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Moderating Factors in an Anti-stigma Intervention for African American Women with HIV in the United States: A Secondary Analysis of the UNITY Trial

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Abstract

African American women experience higher rates of HIV than other women in the United States, and stigma has been identified as an important determinant of engagement in HIV care. Our study examined whether key variables moderated the effect of an anti-stigma intervention on outcomes among African American women receiving treatment for HIV. Twelve potential moderators included: age, years lived with HIV, marital status, employment status, education level, PTSD diagnosis, alcohol use, social support, baseline CD4 count, baseline viral load, and number of children. Outcomes included changes in: HIV-related stigma, social support, depressive symptoms, PTSD symptoms, alcohol use, viral load, and engagement in HIV care. Results suggest that the intervention is associated with greater improvement in engagement in care among participants with PTSD or depression at baseline, and may help maintain engagement in care among participants experiencing certain mental health conditions. This provides opportunities to address discriminatory structural barriers that lead to stigma and drop-offs in HIV care.

Resumen

En los Estados Unidos, mujeres afroamericanas experimentan tasas más altas de VIH que sus contrapartes no-negras, y el estigma ha sido identificado como un factor importante en esa diferencia. Este estudio analizó el efecto moderador de ciertas variables claves hacia una intervención anti-estigma para mujeres afroamericanas en los Estados Unidos. Del conocimiento previo sobre VIH y el estigma hacia mujeres afroamericanas con VIH, se derivaron doce posibles moderadores incluyendo: edad, años viviendo con VIH, estado civil, nivel de educación, diagnóstico de TEPT, puntuación de AUDIT, apoyo social, conteo de CD4, carga viral, y cantidad de hijos. Las variables clínicas observadas incluyeron estigma, apoyo social, síntomas de depresión y/o TEPT, uso de alcohol, carga viral, y el compromiso del paciente al tratamiento. Los resultados sugieren que la intervención anti-estigma está asociado con mayor mejoramiento en compromiso al tratamiento para esos participantes que padecían de TEPT o depresión al inicio del tratamiento. En adición, la intervención puede ayudar a mantener el compromiso al tratamiento para pacientes que padecen ciertas condiciones de salud mental.

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References

  1. McDoom MM, Bokhour B, Sullivan M, Drainoni M-L. How older Black women perceive the effects of stigma and social support on engagement in HIV Care. AIDS Patient Care STDS. 2015;29(2):95–101.

    Article  Google Scholar 

  2. Centers for Disease Control and Prevention. CDC factsheet: HIV among African Americans. 2017. Available from: https://www.cdc.gov/nchhstp/newsroom/docs/factsheets/cdc-hiv-aa-508.pdf. Accessed 2018 Jun 26.

  3. Office of Minority Health. HIV/AIDS—The Office of Minority Health. Available from: https://minorityhealth.hhs.gov/omh/browse.aspx?lvl=4&lvlid=21. Accessed 2018 Jun 20.

  4. Kelso GA, Cohen MH, Weber KM, Dale SK, Cruise RC, Brody LR. Critical consciousness, racial and gender discrimination, and HIV disease markers in African American women with HIV. AIDS Behav. 2014;18(7):1237–46.

    Article  Google Scholar 

  5. Logie C, Ll James, Tharao W, Loutfy M. Associations between HIV-related stigma, racial discrimination, gender discrimination, and depression among HIV-positive African, Caribbean, and Black women in Ontario, Canada. AIDS Patient Care STDS. 2013;27(2):114–22.

    Article  Google Scholar 

  6. Gaston GB, Alleyne-Green B. The impact of African Americans’ beliefs about HIV medical care on treatment adherence: a systematic review and recommendations for interventions. AIDS Behav. 2013;17(1):31–40.

    Article  Google Scholar 

  7. Crenshaw K. Mapping the margins: intersectionality, identity politics, and violence against women of color. Stanford Law Rev. 1991;43(6):1241–99.

    Article  Google Scholar 

  8. Oramasionwu C, Bailey SC, Johnson TL, Mao L. Engagement in outpatient care for persons living with HIV in the United States. AIDS Res Hum Retroviruses. 2015;31(2):177–82.

    Article  Google Scholar 

  9. Dale SK, Pierre-Louis C, Bogart LM, O’Cleirigh C, Safren SA. Still I rise: the need for self-validation and self-care in the midst of adversities faced by Black women with HIV. Cult Divers Ethn Minor Psychol. 2018;24(1):15–25.

    Article  Google Scholar 

  10. HIV Care Continuum | HIV.gov. Available from: https://www.hiv.gov/federal-response/policies-issues/hiv-aids-care-continuum. Accessed 2018 Jun 20.

  11. Hall HI, Frazier EL, Rhodes P, Holtgrave DR, Furlow-Parmley C, Tang T, et al. Differences in human immunodeficiency virus care and treatment among subpopulations in the United States. JAMA Intern Med. 2013;173(14):1337.

    Article  Google Scholar 

  12. Qiao S, Li X, Stanton B. Social support and HIV-related risk behaviors: a systematic review of the global literature. AIDS Behav. 2014;18(2):419–41.

    Article  Google Scholar 

  13. Lifson AR, Workneh S, Hailemichael A, Demissie W, Slater L, Shenie T. Perceived social support among HIV patients newly enrolled in care in rural Ethiopia. AIDS Care. 2015;27(11):1382–6.

    Article  Google Scholar 

  14. Alemu H, Haile Mariam D, Tsui A, Ahmed S, Shewamare A. Effect of depressive symptoms and social support on weight and CD4 count increase at HIV clinic in Ethiopia. AIDS Care. 2012;24(7):866–76.

    Article  Google Scholar 

  15. Hou W, Chen C, Liu H, Lai Y, Lee H, Lee N, et al. Mediating effects of social support on depression and quality of life among patients with HIV infection in Taiwan. AIDS Care. 2014;26(8):996–1003.

    Article  Google Scholar 

  16. Clark HJ, Lindner G, Armistead L, Austin B-J. Stigma, disclosure, and psychological functioning among HIV-infected and non-infected African-American women. Women Health. 2004;38(4):57–71.

    Article  Google Scholar 

  17. Buseh AG, Stevens PE. Constrained but not determined by stigma: resistance by African American women living with HIV. Women Health. 2007;44(3):1–18.

    Article  Google Scholar 

  18. Breet E, Kagee A, Seedat S. HIV-related stigma and symptoms of post-traumatic stress disorder and depression in HIV-infected individuals: does social support play a mediating or moderating role? AIDS Care. 2014;26(8):947–51.

    Article  Google Scholar 

  19. Kidd R, Clay S, Chiiya C. Understanding and challenging HIV/AIDS stigma: a toolkit for action. In: Internatioinal Center for Research on Women, Academy for Educational Development (AED), International AIDS Alliance. 2007. Available from: https://www.icrw.org/wp-content/uploads/2016/10/Understanding-and-Challenging-HIV-Stigma-Toolkit-for-Action.pdf.

  20. Rao D, Andrasik MP, Lipira L. HIV stigma among Black women in the United States: intersectionality, support, resilience. Am J Pub Health. 2018;108(4):446–8.

    Article  Google Scholar 

  21. Bowleg L. The problem with the phrase women and minorities: intersectionality-an important theoretical framework for public health. Am J Pub Health. 2012;102(7):1267–73.

    Article  Google Scholar 

  22. Rao D, Kemp CG, Huh D, Nevin PE, Turan J, Cohn SE, et al. Stigma reduction among African American women with HIV: UNITY Health Study. JAIDS. 2018;78(3):269–75.

    PubMed  Google Scholar 

  23. Rao D, Desmond M, Andrasik M, Rasberry T, Lambert N, Cohn SE, et al. Feasibility, acceptability, and preliminary efficacy of the unity workshop: an internalized stigma reduction intervention for African American women living with HIV. AIDS Patient Care STDS. 2012;26(10):614–20.

    Article  Google Scholar 

  24. Rao D, Molina Y, Lambert N, Cohn SE. Assessing stigma among African Americans living with HIV. Stigma Heal. 2016;1(3):146–55.

    Article  Google Scholar 

  25. Sherbourne C, Stewart A. The MOS social support survey. Soc Sci Med. 1991;32(6):705–14.

    Article  CAS  Google Scholar 

  26. Vyavaharkar M, Moneyham L, Corwin S, Saunders R, Annang L, Tavakoli A. Relationships between stigma, social support, and depression in HIV-infected African American women living in the rural Southeastern United States. J Assoc Nurses AIDS Care. 2010;21(2):144–52.

    Article  Google Scholar 

  27. Blanchard E, Jones Alexander J, Buckley T, Forneris C. Psychometric properties of the PTSD Checklist (PCL). Behav Res Ther. 1996;34:669–73.

    Article  CAS  Google Scholar 

  28. Kroenke K, Spitzer R, Williams J. The PHQ-9: validity of a breif depression severity measure. J Gen Intern Med. 2001;16(9):606–13.

    Article  CAS  Google Scholar 

  29. Bollinger A, Cuevas C, Vielhauer M, Morgan E, Keane T. The operating characteristics of the PTSD Checklist in detecting PTSD in HIV+ substance abusers. J Psychol Trauma. 2008;7(4):213–34.

    Article  Google Scholar 

  30. El-Bassel N, Gilbert L, Vinocur D, Chang M, Wu E. Posttraumatic stress disorder and HIV risk among poor, inner-city women receiving care in an emergency department. Am J Pub Heal. 2011;101(1):120–7.

    Article  Google Scholar 

  31. Kroenke K, Spitzer R. The PHQ-9: a new depression diagnostic and severity measure. Psychiatr Ann. 2002;32(9):509–15.

    Article  Google Scholar 

  32. Huang F, Chung H, Kroenke K, Delucci K, Spitzer R. Using the Patient Health Questionnaire-9 to measure depression among racially and ethnically diverse primary care patients. J Gen Intern Med. 2006;21(6):547–52.

    Article  CAS  Google Scholar 

  33. de Meneses-Gaya C, Zuardi A, Loureiro S, Crippa J. Alcohol Use Disorders Identification Test (AUDIT): an updated systematic review of psychometric properties. Psychol Neurosci. 2009;2(1):83–97.

    Article  Google Scholar 

  34. Benjamini Y, Hochberg Y. Controlling the false discovery rate: a practical and powerful approach to multiple testing. J R Stat Soc Ser B. 1995;57(1):289–300.

    Google Scholar 

  35. Nanni MG, Caruso R, Mitchell AJ, Meggiolaro E, Grassi L. Depression in HIV infected patients: a review. Curr Psychiatry Rep. 2015;17(1):530.

    Article  Google Scholar 

  36. Machtinger E, Wilson T, Haberer J, Weiss D. Psychological trauma and PTSD in HIV-positive women: a meta-analysis. AIDS Behav. 2012;16(8):2091–100.

    Article  CAS  Google Scholar 

  37. Basta T, Shacham E, Reece M. Psychological distress and engagement in HIV-related services among individuals seeking mental health care. AIDS Care. 2008;20(8):969–76.

    Article  Google Scholar 

  38. Remien RH, Bauman LJ, Mantell JE, Tsoi B, Lopez-Rios J, Chhabra R, et al. Barriers and facilitators to engagement of vulnerable populations in HIV primary care in New York City. J Acquir Immune Defic Syndr. 2015;69(Suppl 01):S16–24.

    Article  Google Scholar 

  39. Sherr L, Clucas C, Harding R, Sibley E, Catalan J. HIV and depression-a systematic review of interventions. 2011;16(5):493–527.

    Google Scholar 

  40. Geter A, Sutton MY, Hubbard McCree D. Social and structural determinants of HIV treatment and care among black women living with HIV infection: a systematic review: 2005–2016. AIDS Care. 2018;30(4):409–16.

    Article  Google Scholar 

  41. Rueda S, Mitra S, Chen S, Gogolishvili D, Globerman J, Chambers L, et al. Examining the associations between HIV-related stigma and health outcomes in people living with HIV/AIDS: a series of meta-analyses. BMJ Open. 2016;6(7):e011453.

    Article  Google Scholar 

  42. Johnson M, Dilworth S, Taylor J, Darbes L, Comfort M, Neilands T. Primary relationships, HIV treatment adherence, and virologic control. AIDS Behav. 2012;16(6):1511–21.

    Article  Google Scholar 

  43. Molina Y, Scheel JR, Endeshaw M, Turan JM, Lambert N, Cohn SE, et al. Enacted HIV-related stigma and breast-health beliefs and practices among African American women living with HIV: the mediating roles of internalized HIV-related stigma and depressive symptoms. Stigma Heal. 2018;3(4):377–84.

    Article  Google Scholar 

  44. Kay ES, Batey DS, Mugavero MJ. The HIV treatment cascade and care continuum: updates, goals, and recommendations for the future. AIDS Res Ther. 2016;13:35.

    Article  Google Scholar 

  45. Brief D, Bollinger A, Vielhauer M, Berger-Greenstein J, Morgan E, Brady S, et al. Understanding the interface of HIV, trauma, post-traumatic stress disorder, and substance abuse and its implications for health outcomes. AIDS Care. 2004;16(sup1):97–120.

    Article  Google Scholar 

  46. Lindsay-Dennis L. Black Feminist-Womanist research paradigm. J Black Stud. 2015;46(5):506–20.

    Article  Google Scholar 

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Funding

The study was supported by the National Institutes of Health (NIH), National Institute of Mental Health under Grant No. R01MH098675 (PI: Rao).

Author information

Authors and Affiliations

  1. Department of Global Health, University of Washington, 1959 NE Pacific Street, Seattle, WA, 98195, USA

    Katrin E. Fabian, Christopher G. Kemp, Paul E. Nevin & Deepa Rao

  2. School of Social Work, University of Washington, Seattle, WA, USA

    David Huh

  3. Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA

    Janet M. Turan

  4. Department of Medicine, Northwestern University, Chicago, IL, USA

    Susan E. Cohn

  5. Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA

    Deepa Rao

  6. Department of Psychology, University of Washington, Seattle, WA, USA

    Jane M. Simoni

  7. Fred Hutchinson Cancer Research Center, Seattle, WA, USA

    Michele Andrasik

  8. Division of Infectious Diseases, University of Alabama, Birmingham, AL, USA

    Michael J. Mugavero

Authors
  1. Katrin E. Fabian
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  2. David Huh
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Correspondence to Katrin E. Fabian.

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Fabian, K.E., Huh, D., Kemp, C.G. et al. Moderating Factors in an Anti-stigma Intervention for African American Women with HIV in the United States: A Secondary Analysis of the UNITY Trial. AIDS Behav 23, 2432–2442 (2019). https://doi.org/10.1007/s10461-019-02557-x

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