Skip to main content
SpringerLink
Log in

Social Network Characteristics Moderate the Association Between Stigmatizing Attributions About HIV and Non-adherence Among Black Americans Living with HIV: a Longitudinal Assessment

  • Original Article
  • Published:
Annals of Behavioral Medicine

Abstract

Background

Stigma may contribute to HIV-related disparities among HIV-positive Black Americans.

Purpose

We examined whether social network characteristics moderate stigma’s effects.

Methods

At baseline and 6 months post-baseline, 147 HIV-positive Black Americans on antiretroviral treatment completed egocentric social network assessments, from which we derived a structural social support capacity measure (i.e., ability to leverage support from the network, represented by the average interaction frequency between the participant and each alter). Stigma was operationalized with an indicator of whether any social network member had expressed stigmatizing attributions of blame or responsibility about HIV. Daily medication adherence was monitored electronically.

Results

In a multivariate regression, baseline stigma was significantly related to decreased adherence over time. The association between stigma and non-adherence was attenuated among participants who increased the frequency of their interactions with alters over time.

Conclusions

Well-connected social networks have the potential to buffer the effects of stigma.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. The White House Office of National AIDS Policy. National HIV/AIDS strategy for the United States. Available at http://aids.gov/federal-resources/national-hiv-aids-strategy/nhas.pdf. Accessibility verified March 5, 2014.

  2. Sabin CA, Smith CJ, Gumley H, et al. Late presenters in the era of highly active antiretroviral therapy: Uptake of and responses to antiretroviral therapy. AIDS. 2004; 18: 2145-2151.

    Article  PubMed  Google Scholar 

  3. Simoni JM, Huh D, Wilson IB, et al. Racial/ethnic disparities in ART adherence in the United States: Findings from the MACH14 study. J Acquir Immune Defic Syndr. 2012; 60: 466-472.

    Article  PubMed Central  PubMed  Google Scholar 

  4. Giordano TP, White AC, Sajja P, et al. Factors associated with the use of highly active antiretroviral therapy in patients newly entering care in an urban clinic. J Acquir Immune Defic Syndr. 2003; 32: 399-405.

    Article  PubMed  Google Scholar 

  5. Centers for Disease Control and Prevention. HIV in the United States: The stages of care. Available at http://www.cdc.gov/hiv/pdf/research_mmp_stagesofcare.pdf. Accessibility verified June 11 2015.

  6. Earnshaw VA, Bogart LM, Dovidio JF, Williams DR. Stigma and racial/ethnic HIV disparities: Moving towards resilience. Am Psychol. 2013; 68: 225-236.

    Article  PubMed Central  PubMed  Google Scholar 

  7. Bogart LM, Wagner GJ, Galvan FH, Klein DJ. Longitudinal relationships between antiretroviral treatment adherence and discrimination due to HIV-serostatus, race, and sexual orientation among African-American men with HIV. Ann Behav Med. 2010; 40: 184-190.

    Article  PubMed Central  PubMed  Google Scholar 

  8. Vanable PA, Carey MP, Blair DC, Littlewood RA. Impact of HIV-related stigma on health behaviors and psychological adjustment among HIV-positive men and women. AIDS Behav. 2006; 10: 473-482.

    Article  PubMed Central  PubMed  Google Scholar 

  9. Rajabiun S, Mallinson RK, McCoy K, et al. ‘Getting me back on track’: The role of outreach interventions in engaging and retaining people living with HIV/AIDS in medical care. AIDS Patient Care STDS. 2007; 21: S20-S29.

    Article  PubMed  Google Scholar 

  10. Katz IT, Ryu AE, Onuegbu AG, et al. Impact of HIV-related stigma on treatment adherence: Systematic review and meta-synthesis. J Int AIDS Soc. 2013; 16: 18640.

    Article  PubMed Central  PubMed  Google Scholar 

  11. Pascoe EA, Smart RL. Perceived discrimination and health: A meta-analytic review. Psychol Bull. 2009; 135: 531-554.

    Article  PubMed Central  PubMed  Google Scholar 

  12. Bogart LM, Cowgill BO, Kennedy D, et al. HIV-related stigma among people with HIV and their families: A qualitative analysis. AIDS Behav. 2008; 12: 244-254.

    Article  PubMed  Google Scholar 

  13. Bogart LM, Chetty S, Giddy J, et al. Barriers to care among people living with HIV in South Africa: Contrasts between patient and healthcare provider perspectives. AIDS Care. 2013; 25: 843-853.

    Article  PubMed Central  PubMed  Google Scholar 

  14. Konkle-Parker DJ, Erlen JA, Dubbert PM. Barriers and facilitators to medication adherence in a southern minority population with HIV disease. J Assoc Nurses AIDS Care. 2008; 19: 98-104.

    Article  PubMed Central  PubMed  Google Scholar 

  15. Mbonu NC, van den Borne B, De Vries NK. Stigma of people with HIV/AIDS in Sub-Saharan Africa: A literature review. J Trop Med. 2009; 2009: 145891.

    Article  PubMed Central  PubMed  Google Scholar 

  16. Okoror TA, Falade CO, Olorunlana A, Walker EM, Okareh OT. Exploring the cultural context of HIV stigma on antiretroviral therapy adherence among people living with HIV/AIDS in southwest Nigeria. AIDS Patient Care STDS. 2013; 27: 55-64.

    Article  PubMed  Google Scholar 

  17. Gilbert L, Walker L. ‘My biggest fear was that people would reject me once they knew my status…’: Stigma as experienced by patients in an HIV/AIDS clinic in Johannesburg, South Africa. Health Soc Care Community. 2010; 18: 139-146.

    Article  PubMed  Google Scholar 

  18. Bogart LM, Landrine H, Galvan FH, Wagner GJ, Klein DJ. Perceived discrimination and physical health among HIV-positive Black and Latino men who have sex with men. AIDS Behav. 2013; 17: 1431-1441.

    Article  PubMed Central  PubMed  Google Scholar 

  19. Cohen S. Social relationships and health. Am Psychol. 2004; 59: 676-684.

    Article  PubMed  Google Scholar 

  20. Williams DR, Mohammed SA. Discrimination and racial disparities in health: Evidence and needed research. J Behav Med. 2009; 32: 20-47.

    Article  PubMed Central  PubMed  Google Scholar 

  21. Brondolo E, Rieppi R, Kelly KP, Gerin W. Perceived racism and blood pressure: A review of the literature and conceptual and methodological critique. Ann Behav Med. 2003; 25: 55-65.

    Article  PubMed  Google Scholar 

  22. Landrine H, Klonoff EA. The schedule of racist events: A measure of racial discrimination and a study of its negative physical and mental health consequences. J Black Psychol. 1996; 22: 144-168.

    Article  Google Scholar 

  23. Janicke DM, Gray WN, Kahhan NA, et al. Brief report: The association between peer victimization, prosocial support, and treatment adherence in children and adolescents with inflammatory bowel disease. J Pediatr Psychol. 2009; 34: 769-773.

    Article  PubMed  Google Scholar 

  24. Wills TA, Ainette MG. Social Networks and Social Support. In: Baum A, Revenson TA, eds. Handbook of health psychology. New York: Taylor & Francis; 2012: 465-492.

    Google Scholar 

  25. Newsom JT, Rook KS, Nishishiba M, Sorkin DH, Mahan TL. Understanding the relative importance of positive and negative social exchanges: Examining specific domains and appraisals. J Gerontol B Psychol Sci Soc Sci. 2005; 60: 304-P312.

    Article  Google Scholar 

  26. Newsom JT, Mahan TL, Rook KS, Krause N. Stable negative social exchanges and health. Health Psychol. 2008; 27: 78-86.

    Article  PubMed  Google Scholar 

  27. Sherbourne CD, Stewart AL. The MOS social support survey. Soc Sci Med. 1991; 32: 705-714.

    Article  CAS  PubMed  Google Scholar 

  28. McCarty C. Measuring structure in personal networks. J Soc Struct. 2002; 3: 1.

    Google Scholar 

  29. McCarty C, Bernard H, Killworth P, Shelley GA, Johnsen EC. Eliciting representative samples of personal networks. Soc Networks. 1997; 19: 303-323.

    Article  Google Scholar 

  30. Campbell K, Lee B. Name generators in surveys of personal networks. Soc Networks. 1991; 13: 203-221.

    Article  Google Scholar 

  31. McCarty C, Kilworth PD, Rennell J. Impact of methods for reducing respondent burden on personal network structural measures. Soc Networks. 2007; 29: 300-315.

    Article  Google Scholar 

  32. Herek GM, Capitanio JP, Widaman KF. HIV-related stigma and knowledge in the United States: Prevalence and trends, 1991–1999. Am J Public Health. 2002; 92: 371-377.

    Article  PubMed Central  PubMed  Google Scholar 

  33. Kalichman SC, Simbayi LC, Cloete A, Mthembu PP, Mkhonta RN, Ginindza T. Measuring AIDS stigmas in people living with HIV/AIDS: The Internalized AIDS-Related Stigma Scale. AIDS Care. 2009; 21: 87-93.

    Article  PubMed  Google Scholar 

  34. Arnsten JH, Demas PA, Grant RW, et al. Impact of active drug use on antiretroviral therapy adherence and viral suppression in HIV-infected drug users. J Gen Intern Med. 2002; 17: 377-381.

    Article  PubMed Central  PubMed  Google Scholar 

  35. Bangsberg DR, Hecht FM, Charlebois ED, et al. Adherence to protease inhibitors, HIV-1 viral load, and development of drug resistance in an indigent population. AIDS. 2000; 14: 357-366.

    Article  CAS  PubMed  Google Scholar 

  36. Kobin AB, Sheth NU. Levels of adherence required for virologic suppression among newer antiretroviral medications. Ann Pharmacother. 2011; 45: 372-379.

    Article  CAS  PubMed  Google Scholar 

  37. Bangsberg DR. Less than 95% adherence to nonnucleoside reverse-transcriptase inhibitor therapy can lead to viral suppression. Clin Infect Dis. 2006; 43: 939-941.

    Article  CAS  PubMed  Google Scholar 

  38. Shuter J, Sarlo JA, Kanmaz TJ, Rode RA, Zingman BS. HIV-infected patients receiving lopinavir/ritonavir-based antiretroviral therapy achieve high rates of virologic suppression despite adherence rates less than 95%. J Acquir Immune Defic Syndr. 2007; 45: 4-8.

    Article  CAS  PubMed  Google Scholar 

  39. Bogart LM, Wagner G, Galvan FH, Banks D. Conspiracy beliefs about HIV are related to antiretroviral treatment nonadherence among African American men with HIV. J Acquir Immune Defic Syndr. 2010; 53: 648-655.

    PubMed Central  CAS  PubMed  Google Scholar 

  40. Berg KM, Demas PA, Howard AA, Schoenbaum EE, Gourevitch MN, Arnsten JH. Gender differences in factors associated with adherence to antiretroviral therapy. J Gen Intern Med. 2004; 19: 1111-1117.

    Article  PubMed Central  PubMed  Google Scholar 

  41. Meyer JP, Zelenev A, Wickersham JA, Williams CT, Teixeira PA, Altice FL. Gender disparities in HIV treatment outcomes following release from jail: Results from a multicenter study. Am J Public Health. 2014; 104: 434-441.

    Article  PubMed Central  PubMed  Google Scholar 

  42. Palepu A, Tyndall MW, Chan K, Wood E, Montaner JS, Hogg RS. Initiating highly active antiretroviral therapy and continuity of HIV care: The impact of incarceration and prison release on adherence and HIV treatment outcomes. Antivir Ther. 2004; 9: 713-719.

    PubMed  Google Scholar 

  43. Maman S, Abler L, Parker L, et al. A comparison of HIV stigma and discrimination in five international sites: The influence of care and treatment resources in high prevalence settings. Soc Sci Med. 2009; 68: 2271-2278.

    Article  PubMed Central  PubMed  Google Scholar 

  44. Green HD, Hoover MA, Wagner GJ, Ryan GW, Ssegujja E. Measuring agreement between egos and alters: Understanding informant accuracy in personal network studies. Field Methods. 2013; 26: 126-140.

    Article  Google Scholar 

  45. Rice E, Milburn NG, Rotheram-Borus MJ. Pro-social and problematic social network influences on HIV/AIDS risk behaviours among newly homeless youth in Los Angeles. AIDS Care. 2007; 19: 697-704.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  46. Valente TW, Vlahov D. Selective risk taking among needle exchange participants: Implications for supplemental interventions. Am J Public Health. 2001; 91: 406-411.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  47. Costenbader EC, Astone NM, Latkin CA. The dynamics of injection drug users’ personal networks and HIV risk behaviors. Addiction. 2006; 101: 1003-1013.

    Article  PubMed  Google Scholar 

  48. El-Bassel N, Gilbert L, Wu E, Chang M. A social network profile and HIV risk among men on methadone: Do social networks matter? J Urban Health. 2006; 83: 602-613.

    Article  PubMed Central  PubMed  Google Scholar 

  49. Williams CT, Latkin CA. Neighborhood socioeconomic status, personal network attributes, and use of heroin and cocaine. Am J Prev Med. 2007; 32: S203-S210.

    Article  PubMed Central  PubMed  Google Scholar 

  50. Stangl AL, Lloyd JK, Brady LM, Holland CE, Baral S. A systematic review of interventions to reduce HIV-related stigma and discrimination from 2002 to 2013: How far have we come? J Int AIDS Soc. 2013; 16: 18734.

    Article  PubMed Central  PubMed  Google Scholar 

Download references

Acknowledgments

This study was funded by National Institute of Minority Health and Health Disparities R01MD003964. Support for manuscript preparation was also provided by P30 AI060354. We are grateful to the staff of APLA and SPECTRUM, including Charles Hilliard, PhD, for helping with recruitment and for providing interview space; to Frank Galvan, PhD, for contributions to study design; and to Denedria Banks, Erin Cooper, Sean Jamar Lawrence, Alan Meyer, Argelis Ortiz, and Sandi Paffen for research assistance.

Authors’ Statement of Conflict of Interest and Adherence to Ethical Standards

Authors Bogart, Wagner, Green, Mutchler, Klein, and McDavitt declare that they have no conflict of interest. All procedures, including the informed consent process, were conducted in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000.

Author information

Authors and Affiliations

  1. Division of General Pediatrics, Department of Medicine, Boston Children’s Hospital, Boston, MA, USA

    Laura M. Bogart PhD & David J. Klein MS

  2. Department of Pediatrics, Harvard Medical School, Boston, MA, USA

    Laura M. Bogart PhD

  3. Health Unit, RAND Corporation, 1776 Main Street, P.O. Box 2138, Santa Monica, CA, 90407-2138, USA

    Laura M. Bogart PhD, Glenn J. Wagner PhD & Harold D. Green Jr. PhD

  4. Department of Sociology, California State University, Dominguez Hills, Long Beach, CA, USA

    Matt G. Mutchler PhD & Bryce McDavitt PhD

  5. Community-Based Research, AIDS Project Los Angeles, Los Angeles, CA, USA

    Matt G. Mutchler PhD & Bryce McDavitt PhD

  6. Clinical Psychology, Pacifica Graduate Institute, Carpinteria, CA, USA

    Bryce McDavitt PhD

Authors
  1. Laura M. Bogart PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Glenn J. Wagner PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Harold D. Green Jr. PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Matt G. Mutchler PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. David J. Klein MS
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Bryce McDavitt PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Harold D. Green Jr. PhD.

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Bogart, L.M., Wagner, G.J., Green, H.D. et al. Social Network Characteristics Moderate the Association Between Stigmatizing Attributions About HIV and Non-adherence Among Black Americans Living with HIV: a Longitudinal Assessment. ann. behav. med. 49, 865–872 (2015). https://doi.org/10.1007/s12160-015-9724-1

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12160-015-9724-1

Keywords

Search

Navigation