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Pathways to Health: an Examination of HIV-Related Stigma, Life Stressors, Depression, and Substance Use

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Abstract

Background

Despite antiretroviral treatment (ART) being an efficacious treatment for HIV, essentially making it a chronic non-terminal illness, two related and frequent concerns for many people living with HIV/AIDS (PLWHA) continue to be HIV-related stigma and life stress. These two variables are frequently associated with depression, substance use, and poorer functional health. Studies to date have not fully examined the degree to which these constructs may be associated within one model, which could reveal a more nuanced understanding of how HIV-related stigma and life stress affect functional health in PLWHA.

Methods

The current study employed hybrid structural equation modeling to examine the interconnectedness and potential indirect relationships of HIV-related stigma and life stress to worse health through substance use and depression, controlling for ART adherence and age. Participants were 240 HIV-infected individuals who completed a biopsychosocial assessment battery upon screening for an RCT on treating depression in those infected with HIV.

Results

Both HIV-related stigma and stressful life events were directly related to depression, and depression was directly related to health. There were significant indirect effects from stigma and stress to health via depression. There were no significant effects involving substance use.

Conclusion

It is important to continue to develop ways to address stigma, stressful life events, and their effects on distress in those living with HIV. Expanding our knowledge of disease progression risk factors beyond ART adherence is important to be able to design adjuvant interventions, particularly because treatment means that people living with HIV have markedly improved life expectancy and that successful treatment means that HIV is not transmittable to others.

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Funding

The project described was supported by R01MH084757 (Safren) from the National Institute of Mental Health. Some of the author time was funded by 9K24DA040489 (Safren) from the National Institute on Drug Abuse.

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Authors and Affiliations

  1. Department of Psychology, University of Miami, Coral Gables, FL, USA

    Tiffany R. Glynn, Maria M. Llabre, Jasper S. Lee & Steven A. Safren

  2. Department of Psychiatry, The Fenway Institute, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA

    C. Andres Bedoya & Conall O’Cleirigh

  3. Department of Psychiatry and Human Behavior, The Miriam Hospital, Clinical Behavioral Medicine Service of the Immunology Center, Warren Alpert Medical School of Brown University, Providence, RI, USA

    Megan M. Pinkston

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  1. Tiffany R. Glynn
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Correspondence to Steven A. Safren.

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Glynn, T.R., Llabre, M.M., Lee, J.S. et al. Pathways to Health: an Examination of HIV-Related Stigma, Life Stressors, Depression, and Substance Use. Int.J. Behav. Med. 26, 286–296 (2019). https://doi.org/10.1007/s12529-019-09786-3

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