Health Care-Specific Enacted HIV-Related Stigma's Association with Antiretroviral Therapy Adherence and Viral Suppression Among People Living with HIV in Florida

• Published in: AIDS patient care and STDs Vol. 34; no. 7; p. 316
• Main Authors: Algarin, Angel B, Sheehan, Diana M, Varas-Diaz, Nelson, Fennie, Kristopher P, Zhou, Zhi, Spencer, Emma C, Cook, Robert L, Morano, Jamie P, Ibanez, Gladys E
• Format: Journal Article
• Language: English
• Published: United States 01.07.2020
• Subjects: Adult; Anti-HIV Agents - administration & dosage; Anti-HIV Agents - therapeutic use; Anti-Retroviral Agents - therapeutic use; Antiretroviral Therapy, Highly Active - methods; Attitude of Health Personnel; Cohort Studies; Continuity of Patient Care; Discrimination, Psychological; Female; Florida - epidemiology; HIV Infections - drug therapy; HIV Infections - epidemiology; HIV Infections - psychology; HIV Infections - virology; Humans; Male; Medication Adherence - psychology; Medication Adherence - statistics & numerical data; Middle Aged; Prejudice; Social Stigma; Viral Load - drug effects; Florida; HIV/AIDS; antiretroviral therapy adherence; viral suppression; stigma; Florida; continuum of care
• ISSN: 1557-7449
• DOI: 10.1089/apc.2020.0031

Among people living with HIV (PLWH) in Florida, <2/3 are virally suppressed (viral load <200 copies/mL). Previous theoretical frameworks have pointed to HIV-related stigma as an important factor for viral suppression; an important outcome related to the HIV continuum of care. This study aims to analyze the association between enacted HIV-related stigma and antiretroviral therapy (ART) adherence and viral suppression among a sample of PLWH in Florida. The overall sample (  = 932) was male (66.0%), majority greater than 45 years of age (63.5%), black (58.1%), and non-Hispanic (79.7%). Adjusted odds ratios (AOR) and 95% confidence intervals (CI) were estimated using logistic regression models. The odds of nonadherence to ART was not significantly greater for those reporting low/moderate or high levels of general enacted HIV-related stigma (vs. no stigma) [AOR = 1.30, CI: (0.87-1.95),  = 0.198; AOR = 1.17, CI: (0.65-2.11),  = 0.600, respectively]. Moreover, the odds of nonviral suppression were not significantly greater for those reporting low/moderate or high levels of general enacted HIV-related stigma (vs. no stigma) [AOR = 0.92, CI: (0.60-1.42),  = 0.702; AOR = 1.16, CI: (0.64-2.13),  = 0.622, respectively]. However, ever experiencing health care-specific enacted HIV-related stigma was associated with both nonadherence [AOR = 2.29, CI: (1.25-4.20),  = 0.008] and nonsuppression [AOR = 2.16, CI: (1.19-3.92),  = 0.011]. Despite limitations, the results suggest that the perpetuation of stigma by health care workers may have a larger impact on continuum of care outcomes of PLWH than other sources of enacted stigma. Based on the results, there is a need to develop and evaluate interventions for health care workers intended to reduce experienced stigma among PLWH and improve health outcomes.