Longitudinal associations between intersectional stigmas, antiretroviral therapy adherence, and viral load among women living with HIV using multidimensional latent transition item response analysis

Andrea Norcini-Pala; Kristi L Stringer; Mirjam-Colette Kempf; Deborah Konkle-Parker; Tracey E Wilson; Phyllis C Tien; Gina Wingood; Torsten B Neilands; Mallory O Johnson; Sheri D Weiser; Carmen H Logie; Elizabeth F Topper; Janet M Turan; Bulent Turan

doi:10.1016/j.socscimed.2024.117643

Longitudinal associations between intersectional stigmas, antiretroviral therapy adherence, and viral load among women living with HIV using multidimensional latent transition item response analysis

Soc Sci Med. 2024 Dec 19:366:117643. doi: 10.1016/j.socscimed.2024.117643. Online ahead of print.

Authors

Affiliations

¹ Department of Community Health Sciences, School of Public Health, State University of New York Downstate Health Sciences University, Brooklyn, NY, USA. Electronic address: [email protected].
² Community and Public Health, Middle Tennessee State University, Murfreesboro, TN, USA.
³ Schools of Nursing, Public Health and Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
⁴ Division of Infectious Diseases, School of Medicine and School of Nursing, University of Mississippi Medical Center, Jackson, MS, USA.
⁵ Department of Community Health Sciences, School of Public Health, State University of New York Downstate Health Sciences University, Brooklyn, NY, USA.
⁶ Department of Medicine, University of California, San Francisco and Medical Service, Department of Veteran Affairs Medical Center, San Francisco, CA, USA.
⁷ Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York City, NY, USA.
⁸ Department of Medicine, University of California, San Francisco, CA, USA.
⁹ Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada.
¹⁰ Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA.
¹¹ Department of Health Policy and Organization, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA.
¹² Department of Psychology, Koc University, Istanbul, Turkey; Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA.

PMID: 39746230
DOI: 10.1016/j.socscimed.2024.117643

Abstract

Background: In the US, Women, especially Black and Latina women living in disadvantaged environments, are disproportionally affected by HIV. Women living with HIV (WLHIV) have higher rates of suboptimal antiretroviral therapy (ART) adherence, and detectable viral load (VL). Experiences of intersectional poverty, HIV, gender, and racial stigmas may increase the rates of detectable VL through suboptimal ART adherence.

Aims: To explore longitudinal associations between intersectional stigmas, ART adherence, and detectable VL using multidimensional latent transition item response analysis.

Participants: WLHIV (N = 459) in the [masked] sub-study of the [masked], from sites in Birmingham, AL, Jackson, MS, Atlanta, GA, and San Francisco, CA.

Assessment: Experienced poverty, HIV, gender, and racial stigma, self-report ART adherence, and VL were assessed at four yearly follow-ups between 2016 and 2020.

Results: We identified five classes of WLHIV with different combinations of experienced intersectional stigmas. Longitudinally, WLHIV with higher levels of poverty, gender, and racial stigma had higher odds of suboptimal ART adherence (<90%) (OR = 3.59, p < 0.001) and detectable VL (OR = 2.08, p = 0.028) compared to WLHIV with lower/moderately low stigmas levels. WLHIV in the highest stigma classes had higher odds of detectable VL, independently of ART adherence (Class 3: OR = 1.38, p = 0.016; Class 5: OR = 1.31, p = 0.046). These findings underscore the compounded effects of intersectional stigmas on HIV treatment outcomes.

Conclusion: Intersecting experiences of HIV, racial, gender, and poverty stigmas can increase detectable VL risk through suboptimal ART adherence, although other mechanisms may also be involved. Recognizing the complexity of intersectional stigmas is essential for developing approaches to improve WLHIV's HIV treatment outcomes.