Association between Perceived Discrimination in Healthcare Settings and HIV Medication Adherence: Mediating Psychosocial Mechanisms

• Type of Material: Article
• Authors: Bulent Turan, University of Alabama Birmingham; Anna Joy Rogers, University of Alabama Birmingham; Whitney S. Rice, University of Alabama Birmingham; Ghislaine C. Atkins, University of Alabama Birmingham; Mardge H. Cohen, Stroger Hospital of Cook County; Tracey E. Wilson, Suny Downstate Medical Center; Adaora A. Adimora, University of North Carolina Chapel Hill; Daniel Merenstein, Georgetown University; Adebola Adedimeji, Albert Einstein College of Medicine; Eryka L. Wentz, Johns Hopkins University; Ighovwerha Ofotokun, Emory University; Lisa Metsch, Columbia University; Phyllis C. Tien, University of California San Francisco; Mallory O. Johnson, University of California San Francisco; Janet M. Turan, University of Alabama Birmingham; Sheri D. Weiser, University of California San Francisco
• Language: English
• Date: 2017-12-01
• Publisher: Springer (part of Springer Nature): Springer Open Choice Hybrid Journals
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2017, Springer Science+Business Media, LLC.
• Final Published Version (URL): http://dx.doi.org/10.1007/s10461-017-1957-5
• Title of Journal or Parent Work: AIDS and Behavior
• ISSN: 1090-7165
• Volume: 21
• Issue: 12
• Start Page: 3431
• End Page: 3439
• Grant/Funding Information: The contents of this publication are solely the responsibility of the authors and do not represent the official views of the National Institutes of Health (NIH).; Targeted supplemental funding for specific projects is also provided by the National Institute of Dental and Craniofacial Research (NIDCR), the National Institute on Alcohol Abuse and Alcoholism (NIAAA), the National Institute on Deafness and other Communication Disorders (NIDCD), and the NIH Office of Research on Women’s Health.; Trainee support was provided by the Agency for Healthcare Research and Quality (grant number T32HS013852).; This study was funded by Women’s Interagency HIV Study (WIHS) sub-study grants from the National Institute of Mental Health, R01MH095683 and R01MH104114.; The WIHS is funded primarily by the National Institute of Allergy and Infectious Diseases (NIAID), with additional co-funding from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), the National Cancer Institute (NCI), the National Institute on Drug Abuse (NIDA), and the National Institute on Mental Health (NIMH).; WIHS data collection is also supported by UL1-TR000004 (UCSF CTSA) and UL1-TR000454 (Atlanta CTSA).; WIHS (Principal Investigators): UAB-MS WIHS (Michael Saag, Mirjam-Colette Kempf, and Deborah Konkle-Parker), U01-AI-103401; Atlanta WIHS (Ighovwerha Ofotokun and Gina Wingood), U01-AI-103408; Bronx WIHS (Kathryn Anastos), U01-AI-035004; Brooklyn WIHS (Howard Minkoff and Deborah Gustafson), U01-AI-031834; Chicago WIHS (Mardge Cohen, Audrey French), U01-AI-034993; Metropolitan Washington WIHS (Mary Young), U01-AI-034994; Miami WIHS (Margaret Fischl and Lisa Metsch), U01-AI-103397; UNC WIHS (Adaora Adimora), U01-AI-103390; Connie Wofsy Women’s HIV Study, Northern California (Ruth Greenblatt, Bradley Aouizerat, and Phyllis Tien), U01-AI-034989; WIHS Data Management and Analysis Center (Stephen Gange and Elizabeth Golub), U01-AI-042590; Southern California WIHS (Alexandra Levine and Marek Nowicki), U01-HD-032632 (WIHS I – WIHS IV).; This research was also supported by the University of Alabama at Birmingham (UAB) Center for AIDS Research CFAR, an NIH funded program (P30 AI027767) that was made possible by the following institutes: NIAID, NCI, NICHD, NHLBI, NIDA, NIA, NIDDK, NIGMS, and OAR.
• Keywords: ANTIRETROVIRAL THERAPY ADHERENCE; HIV/AIDS; Stigma; Mental health; Adherence; Social Sciences, Biomedical; Depression; Life Sciences & Biomedicine; DEPRESSION; SOCIAL SUPPORT; Science & Technology; CLINICAL CARE; Social Sciences; RURAL UGANDA; Public, Environmental & Occupational Health; STIGMA SCALE; Discrimination; Biomedical Social Sciences; WOMENS INTERAGENCY HIV; SUBJECTIVE SOCIOECONOMIC-STATUS; HIV; MENTAL-HEALTH
• Research Categories: Health Sciences, Public Health; Health Sciences, Mental Health

Abstract

There is insufficient research on the impact of perceived discrimination in healthcare settings on adherence to antiretroviral therapy (ART), particularly among women living with HIV, and even less is known about psychosocial mechanisms that may mediate this association. Cross-sectional analyses were conducted in a sample of 1356 diverse women living with HIV enrolled in the Women’s Interagency HIV Study (WIHS), a multi-center cohort study. Indirect effects analysis with bootstrapping was used to examine the potential mediating roles of internalized stigma and depressive symptoms in the association between perceived discrimination in healthcare settings and ART adherence. Perceived discrimination in healthcare settings was negatively associated with optimal (95% or better) ART adherence (adjusted odds ratio (AOR) = 0.81, p = 0.02, 95% confidence interval (CI) [0.68, 0.97]). Furthermore, internalization of stigma and depressive symptoms mediated the perceived discrimination-adherence association: Serial mediation analyses revealed a significant indirect effect of perceived discrimination in healthcare settings on ART adherence, first through internalized HIV stigma, and then through depressive symptoms (B = − 0.08, SE = 0.02, 95% CI [− 0.12, − 0.04]). Perceiving discrimination in healthcare settings may contribute to internalization of HIV-related stigma, which in turn may lead to depressive symptoms, with downstream adverse effects on ART adherence among women. These findings can guide the design of interventions to reduce discrimination in healthcare settings, as well as interventions targeting psychosocial mechanisms that may impact the ability of women living with HIV to adhere to ART regimens.