Abstract
Stigma impedes HIV treatment in multiple ways, including diminished engagement in care, refusing ART, and concealing ART to evade stigma. This study disentangled the degree to which intentionally not taking ART to evade stigma influences overall non-adherence to ART. Patients receiving ART at a community clinic in Cape Town, South Africa (N = 288) completed confidential surveys of demographic and health characteristics, stigma-avoidance non-adherence, and non-stigma-related predictors of non-adherence. Results found nearly half of participants (48%) had forgone taking their ART in social settings. Hierarchically structured regression models showed that alcohol use, medication concerns, and internalized HIV stigma significantly predicted ART non-adherence, accounting for 9.9% of the variance. Stigma-avoidance non-adherence explained an additional 2.6% of the variance in ART non-adherence. The current findings extend previous research to show that stigma-avoidance independently contributes to ART non-adherence, including over and above depression and alcohol use.
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Funding was provided by Eunice Kennedy Shriver National Institute of Child Health and Human Development (Grant No. R01HD074560) and the National Institute of Mental Health (Grant No. R01MH119913).
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Seth Kalichman, Catherine Mathews, Renee El-Krab, Ellen Banas and Moira Kalichman declare no conflict of interest.
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This study was approved by the ethical review committees of the University of Connecticut and the South African Medical Research Council. All procedures were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000.
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Kalichman, S., Mathews, C., El-Krab, R. et al. Forgoing antiretroviral therapy to evade stigma among people living with HIV, Cape Town, South Africa. J Behav Med 44, 653–661 (2021). https://doi.org/10.1007/s10865-021-00212-2
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DOI: https://doi.org/10.1007/s10865-021-00212-2