Skip to main content

Advertisement

SpringerLink
Log in

A Structural Equation Model of HIV-Related Stigma, Depressive Symptoms, and Medication Adherence

  • Original Paper
  • Published:
AIDS and Behavior Aims and scope Submit manuscript

Abstract

HIV-related stigma has a damaging effect on health outcomes among people living with HIV (PLWH), as studies have associated it with poor HIV medication adherence and depressive symptoms. We investigated whether depressive symptoms mediate the relationship between stigma and medication adherence. In a cross-sectional study, 720 PLWH completed instruments measuring HIV-related stigma, depressive symptoms, and HIV medication adherence. We used structural equation modeling (SEM) to investigate associations among these constructs. In independent models, we found that poorer adherence was associated with higher levels of stigma and depressive symptoms. In the simultaneous model that included both stigma and depressive symptoms, depression had a direct effect on adherence, but the effect of stigma on adherence was not statistically significant. This pattern suggested that depressive symptoms at least partially mediated the association between HIV-related stigma and HIV medication adherence. These findings suggest that interconnections between several factors have important consequences for adherence.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Lee RS, Kochman A, Sikkema KJ. Internalized stigma among people living with HIV-AIDS. AIDS Behav. 2002;6(4):309–19.

    Article  Google Scholar 

  2. Rao D, Chen W-T, Pearson C, Simoni J, Fredriksen-Goldsen K, Nelson K, et al. Social support mediates the relationship between HIV stigma, depression, and quality of life among people living with HIV in Beijing, China. Int J STD AIDS. in press.

  3. Murphy DA, Austin EL, Greenwell L. Correlates of HIV-related stigma among HIV-positive mothers and their uninfected adolescent children. Women Health. 2006;44(3):19–42.

    PubMed  Google Scholar 

  4. Wu DY, Munoz M, Espiritu B, Zeladita J, Sanchez E, Callacna M, et al. Burden of depression among impoverished HIV-positive women in Peru. J Acquir Immune Defic Syndr. 2008;48(4):500–4.

    Article  PubMed  Google Scholar 

  5. Pulerwitz J, Michaelis AP, Lippman SA, Chinaglia M, Díaz J. HIV-related stigma, service utilization, and status disclosure among truck drivers crossing the Southern borders in Brazil. AIDS Care. 2008;20(7):764–70.

    Article  PubMed  CAS  Google Scholar 

  6. Rao D, Kekwaletswe TC, Hosek S, Martinez J, Rodriguez F. Stigma and social barriers to medication adherence with urban youth living with HIV. AIDS Care. 2007;19(1):28–33.

    Article  PubMed  CAS  Google Scholar 

  7. Goffman E. Stigma: notes on the management of spoiled identity. New York: Simon and Schuster Inc; 1963.

    Google Scholar 

  8. Corrigan P, Watson A. The paradox of self-stigma and mental illness. Clin Psychol Sci Pract. 2002;9(1):35–53.

    Article  Google Scholar 

  9. Nyblade LC. Measuring HIV stigma: existing knowledge and gaps. Psychol Health Med. 2006;11(3):335–45.

    Article  PubMed  Google Scholar 

  10. Sayles J, Wong M, Kinsler J, Martins D, Cunningham W. The association of stigma with self-reported access to medical care and antiretroviral therapy adherence in persons living with HIV/AIDS. J Gen Intern Med. 2009;24:1101–8.

    Article  PubMed  Google Scholar 

  11. Singh N, Squier C, Sivek C, Wagener M, Nguyen MH, Yu VL. Determinants of compliance with antiretroviral therapy in patients with human immunodeficiency virus: prospective assessment with implications for enhancing compliance. AIDS Care. 1996;8(3):261–9.

    Article  PubMed  CAS  Google Scholar 

  12. Gordillo V, del Amo J, Soriano V, Gonzalez-Lahoz J. Sociodemographic and psychological variables influencing adherence to antiretroviral therapy. AIDS. 1999;13(13):1763–9.

    Article  PubMed  CAS  Google Scholar 

  13. Bing EG, Burnam MA, Longshore D, Fleishman JA, Sherbourne CD, London AS, et al. Psychiatric disorders and drug use among human immunodeficiency virus-infected adults in the United States. Arch Gen Psychiatry. 2001;58(8):721–8.

    Article  PubMed  CAS  Google Scholar 

  14. Valente SM. Depression and HIV disease. J Assoc Nurses AIDS Care. 2003;14(2):41–51.

    Article  PubMed  Google Scholar 

  15. Catz SL, Kelly JA, Bogart LM, Benotsch EG, McAuliffe TL. Patterns, correlates, and barriers to medication adherence among persons prescribed new treatments for HIV disease. Health Psychol. 2000;19(2):124–33.

    Article  PubMed  CAS  Google Scholar 

  16. Rao D, Simoni J, Nelson K, Chen W, Zhao H, Zhang F. Depressive symptoms predict adherence to ART in people living with HIV in Beijing, China. In: 5th International conference on HIV treatment adherence, Miami, Florida, 23–25 May 2010.

  17. Crane H, Lober W, Webster E, Harrington R, Crane P, Davis T, et al. Routine collection of patient-reported outcomes in an HIV clinic setting: the first 100 patients. Curr HIV Res. 2007;5:109–18.

    Article  PubMed  CAS  Google Scholar 

  18. Rao D, Choi S, Victorson D, Bode R, Heinemann A, Peterman A, et al. Measuring stigma across neurological conditions: the development of the stigma scale for chronic illness (SSCI). Qual Life Res. 2009;18:585–95.

    Article  PubMed  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  20. Spitzer RL, Kroenke K, Williams JB. Validation and utility of a self-report version of PRIME-MD: the PHQ primary care study. Primary care evaluation of mental disorders patient health questionnaire. JAMA J Am Med Assoc. 1999;282(18):1737–44.

    Article  CAS  Google Scholar 

  21. Kroenke K, Spitzer R, Williams J. The patient health questionnaire-2: validity of a two-item depression screener. Med Care. 2003;41(11):1284–92.

    Article  PubMed  Google Scholar 

  22. Chesney M, Ickovics J, Chambers D, Gifford A, Neidig J, Zwickl B, et al. Self-reported adherence to antiretroviral medications among participants in HIV clinical trials: the AACTG adherence instruments. AIDS Care. 2000;12(3):255–66.

    Article  PubMed  CAS  Google Scholar 

  23. Simoni J, Kurth A, Pearson C, Pantalone D, Merrill J, Frick P. Self-report measures of antiretroviral therapy adherence: a review with recommendations for HIV research and clinical management. AIDS Behav. 2006;10:227–45.

    Article  PubMed  Google Scholar 

  24. Lu M, Safren S, Skolnik P, Rogers W, Coady W, Hardy H, et al. Optimal recall period and response task for self-reported HIV medication adherence. AIDS Behav. 2008;12:86–94.

    Article  PubMed  Google Scholar 

  25. Amico K, Fisher W, Cornman D, Shuper P, Redding C, Konkle-Parker D, et al. Visual analog scale of ART adherence: association with 3-day self-report and adherence barriers. J Acquir Immune Defic Syndr. 2006;42:455–9.

    Article  PubMed  Google Scholar 

  26. Skrondal A, Rabe-Hesketh S. Generalized linear latent and mixed models with composite links and exploded likelihoods. In: Biggeri A, Dreassi E, Lagazio C, Marchi M, editors. Statistical modelling. Firenze: Firenze University Press; 2004. p. 27–39.

    Google Scholar 

  27. MacKinnon DP, Fairchild AJ, Fritz MS. Mediation Analysis. Annu Rev Psychol. 2007;58:593–614.

    Article  PubMed  Google Scholar 

  28. Bollen KA. Structural equations with latent variables. New York: John Wiley; 1989.

    Google Scholar 

  29. Muthén LK, Muthén BO. Mplus user’s guide. 6th ed. Los Angeles: Muthén & Muthén; 1998–2010.

  30. Little RJA. Modeling the drop-out mechanism in repeated-measures studies. J Am Stat Assoc. 1995;90(431):1112–21.

    Article  Google Scholar 

  31. Hu L, Bentler P. Fit indices in covariance structure modeling: sensitivity to under parameterized model misspecification. Psychol Methods. 1998;3:424–53.

    Article  Google Scholar 

  32. Glass TR, Battegay M, Cavassini M, De Geest S, Furrer H, Vernazza PL, et al. Longitudinal analysis of patterns and predictors of changes in self-reported adherence to antiretroviral therapy: Swiss HIV cohort study. J Acquir Immune Defic Syndr. 2010;54:197–203.

    PubMed  Google Scholar 

  33. Golin CE, Liu H, Hays RD, Miller LG, Beck CK, Ickovics J, et al. A prospective study of predictors of adherence to combination antiretroviral medication. J Gen Intern Med. 2002;17(10):756–65.

    Article  PubMed  Google Scholar 

  34. Kidder D, Wolitski R, Campsmith M, Nakamura G. Health status, health care use, medication use, and medication adherence among homeless and housed people living with HIV/AIDS. Am J Public Health. 2007;97(12):2238–45.

    Article  PubMed  Google Scholar 

  35. Singh N, Berman SM, Swindells S, Justis JC, Mohr JA, Squier C, et al. Adherence of human immunodeficiency virus-infected patients to antiretroviral therapy. Clin Infect Dis. 1999;29(4):824–30.

    Article  PubMed  CAS  Google Scholar 

  36. Paterson DL, Swindells S, Mohr J, Brester M, Vergis EN, Squier C, et al. Adherence to protease inhibitor therapy and outcomes in patients with HIV infection. Ann Intern Med. 2000;133(1):21–30.

    PubMed  CAS  Google Scholar 

Download references

Acknowledgments

The present study was funded by National Institutes of Mental Health grant number K23 MH 084551 (PI: Rao) and R01 MH 084759 (PI: H. Crane). Initial results from this study were presented at the 5th International Conference on HIV Treatment Adherence, May 23–25, 2010, Miami, Florida.

Author information

Authors and Affiliations

  1. Department of Global Health, University of Washington, Seattle, WA, USA

    Deepa Rao

  2. Division of Infectious Diseases, University of Washington, Seattle, WA, USA

    Betsy J. Feldman, Rob J. Fredericksen, Mari M. Kitahata & Heidi M. Crane

  3. Division of General Internal Medicine, University of Washington, Seattle, WA, USA

    Paul K. Crane

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

    Jane M. Simoni

  5. Harborview Medical Center, 325 9th Avenue, PO Box 359932, Seattle, WA, 98104, USA

    Deepa Rao

Authors
  1. Deepa Rao
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Betsy J. Feldman
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Rob J. Fredericksen
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Paul K. Crane
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jane M. Simoni
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Mari M. Kitahata
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Heidi M. Crane
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Deepa Rao.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Rao, D., Feldman, B.J., Fredericksen, R.J. et al. A Structural Equation Model of HIV-Related Stigma, Depressive Symptoms, and Medication Adherence. AIDS Behav 16, 711–716 (2012). https://doi.org/10.1007/s10461-011-9915-0

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10461-011-9915-0

Keywords

Search

Navigation