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HIV stigma and viral load among African-American women receiving treatment for HIV.

ABSTRACT: OBJECTIVE:African-American women are more likely than other women in the United States to experience poor HIV-related health; HIV stigma may contribute to these outcomes. This study assessed the relationship between HIV stigma and viral load, over time, among a sample of African-American women receiving treatment for HIV, and explored social support and depressive symptoms as mediators. DESIGN:Secondary analysis of longitudinal data. METHODS:Data came from a randomized trial of an intervention to reduce HIV stigma among African-American women in HIV care in Chicago, Illinois and Birmingham, Alabama. Sociodemographic and psychosocial data were collected at up to six study visits over 14 months. Viral loads were extracted from medical records during the study period. Generalized linear mixed effects models were used to estimate associations among overall, internalized, and enacted HIV stigma and viral load over time. Mediation analyses were used to estimate indirect effects via social support and depressive symptoms. RESULTS:Data from 234 women were analyzed. Overall HIV stigma was significantly associated with subsequent viral load (adjusted ??=?0.24, P?=?0.005). Both between-subject (adjusted ??=?0.74, P?

SUBMITTER: Kemp CG

PROVIDER: S-EPMC6621603 | biostudies-literature | 2019 Jul

REPOSITORIES: biostudies-literature

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HIV stigma and viral load among African-American women receiving treatment for HIV.

Kemp Christopher G CG Lipira Lauren L Huh David D Nevin Paul E PE Turan Janet M JM Simoni Jane M JM Cohn Susan E SE Bahk Mieoak M Berzins Baiba B Andrasik Michele M Mugavero Michael J MJ Rao Deepa D

AIDS (London, England) 20190701 9

<h4>Objective</h4>African-American women are more likely than other women in the United States to experience poor HIV-related health; HIV stigma may contribute to these outcomes. This study assessed the relationship between HIV stigma and viral load, over time, among a sample of African-American women receiving treatment for HIV, and explored social support and depressive symptoms as mediators.<h4>Design</h4>Secondary analysis of longitudinal data.<h4>Methods</h4>Data came from a randomized tria ...[more]

PMID: 31259767

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Project description:Background Viral load (VL) testing is the gold-standard approach for monitoring human immunodeficiency virus (HIV) treatment success and virologic failure, but uptake is suboptimal in resource-limited and rural settings. We conducted a cross-sectional study of risk factors for non-uptake of VL testing in rural Uganda. Methods We conducted a cross-sectional analysis of uptake of VL testing among randomly selected people with HIV (PWH) receiving anti-retroviral treatment (ART) for at least 6 months at all eight primary health centers in Gomba district, rural Uganda. Socio-demographic and clinical data were extracted from medical records for the period January to December 2017. VL testing was routinely performed 6?months after ART initiation and 12?months thereafter for PWH stable on ART. We used descriptive statistics and multivariable logistic regression to evaluate factors associated with non-uptake of VL testing (the primary outcome). Results Of 414 PWH, 60% were female, and the median age was 40?years (interquartile range [IQR] 31–48). Most (62.3%) had been on ART >?2?years, and the median duration of treatment was 34?months (IQR 14–55). Thirty three percent did not receive VL testing: 36% of women and 30% of men. Shorter duration of ART (?2?years) (adjusted odds ratio [AOR] 2.38; 95% CI:1.37–4.12; p =?0.002), younger age 16–30?years (AOR 2.74; 95% CI:1.44–5.24; p =?0.002) and 31–45?years (AOR 1.92; 95% CI 1.12–3.27; p =?0.017), and receipt of ART at Health Center IV (AOR 2.85; 95% CI: 1.78–4.56; p <?0.001) were significantly associated with non-uptake of VL testing. Conclusions One-in-three PWH on ART missed VL testing in rural Uganda. Strategies to improve coverage of VL testing, such as VL focal persons to flag missed tests, patient education and demand creation for VL testing are needed, particularly for recent ART initiates and younger persons on treatment, in order to attain the third Joint United Nations Program on HIV/AIDS (UNAIDS) 95–95-95 target – virologic suppression for 95% of PWH on ART.

Dataset Information

HIV stigma and viral load among African-American women receiving treatment for HIV.

Publications

HIV stigma and viral load among African-American women receiving treatment for HIV.

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