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Experienced HIV-Related Stigma and Psychological Distress in Peruvian Sexual and Gender Minorities: A Longitudinal Study to Explore Mediating Roles of Internalized HIV-Related Stigma and Coping Styles

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Abstract

Experiencing HIV-related stigma has important impacts on the mental health of people living with HIV, which has implications for treatment adherence, disease progression, and health outcomes. The impacts of stigma are particularly important to consider among sexual and gender minorities, who often face a disproportionate burden of HIV. To address the implications of stigma in these key populations, we leveraged a longitudinal study conducted among Peruvian sexual and gender minorities to compare the relative effects of multiple mediators affecting the relationship between experienced HIV-related stigma and psychological distress: internalized HIV-related stigma, adaptive coping, and maladaptive coping. HIV-related stigma, coping, and distress were measured, respectively, at 24 weeks, 36 weeks, and 48 weeks post-diagnosis for 145 participants from the Sabes Study. HIV-related maladaptive coping largely mediated the relationship between experienced HIV-related stigma and distress. Our findings suggest interventions targeting maladaptive coping may alleviate the mental health consequences of experiencing HIV-related stigma.

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Change history

  • 07 February 2019

    Correction to: AIDS and Behavior (2018) 1–14 <ExternalRef><RefSource>https://doi.org/10.1007/s10461-018-2348-2</RefSource><RefTarget Address="10.1007/s10461-018-2348-2" TargetType="DOI"/></ExternalRef>. In the original publication of the article, the given name of the second author was not correct. The name has been corrected with this erratum.

References

  1. Sherbourne CD, Hays RD, Fleishman JA, et al. Impact of psychiatric conditions on health-related quality of life in persons with HIV infection. Am J Psych. 2000;157:248–54.

    Article  CAS  Google Scholar 

  2. Boarts JM, Sledjeski EM, Bogart LM, Delahanty DL. The differential impact of PTSD and depression on HIV disease markers and adherence to HAART in people living with HIV. AIDS Behav. 2006;10(3):253–61.

    Article  PubMed  Google Scholar 

  3. Carrieri MP, Leport C, Protopopescu C, et al. Factors associated with nonadherence to highly active antiretroviral therapy: a 5-year follow-up analysis with correction for the bias induced by missing data in the treatment maintenance phase. J Acquir Immune Defic Syndr. 2006;41(4):477–85.

    Article  PubMed  Google Scholar 

  4. Kacanek D, Jacobson DL, Spiegelman D, Wanke C, Isaac R, Wilson IB. Incident depression symptoms are associated with poorer HAART adherence: a longitudinal analysis from the Nutrition for Healthy Living study. J Acquir Immune Defic Syndr. 2010;53(2):266–72.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Keuroghlian AS, Kamen CS, Neri E, Lee S, Liu R, Gore-Felton C. Trauma, dissociation, and antiretroviral adherence among persons living with HIV/AIDS. J Psychiatr Res. 2011;45(7):942–8.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Boarts JM, Buckley-Fischer BA, Armelie AP, Bogart LM, Delahanty DL. The impact of HIV diagnosis-related vs. non-diagnosis related trauma on PTSD, depression, medication adherence, and HIV disease markers. J Evid Based Soc Work. 2009;6(1):4–16.

    Article  PubMed  Google Scholar 

  7. Bing EG, Burnam MA, Longshore D, Fleishman JA, Sherbourne CD, London AS, et al. Psychiatric disorders and drug use among human immunodeficiency virus-infected adults in the United States. Arch Gen Psychiatry. 2001;58(8):721–8.

    Article  CAS  PubMed  Google Scholar 

  8. Valente SM. Depression and HIV disease. J Assoc Nurses AIDS Care. 2003;14(2):41–51.

    Article  PubMed  Google Scholar 

  9. Tegger MK, Crane HM, Tapia KA, Uldall KK, Holte SE, Kitahata MM. The effect of mental illness, substance use, and treatment for depression on the initiation of highly active antiretroviral therapy among HIV-infected individuals. AIDS Patient Care STDS. 2008;22(3):233–43.

    Article  PubMed  Google Scholar 

  10. O’Cleirigh CO, Skeer M, Mayer KH, et al. Functional impairment and health care utilization among HIV-infected men who have sex with men: the relationship with depression and post-traumatic stress. J Behav Med. 2009;32:466–77.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Valencia-Garcia D, Rao D, Strick L, Simoni JM. Women’s experiences with HIV-related stigma from health care providers in Lima, Peru: “I would rather die than go back for care”. Health Care Women Int. 2017;38(2):144–58.

    Article  PubMed  Google Scholar 

  12. Wohl AR, Galvan FH, Carlos JA, et al. A comparison of MSM stigma, HIV stigma and depression in HIV-positive Latino and African American men who have sex with men (MSM). AIDS Behav. 2013;17(4):1454–64.

    Article  PubMed  Google Scholar 

  13. Jeffries WL 4th, Townsend ES, Gelaude DJ, Torrone EA, Gasiorowicz M, Bertolli J. HIV stigma experienced by young men who have sex with men (MSM) living with HIV infection. AIDS Educ Prev. 2015;27(1):58–71.

    Article  PubMed  Google Scholar 

  14. Valenzuela C, Ugarte-Gil C, Paz J, et al. HIV stigma as a barrier to retention in HIV care at a general hospital in Lima, Peru: a case–control study. AIDS Behav. 2015;19(2):235–45.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Turan B, Smith W, Cohen MH, et al. Mechanisms for the negative effects of internalized HIV-related stigma on antiretroviral therapy adherence in women: the mediating roles of social isolation and depression. J Acquir Immune Defic Syndr. 2016;72(2):198–205.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Logie C, Gadalla TM. Meta-analysis of health and demographic correlates of stigma towards people living with HIV. AIDS Care. 2009;21(6):742–53.

    Article  CAS  PubMed  Google Scholar 

  17. Chen WT, Shiu CS, Yang JP, et al. Antiretroviral therapy (ART) side effect impacted on quality of life, and depressive symptomatology: a mixed-method study. J AIDS Clin Res. 2013;29(4):218.

    CAS  Google Scholar 

  18. Pappin M, Wouters E, Booysen FL. Anxiety and depression amongst patients enrolled in a public sector antiretroviral treatment programme in South Africa: a cross-sectional study. BMC Public Health. 2012;12:244.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Katz IT, Ryu AE, Onuegbu AG, Psaros C, Weiser SD, Bangsberg DR, Tsai AC. Impact of HIV-related stigma on treatment adherence: systematic review and meta-synthesis. J Int AIDS Soc. 2013;16(3 Suppl 2):18640.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Secor AM, Wahome E, Micheni M, et al. Depression, substance abuse and stigma among men who have sex with men in coastal Kenya. AIDS. 2015;29(Suppl 3):S251–9.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Rao D, Feldman BJ, Fredericksen RJ, Crane PK, Simoni JM, Kitahata MM, Crane HM. A structural equation model of HIV-related stigma, depressive symptoms, and medication adherence. AIDS Behav. 2012;16(3):711–6.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Pearson CR, Micek MA, Pfeiffer J, Montoya P, et al. One year after ART initiation: psychosocial factors associated with stigma among HIV-positive mozambicans. AIDS Behav. 2009;13:1189–96.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Endeshaw M, Walson J, Rawlins S, et al. Stigma in Ethiopia: association with depressive symptoms in people with HIV. AIDS Care. 2014;26(8):935–9.

    Article  PubMed  Google Scholar 

  24. Goffman E. Stigma: Notes on the Management of a Spoiled Identity. New York: Simon & Schuster; 1963.

    Google Scholar 

  25. Goffman E. Stigma: Notes on the management of spoiled identity. New York: Simon and Schuster; 2009.

    Google Scholar 

  26. Earnshaw VA. From conceptualizing to measuring HIV stigma: a review of HIV stigma mechanism measures. AIDS Behav. 2009;13(6):1160–77. https://doi.org/10.1007/s10461-009-9593-3.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Earnshaw VA, Smith LR, Chaudoir SR, Amico KR, Copenhaver MM. HIV stigma mechanisms and well-being among PLWH: a test of the HIV stigma framework. AIDS Behav. 2013;17(5):1785–95. https://doi.org/10.1007/s10461-013-0437-9.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Earnshaw VA, Lang SM, Lippitt M, Jin H, Chaudoir SR. HIV stigma and physical health symptoms: do social support, adaptive coping, and/or identity centrality act as resilience resources? AIDS Behav. 2015;19(1):41–9.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Franke MF, Muñoz M, Finnegan K, Zeladita J, Sebastian JL, Bayona JN, Shin SS. Validation and abbreviation of an HIV stigma scale in an adult spanish-speaking population in urban Peru. AIDS Behav. 2010;14(1):189–99.

    Article  PubMed  Google Scholar 

  30. Shin S, Muñoz M, Caldas A, et al. Mental health burden among impoverished HIV-positive patients in Peru. J Int Assoc Phys AIDS Care. 2011;10(1):18–25.

    Article  Google Scholar 

  31. Bastos FI, Caceres C, Galvao J, Veras MA, Castilho EA. AIDS in Latin America: assessing the current status of the epidemic and the ongoing response. Int J Epidemiol. 2008;37(4):729–37.

    Article  PubMed  Google Scholar 

  32. UNAIDS. Global report: UNAIDS report on the global AIDS epidemic 2013. Geneva, Switzerland: Joint United Nations Programme on HIV/AIDS (UNAIDS); 2013. Contract No.: UNAIDS/JC2502/1/E.

  33. Perez-Brumer AG, Reisner SL, McLean SA, et al. Leveraging social capital: multilevel stigma, associated HIV vulnerabilities, and social resilience strategies among transgender women in Lima, Peru. J Int AIDS Soc. 2017;20(1):21462.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Beyrer C, Baral SD, Walker D, Wirtz AL, Johns B, Sifakis F. The expanding epidemics of HIV type 1 among men who have sex with men in low-and middle-income countries: diversity and consistency. Epidemiol Rev. 2010;32(1):137–51.

    Article  PubMed  Google Scholar 

  35. Caceres CF. HIV among gay and other men who have sex with men in Latin America and the Caribbean: a hidden epidemic? AIDS. 2002;16:S23–33.

    Article  PubMed  Google Scholar 

  36. Garcia J, Perez-Brumer AG, Cabello R, Clark JL. “And Then Break the Cliché”: understanding and addressing HIV vulnerability through development of an HIV prevention telenovela with men who have sex with men and transwomen in Lima, Peru. Arch Sexual Behav. 2018;1:11.

    Google Scholar 

  37. UNAIDS. Expanding the global response to HIV/AIDS through focused action. Reducing risk and vulnerability: definitions, principles, and strategies. UNAIDS Best Practices Collection. Geneva, 1998.

  38. Goodreau SM, Carnegie NB, Vittinghoff E, Lama JR, Sanchez J, Grinsztej B, et al. What drives the US and Peruvian HIV epidemics in men who have sex with men (MSM)? PLoS ONE. 2012;7(11):e50522.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  39. Maldonado Ruiz H, Peña Olano RF, Torvisco T, David J. Frecuencia de episodio depresivo mayor y factores relacionados en pacientes infectados por el virus de la inmunodeficiencia humana en tratamiento antirretroviral de gran actividad (TARGA) en un hospital público de Lima. Revista de Neuro-Psiquiatría. 2015;78(1):3–13.

    Article  Google Scholar 

  40. McLaughlin MM, Franke MF, Muñoz M, Nelson AK, Saldana O, Santa Cruz J, et al. Community-based accompaniment with supervised antiretrovirals for HIV-positive adults in Peru: a cluster-randomized trial. AIDS Behav. 2018;22(1):287–96.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Shin S, Muñoz M, Espiritu B, Zeladita J, Sanchez E, Callacna M, et al. Psychosocial impact of poverty on antiretroviral nonadherence among HIV-TB coinfected patients in Lima, Peru. J Int Assoc Phys AIDS Care. 2008;7(2):74–81.

    Article  Google Scholar 

  42. Wu DY, Munoz M, Espiritu B, Zeladita J, Sanchez E, Callacna M, et al. Burden of depression among impoverished HIV-positive women in Peru. JAIDS J Acquir Imm Defic Syndr. 2008;48(4):500–4.

    Article  Google Scholar 

  43. Lyimo RA, Stutterheim SE, Hospers HJ, et al. Stigma, disclosure, coping, and medication adherence among people living with HIV/AIDS in Northern Tanzania. AIDS Patient Care STDS. 2014;28(2):98–105.

    Article  PubMed  Google Scholar 

  44. Budhwani H, Hearld KR, Hasbun J, et al. Transgender female sex workers’ HIV knowledge, experienced stigma, and condom use in the Dominican Republic. PLoS ONE. 2017;12(11):e0186457.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  45. Smith R, Rossetto K, Peterson L. A meta-analysis of disclosure of one’s HIV-positive status, stigma and social support. AIDS Care. 2008;20(10):1266–75.

    Article  PubMed  Google Scholar 

  46. Nyblade LC. Measuring HIV stigma: Existing knowledge and gaps. Psych Health Med. 2006;11(3):335–45.

    Article  Google Scholar 

  47. Fay H, Baral SD, Trapence G, et al. Stigma, health care access, and HIV knowledge among men who have sex with men in Malawi, Namibia, and Botswana. AIDS Behav. 2011;15(6):1088–97.

    Article  PubMed  Google Scholar 

  48. Brohan E, Slade M, Clement S, Thornicroft G. Experiences of mental illness stigma, prejudice and discrimination: a review of measures. BMC Health Serv Res. 2010. https://doi.org/10.1186/1472-6963-10-80.

    Article  PubMed  PubMed Central  Google Scholar 

  49. Kumar S, Mohanraj R, Rao D, Murray KR, Manhart LE. Positive coping strategies and HIV-related stigma in South India. AIDS Patient Care STDS. 2015;29(3):157–63.

    Article  PubMed  PubMed Central  Google Scholar 

  50. Breet E, Kagee A, Seedat S. HIV-related stigma and symptoms of post-traumatic stress disorder and depression in HIV-infected individuals: Does social support play a mediating or moderating role? AIDS Care. 2014;26(8):947–51.

    Article  PubMed  Google Scholar 

  51. Earnshaw VA, Smith LR, Cunningham CO, Copenhaver MM. Intersectionality of internalized HIV stigma and internalized substance use stigma: Implications for depressive symptoms. J Health Psychol. 2015;20(8):1083–9.

    Article  PubMed  Google Scholar 

  52. Frydenberg E. Coping research: Historical background, links with emotion, and new research directions on adaptive processes. Austral J Psychol. 2014;66(2):82–92.

    Article  Google Scholar 

  53. Lama JR, Brezak A, Dobbins JG, Sanchez H, Cabello R, Rios J, et al. Design strategy of the Sabes Study: diagnosis and treatment of early HIV infection among men who have sex with men and transgender women in Lima, Peru, 2013–2017. Am J Epidemiol. 2018;187:1577–85.

    Article  PubMed  PubMed Central  Google Scholar 

  54. Molina Y, Ramirez-Valles J. HIV/AIDS stigma: Measurement and relationships to psycho-behavioral factors in Latino gay/bisexual men and transgender women. AIDS Care. 2013;25:1559–68.

    Article  CAS  PubMed  Google Scholar 

  55. Molina Y, Dirkes J, Valles-Ramirez J. Burn-out among HIV/AIDS volunteers: a socio-cultural analysis among Latino gay and bisexual men and transgender people. Nonprofit Volunt Sector Quart. 2017;46:1231–49.

    Article  Google Scholar 

  56. Carver CS. You want to measure coping but your protocol’s too long: consider the brief COPE. Int J Behav Med. 1997;4:92–100.

    Article  CAS  PubMed  Google Scholar 

  57. Perczek R, Carver CS, Price AA, Pozo-Kaderman C. Coping, mood, and aspects of personality in Spanish translation and evidence of convergence with English versions. J Pers Assess. 2000;74:63–87.

    Article  CAS  PubMed  Google Scholar 

  58. Vilagut G, Forero CG, Barbaglia G, Alonso J. Screening for depression in the general population with the center for epidemiologic studies depression (CES-D): a systematic review with meta-analysis. PLoS ONE. 2016;11(5):e0155431.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  59. Ruiz-Grosso P, Loret de Mola C, Vega-Dienstmaier JM, Arevalo JM, Chavez K, Vilela A, et al. Validation of the Spanish Center for epidemiological studies depression and Zung self-rating depression scales: a comparative validation study. PLoS ONE. 2012;7(10):e45413.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  60. Caamaño WL, Fuentes MD, González BL, Melipillán AR, Sepúlveda CM, Valenzuela GE. Assessment of the impact of event scale revised for post traumatic stress disorder in Chilean subjects. Rev Med Chil. 2011;139(9):1163–8.

    Article  Google Scholar 

  61. Contreras-Pezzotti L, Arteaga-Medina J, Campo-Arias A. Study of the internal consistency and factor structure of the impact of event scale among Colombian women victim of violence. Vertex. 2009;20(83):5–9.

    PubMed  Google Scholar 

  62. Sheppard T, Tamblyn R, Abrahamowicz M, Lunt M, Sperrin M, Dixon WG. A comparison of methods for estimating the temporal change in a continuous variable: example of HbA1c in patients with diabetes. Pharmacoepidemiol Drug Saf. 2017;26(12):1474–82.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  63. Hayes AF. Introduction to mediation, moderation, and conditional process analysis, first edition: a regression-based approach. Methodol Soc Sci. 2013;1:692.

    Google Scholar 

  64. Preacher KJ, Kelley K. Effect size measures for mediation models: quantitative strategies for communicating indirect effects. Psychol Methods. 2011;16(2):93.

    Article  PubMed  Google Scholar 

  65. Martinez J, Harper G, Carleton RA, et al. The impact of stigma on medication adherence among HIV-positive adolescent and young adult females and the moderating effects of coping and satisfaction with health care. AIDS Patient Care STDs. 2012;26(2):108–15.

    Article  PubMed  PubMed Central  Google Scholar 

  66. Rao D, Choi SW, Victorson D, et al. Measuring stigma across neurological conditions: the development of the stigma scale for chronic illness (SSCI). Qual Life Res. 2009;18(5):585–95.

    Article  PubMed  PubMed Central  Google Scholar 

  67. Krueger EA, Chiu CJ, Menacho LA, Young SD. HIV testing among social media-using Peruvian men who have sex with men: correlates and social context. AIDS Care. 2016;28(10):1301–5. https://doi.org/10.1080/09540121.2016.1178699.

    Article  PubMed  PubMed Central  Google Scholar 

  68. Heijnders M, Van Der Meij S. The fight against stigma: an overview of stigma-reduction strategies and interventions. Psych health med. 2006;11(3):353–63.

    Article  Google Scholar 

  69. Brown L, Macintyre K, Trujillo L. Interventions to reduce HIV/AIDS stigma: what have we learned? AIDS Educ Prev. 2003;15(1):49–69.

    Article  PubMed  Google Scholar 

  70. Collins PY, Holman AR, Freeman MC, Patel V. What is the relevance of mental health to HIV/AIDS care and treatment programs in developing countries? A systematic review. AIDS. 2006;20(12):1571.

    Article  PubMed  PubMed Central  Google Scholar 

  71. Chuah FL, Haldane VE, Cervero-Liceras F, Ong SE, Sigfrid LA, Murphy G, Watt N, Balabanova D, Hogarth S, Maimaris W, Otero L. Interventions and approaches to integrating HIV and mental health services: a systematic review. Health Policy Plan. 2017;32:27–47.

    Article  Google Scholar 

  72. Maiorana A, Kegeles S, Salazar X, Konda K, Silva-Santisteban A, Cáceres C. ‘Proyecto Orgullo’, an HIV prevention, empowerment and community mobilisation intervention for gay men and transgender women in Callao/Lima, Peru. Glob Public Health. 2016;11(7–8):1076–92.

    Article  PubMed  PubMed Central  Google Scholar 

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Funding

This study was funded by National Institutes on Drug Abuse (RO1 DA032106; PI: Ann Duerr). Dr. Molina’s efforts were supported by the National Cancer Institute (K01CA193918). We acknowledge ART drug donation from Gilead Sciences Inc. and Merck & Co Inc.

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Authors and Affiliations

  1. Fred Hutchinson Cancer Research Center, Seattle, USA

    Rachel Rinehart, Siavash Pasalar, Ann Duerr & Yamile Molina

  2. Department of Global Health, University of Washington, Seattle, USA

    Deep Rao & Ann Duerr

  3. Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, USA

    Rivet K. Amico

  4. La Asociación Civil Impacta Salud y Educación, Lima, Peru

    Eduardo Ruiz, Peter Brandes, Cecilia Correa & Javier R. Lama

  5. Division of Community Health Sciences, University of Illinois at Chicago, 1603 West Taylor Street, Room 649, Chicago, IL, 60612, USA

    Yamile Molina

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  1. Rachel Rinehart
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Correspondence to Yamile Molina.

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Conflict of interest

Rachel Rinehart declares that she has no conflict of interest. Deepa Rao declares that she has no conflict of interest. Rivet Amico declares that she has no conflict of interest. Eduardo Ruiz declares that he has no conflict of interest. Peter Brandes declares that he has no conflict of interest. Cecilia Correa declares that she has no conflict of interest. Siavash Pasalar declares that he has no conflict of interest. Javier Lama declares that he has no conflict of interest. Ann Duerr declares that she has no conflict of interest. Yamile Molina declares that she has no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Rinehart, R., Rao, D., Amico, R.K. et al. Experienced HIV-Related Stigma and Psychological Distress in Peruvian Sexual and Gender Minorities: A Longitudinal Study to Explore Mediating Roles of Internalized HIV-Related Stigma and Coping Styles. AIDS Behav 23, 661–674 (2019). https://doi.org/10.1007/s10461-018-2348-2

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