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Brief Report: Interpersonal and Intrapersonal Factors as Parallel Independent Mediators in the Association Between Internalized HIV Stigma and ART Adherence.

ABSTRACT: INTRODUCTION:People living with HIV (PLWH) need to adhere to antiretroviral therapy (ART) to achieve optimal health. One reason for ART nonadherence is HIV-related stigma. OBJECTIVES:We aimed to examine whether HIV treatment self-efficacy (an intrapersonal mechanism) mediates the stigma-adherence association. We also examined whether self-efficacy and the concern about being seen while taking HIV medication (an interpersonal mechanism) are parallel mediators independent of each other. METHODS:A total of 180 people living with HIV self-reported internalized HIV stigma, ART adherence, HIV treatment self-efficacy, and concerns about being seen while taking HIV medication. We calculated bias-corrected 95% confidence intervals for indirect effects using bootstrapping to conduct mediation analyses. RESULTS:Adherence self-efficacy mediated the relationship between internalized stigma and ART adherence. Additionally, self-efficacy and concern about being seen while taking HIV medication uniquely mediated and explained almost all the stigma-adherence association in independent paths (parallel mediation). CONCLUSION:These results can inform intervention strategies to promote ART adherence.

SUBMITTER: Seghatol-Eslami VC

PROVIDER: S-EPMC5147512 | biostudies-literature | 2017 Jan

REPOSITORIES: biostudies-literature

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Brief Report: Interpersonal and Intrapersonal Factors as Parallel Independent Mediators in the Association Between Internalized HIV Stigma and ART Adherence.

Seghatol-Eslami Victoria C VC Dark Heather E HE Raper James L JL Mugavero Michael J MJ Turan Janet M JM Turan Bulent B

Journal of acquired immune deficiency syndromes (1999) 20170101 1

<h4>Introduction</h4>People living with HIV (PLWH) need to adhere to antiretroviral therapy (ART) to achieve optimal health. One reason for ART nonadherence is HIV-related stigma.<h4>Objectives</h4>We aimed to examine whether HIV treatment self-efficacy (an intrapersonal mechanism) mediates the stigma-adherence association. We also examined whether self-efficacy and the concern about being seen while taking HIV medication (an interpersonal mechanism) are parallel mediators independent of each ot ...[more]

PMID: 27926668

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Project description:Other than cognitive ability, what competencies should schools promote in children? How are they organized, and to what extent do they predict consequential outcomes? Separate theoretical traditions have suggested interpersonal, intrapersonal, and intellectual dimensions, reflecting how children relate to other people, manage their own goals and impulses, and engage with ideas, respectively. However, very little work has examined character empirically. In the current investigation, we partnered with middle schools that had previously identified character strengths relevant in their communities. Across three longitudinal, prospective studies, we examined the factor structure of character, associations with intelligence and Big Five personality traits, and predictive validity for consequential outcomes like peer relations, class participation, and report card grades. In Study 1, teachers rated their students on behaviors exemplifying character strengths as they played out in students' daily lives. Exploratory factor analyses yielded a three-factor structure consisting of interpersonal (interpersonal self-control, gratitude, social intelligence), intellectual (zest, curiosity), and intrapersonal (academic self-control, grit) factors of character. In Study 2, children rated their own behavior and completed a test of cognitive ability. Confirmatory factor analyses supported the same three-factor structure, and these factors were only weakly associated with cognitive ability. In Study 3, teachers provided character ratings; in parallel, students completed measures of character as well as Big Five personality factors. As expected, intellectual, interpersonal, and intrapersonal character factors related to Big Five openness to experience, agreeableness, and conscientiousness, respectively. Across studies, positive peer relations were most consistently predicted by interpersonal character, class participation by intellectual character, and report card grades by intrapersonal character. Collectively, our findings support a tripartite taxonomy of character in the school context.

Project description:BackgroundFew studies have explored the association between depressive symptoms, HIV infection and stigma in vulnerable populations. The objective of this study is to examine factors associated with depressive symptoms among caregivers living in vulnerable households in Malawi and assess how reported depressive symptoms and other factors affect ART adherence among caregivers who report testing positive for HIV and currently on ART.MethodsWe interviewed 818 adult caregivers of children aged 0-17 years living in vulnerable households in 24 health facility catchment areas in five districts in rural southern Malawi in 2016-2017. Vulnerable households had either economic and food insecurity, or chronic illness. Questions on five depressive symptoms were used. ART adherence was self-report of not forgetting to take ART medication in the last week. Perceived and anticipated measures of stigma were used. Multivariable linear and logistic regressions documented relationships between depressive symptoms, self-reported HIV status, HIV-related stigma, and ART adherence.ResultsMost caregivers were women (86.2%); about one third had no spouse or live-in partner. Fifty-seven percent of caregivers reported having three or more depressive symptoms. Forty-one percent of caregivers reported testing positive for HIV. Self-reported HIV positive status was associated with depressive symptoms (adjusted coeff = 0.355, p-value <0.001), which were in turn associated with poorer ART adherence among caregivers (aOR 0.639, p-value = 0.023). HIV-related stigma was also associated with depressive symptoms for caregivers who reported having HIV (coeff = 0.302, p-value = 0.028) and those who reported testing negative for HIV (coeff = 0.187, p-value <0.001). Having social support was associated with lower depressive symptoms (coeff = -0.115, p = 0.007). HIV-related stigma, having social support, and other socio-demographic characteristics were not found to be associated with ART adherence.ConclusionsAddressing mental health among caregivers in vulnerable households may be an important step toward achieving viral suppression among vulnerable populations living with HIV in Malawi. Integrating depression screening into HIV care and treatment protocols could be a promising intervention to improve longer-term outcomes.

Dataset Information

Brief Report: Interpersonal and Intrapersonal Factors as Parallel Independent Mediators in the Association Between Internalized HIV Stigma and ART Adherence.

Publications

Brief Report: Interpersonal and Intrapersonal Factors as Parallel Independent Mediators in the Association Between Internalized HIV Stigma and ART Adherence.

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