Culturally Relevant Africultural Coping Moderates the Association Between Discrimination and Antiretroviral Adherence Among Sexual Minority Black Americans Living with HIV

• Published in: AIDS and behavior Vol. 28; no. 2; pp. 408 - 420
• Main Authors: Wagner, Glenn J., Bogart, Laura M., Klein, David J., Lawrence, Sean J., Goggin, Kathy, Gizaw, Mahlet, Mutchler, Matt G.
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.02.2024; Springer Nature B.V
• Subjects: African Americans; African culture; Anti-Retroviral Agents - therapeutic use; Antiretroviral agents; Antiretroviral drugs; Antiretroviral therapy; Black or African American - psychology; Cognition; Cognitive ability; Coping; Coping Skills; Coping strategies; Culturally Competent Care - ethnology; Discrimination; Emotions; Female; Gays & lesbians; Health behavior; Health Psychology; HIV; HIV Infections - psychology; Homophobia - ethnology; Human immunodeficiency virus; Humans; Infectious Diseases; Intersectionality; Male; Medication Adherence - psychology; Medicine; Medicine & Public Health; Original Paper; Patient compliance; Prejudice - ethnology; Prescription drugs; Public Health; Race; Racial discrimination; Racism - ethnology; Rituals; Sexual and Gender Minorities - psychology; Sexual behavior; Sexual orientation; Sexually transmitted diseases; Statistical analysis; STD; Stress; United States > US; Adherence; Discrimination; Sexual minorities; HIV; Africultural coping
• ISSN: 1090-7165; 1573-3254; 1573-3254
• DOI: 10.1007/s10461-023-04233-7

Exposure to discrimination has been linked to lower HIV antiretroviral therapy (ART) adherence and poor HIV care outcomes among Black Americans. Coping has been shown to mitigate the harmful effects of discrimination on health behaviors, but the use of cultural relevant Africultural coping strategies is understudied as a moderator of the association between intersectional discrimination and ART adherence among Black Americans. We used adjusted logistic regression to test whether Africultural coping strategies (cognitive/emotional debriefing; collective; spiritual-centered; ritual-centered) moderated associations between multiple forms of discrimination (HIV, sexual orientation, race) and good ART adherence (minimum of 75% or 85% of prescribed doses taken, as measured by electronic monitoring in separate analyses) among 92 sexual minority Black Americans living with HIV. Mean adherence was 66.5% in month 8 after baseline (36% ≥ 85% adherence; 49% ≥ 75% adherence). Ritual-centered coping moderated the relationship between each of the three types of discrimination at baseline and good ART adherence in month 8 (regardless of the minimum threshold for good adherence); when use of ritual coping was low, the association between discrimination and adherence was statistically significant. The other three coping scales each moderated the association between racial discrimination and good ART adherence (defined by the 75% threshold); cognitive/emotional debriefing was also a moderator for both HIV- and race-related discrimination at the 85% adherence threshold. These findings support the benefits of Africultural coping, particularly ritual-centered coping, to help sexual minority Black Americans manage stressors associated with discrimination and to adhere well to ART.