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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.
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1 Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA
2 Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
3 Department of Medicine, Stroger Hospital, Chicago, IL, USA
4 Department of Community Health Sciences, School of Public Health, State University of New York Downstate Medical Center, Brooklyn, NY, USA
5 School of Medicine and UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
6 Department of Family Medicine, Georgetown University Medical Center, Washington, DC, USA
7 Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
8 Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
9 School of Medicine, Emory University, Atlanta, GA, USA
10 Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
11 Department of Medicine, Department of Veteran Affairs Medical Center, University of California, San Francisco and Medical Service, San Francisco, CA, USA
12 Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
13 Division of HIV, ID and Global Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA