1. Pathways From HIV-Related Stigma to Antiretroviral Therapy Measures in the HIV Care Cascade for Women Living With HIV in Canada
- Author
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Marcie Summers, Danièle Dubuc, Mona Loutfy, Alexandra de Pokomandy, Anita Rachlis, Corinna Quan, Ashley Lacombe-Duncan, Jean-Guy Baril, Wendy Wobeser, Gina Ogilvie, Danielle Rouleau, Kath Webster, Curtis Cooper, Trevor A Hart, Wangari Tharao, Christos M. Tsoukas, Denise Becker, Renée Masching, Aranka Anema, Carmen Logie, Johanna Lewis, Sylvie Trottier, Marvelous Muchenje, Charlene Ouellette, Stephanie Smith, Joanne Otis, Guillaume Colley, Annette Fraleigh, Logan Kennedy, Mylène Fernet, Maxime Kiboyogo, Evin Jones, Angela Kaida, Shazia Islam, Breklyn Bertozzi, Roger Sandre, Jason Brophy, Eric A. Roth, Claudette Cardinal, Mary Ndungʼu, Janice Duddy, Sharon Walmsley, Lori A. Brotto, Janice Dayle, Terry Hosward, Shahab Jabbari, Sean B. Rourke, Brenda Gagnier, Carmen H. Logie, Sergio Rueda, Shari Margolese, Jeff Powis, Benoit Trottier, Andrea Langlois, Allison Carlson, Cécile Tremblay, Sheila Borton, Melissa Medjuck, Alie Pierre, Jacquie Sas, Lu Wang, Anita C Benoit, Marina B. Klein, Lynne Leonard, Jeffrey A. Cohen, Lyne Massie, Karène Proulx-Boucher, Jonathan B. Angel, Tsitsi Tigere, Jacqueline Gahagan, Rahma Abdul-Noor, Greta R. Bauer, Robert S. Hogg, Kerrigan Beaver, Edward D. Ralph, Pierrette Clément, Nadia OʼBrien, Doris Peltier, Kelly OʼBrien, Janet Raboud, Nada Gataric, Paul Sereda, Cari L. Miller, Desiree Kerr, Erin Ding, Sophie Patterson, Ann N. Burchell, Fiona Smaill, Susanna Ogunnaike-Cooke, Aurélie Hot, Margarite Sanchez, Jessica Yee, Claudine Gasingirwa, Mary Kestler, Tammy Bourque, Gladys Kwaramba, Catherine Hankins, Mark H. Yudin, Elisa Lloyd-Smith, Saara Greene, Danielle Groleau, Charu Kaushic, Ying Wang, Christina Tom, Allison Carter, Valerie Nicholson, Brigitte Ménard, Nora Butler Burke, Tracey Conway, Deborah Money, Carrie Martin, Kate Salters, Fatimatou Barry, Jasmine Cotnam, Neora Pick, Lynne Cioppa, Édénia Savoie, Wendy Zhang, Janette Cousineau, and Viviane D. Lima
- Subjects
Adult ,Canada ,Mediation (statistics) ,medicine.medical_specialty ,HIV stigma ,Social stigma ,Epidemiology ,Cross-sectional study ,Social Stigma ,antiretroviral therapy ,Psychological intervention ,MEDLINE ,Stigma (botany) ,HIV Infections ,structural equation modeling ,Structural equation modeling ,Medication Adherence ,03 medical and health sciences ,0302 clinical medicine ,Antiretroviral Therapy, Highly Active ,Humans ,Medicine ,Pharmacology (medical) ,adherence ,030212 general & internal medicine ,Psychiatry ,Depression (differential diagnoses) ,030505 public health ,business.industry ,Middle Aged ,Cross-Sectional Studies ,Infectious Diseases ,Anti-Retroviral Agents ,depression ,Female ,women ,0305 other medical science ,business ,Clinical psychology - Abstract
Background: Associations between HIV-related stigma and reduced antiretroviral therapy (ART) adherence are widely established, yet the mechanisms accounting for this relationship are underexplored. There has been less attention to HIV-related stigma and its associations with ART initiation and current ART use. We examined pathways from HIV-related stigma to ART initiation, current ART use, and ART adherence among women living with HIV in Canada. Methods: We used baseline survey data from a national cohort of women living with HIV in Canada (n = 1425). Structural equation modeling using weighted least squares estimation methods was conducted to test the direct effects of HIV-related stigma dimensions (personalized, negative self-image, and public attitudes) on ART initiation, current ART use, and 90% ART adherence, and indirect effects through depression and HIV disclosure concerns, adjusting for sociodemographic factors. Results: In the final model, the direct paths from personalized stigma to ART initiation (β = −0.104, P < 0.05) and current ART use (β = −0.142, P < 0.01), and negative self-image to ART initiation (β = −0.113, P < 0.01) were significant, accounting for the mediation effects of depression and HIV disclosure concerns. Depression mediated the pathways from personalized stigma to ART adherence, and negative self-image to current ART use and ART adherence. Final model fit indices suggest that the model fit the data well [χ2(25) = 90.251, P < 0.001; comparative fit index = 0.945; root-mean-square error of approximation = 0.044]. Conclusions: HIV-related stigma is associated with reduced likelihood of ART initiation and current ART use, and suboptimal ART adherence. To optimize the benefit of ART among women living with HIV, interventions should reduce HIV-related stigma and address depression.
- Published
- 2018
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