janet M, additional

Published
2022
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144. Biopsychosocial Health Outcomes and Experienced Intersectional Stigma in a Mixed HIV Serostatus Longitudinal Cohort of Aging Sexual Minority Men, United States, 2008‒2019

Author

Friedman, M. Reuel, primary, Liu, Qimin, additional, Meanley, Steven, additional, Haberlen, Sabina A., additional, Brown, Andre L., additional, Turan, Bulent, additional, Turan, Janet M., additional, Brennan-Ing, Mark, additional, Stosor, Valentina, additional, Mimiaga, Matthew J., additional, Ware, Deanna, additional, Egan, James E., additional, and Plankey, Michael W., additional

Published
2022
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148. Internalized HIV-Related Stigma and Neurocognitive Functioning Among Women Living with HIV.

Author

Thompson, Emma, Thompson, Emma, Muhammad, Josh, Adimora, Adoara, Chandran, Aruna, Cohen, Mardge, Crockett, Kaylee, Goparaju, Lakshmi, Henderson, Emmett, Kempf, Mirjam-Colette, Konkle-Parker, Deborah, Kwait, Jennafer, Ofotokun, Igho, Rubin, Leah, Sharma, Anjala, Teplin, Linda, Vance, David, Weiss, Deborah, Wilson, Tracey, Turan, Janet, Turan, Bulent, Weiser, Sheri, Mimiaga, Matthew, Thompson, Emma, Thompson, Emma, Muhammad, Josh, Adimora, Adoara, Chandran, Aruna, Cohen, Mardge, Crockett, Kaylee, Goparaju, Lakshmi, Henderson, Emmett, Kempf, Mirjam-Colette, Konkle-Parker, Deborah, Kwait, Jennafer, Ofotokun, Igho, Rubin, Leah, Sharma, Anjala, Teplin, Linda, Vance, David, Weiss, Deborah, Wilson, Tracey, Turan, Janet, Turan, Bulent, Weiser, Sheri, and Mimiaga, Matthew

Abstract

The prevalence of HIV-associated neurocognitive impairment persists despite highly effective antiretroviral therapy (ART). In this study we explore the role of internalized stigma, acceptance of negative societal characterizations, and perceptions about people living with HIV (PLWH) on neurocognitive functioning (executive function, learning, memory, attention/working memory, psychomotor speed, fluency, motor skills) in a national cohort of women living with HIV (WLWH) in the United States. We utilized observational data from a multicenter study of WLWH who are mostly African American living in low-resource settings. Neurocognitive function was measured using an eight-test battery. A multiple linear regression model was constructed to investigate the relationship between internalized stigma and overall neurocognitive functioning (mean of all neurocognitive domain standardized T-scores), adjusting for age, education, race, previous neuropsychological battery scores, illicit drug use, viral load, and years on ART. Our analysis revealed that internalized HIV-related stigma is significantly associated with worse performance on individual domain tests and overall neurocognitive performance (B = 0.27, t = 2.50, p = 0.01). This suggests HIV-related internalized stigma may be negatively associated with neurocognitive functioning for WLWH. This finding highlights a specific psychosocial factor associated with poor neurocognitive function that may be targeted to better promote the health of PLWH. Future research on the longitudinal relationship between these variables and the effects of other stigma dimensions on poor neurocognitive function would provide further insights into the pathways explaining the relationship between internalized stigma and neurocognition.

Published
2022

149. Intersectional stigmas are associated with lower viral suppression rates and antiretroviral therapy adherence among women living with HIV.

Author

Norcini Pala, Andrea, Norcini Pala, Andrea, Kempf, Mirjam-Colette, Konkle-Parker, Deborah, Wilson, Tracey, Tien, Phyllis, Wingood, Gina, Neilands, Torsten, Logie, Carmen, Turan, Janet, Turan, Bulent, Johnson, Mallory, Weiser, Sheri, Norcini Pala, Andrea, Norcini Pala, Andrea, Kempf, Mirjam-Colette, Konkle-Parker, Deborah, Wilson, Tracey, Tien, Phyllis, Wingood, Gina, Neilands, Torsten, Logie, Carmen, Turan, Janet, Turan, Bulent, Johnson, Mallory, and Weiser, Sheri

Abstract

OBJECTIVES: To explore the associations between intersectional poverty, HIV, sex, and racial stigma, adherence to antiretroviral therapy (ART), and viral suppression among women with HIV (WHIV). DESIGN: We examined intersectional stigmas, self-report ART adherence, and viral suppression using cross-sectional data. METHODS: Participants were WHIV ( N = 459) in the Womens Adherence and Visit Engagement, a Womens Interagency HIV Study substudy. We used Multidimensional Latent Class Item Response Theory and Bayesian models to analyze intersectional stigmas and viral load adjusting for sociodemographic and clinical covariates. RESULTS: We identified five intersectional stigma-based latent classes. The likelihood of viral suppression was approximately 90% lower among WHIV who experienced higher levels of poverty, sex, and racial stigma or higher levels of all intersectional stigmas compared with WHIV who reported lower experiences of intersectional stigmas. ART adherence accounted for but did not fully mediate some of the associations between latent intersectional stigma classes and viral load. CONCLUSION: The negative impact of intersectional stigmas on viral suppression is likely mediated, but not fully explained, by reduced ART adherence. We discuss the research and clinical implications of our findings.

Published
2022

150. Mechanisms linking gender-based violence to worse HIV treatment and care outcomes among women in the United States.

Author

Frongillo, Edward, Frongillo, Edward, Neilands, Torsten, Cohen, Mardge, Wilson, Tracey, Chandran, Aruna, Adimora, Adaora, Kassaye, Seble, Sheth, Anandi, Fischl, Margaret, Adedimeji, Adebola, Turan, Janet, Tien, Phyllis, Conroy, Amy, Weiser, Sheri, Jain, Jennifer, Sheira, Lila, Frongillo, Edward, Frongillo, Edward, Neilands, Torsten, Cohen, Mardge, Wilson, Tracey, Chandran, Aruna, Adimora, Adaora, Kassaye, Seble, Sheth, Anandi, Fischl, Margaret, Adedimeji, Adebola, Turan, Janet, Tien, Phyllis, Conroy, Amy, Weiser, Sheri, Jain, Jennifer, and Sheira, Lila

Abstract

OBJECTIVE: To test whether substance use mediates the associations between gender-based violence (GBV) and suboptimal adherence to antiretroviral therapy (ART), and GBV and poor engagement in care, among women living with HIV (WLHIV) in the United States (US). DESIGN: We analyzed longitudinal data collected among 1717 WLHIV in the Womens Interagency HIV Study (WIHS). METHODS: From 2013 to 2017, WLHIV completed semi-annual assessments on GBV, substance use, and HIV treatment and care. Adjusted multilevel logistic regression models were built to estimate the impact of GBV on; suboptimal (<95%) adherence and at least one missed HIV care appointment without rescheduling in the past 6 months. Mediation analyses were performed to test whether heavy drinking and illicit drug use mediated the associations between GBV and the two HIV outcomes. RESULTS: The mean age was 47 (standard deviation = 9), 5% reported experiencing GBV, 17% reported suboptimal adherence and 15% reported at least one missed appointment in the past 6 months. Women who experienced GBV had a significantly higher odds of suboptimal adherence [adjusted odds ratio (aOR) = 1.99; 95% confidence interval (CI) = 1.40-2.83] and missed appointments (aOR = 1.92, 95% CI = 1.32-2.33). Heavy drinking and illicit drug use mediated 36 and 73% of the association between GBV and suboptimal adherence and 29 and 65% of the association between GBV and missed appointments, respectively. CONCLUSIONS: Substance use is an underlying mechanism through which GBV affects outcomes along the HIV care continuum among WLHIV in the US. To optimize HIV treatment and care among women, interventions should address the combined epidemics of substance use, violence, and HIV.

Published
2022

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