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Internalized HIV Stigma and Pain among Women with HIV in the United States: The Mediating Role of Depressive Symptoms

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Abstract

Pain is common in women with HIV, though little research has focused on psychosocial experiences contributing to pain in this population. In the present study we examined whether internalized HIV stigma predicts pain, and whether depressive symptoms mediate this relationship among women with HIV. Data were drawn from the Women’s Interagency HIV Study (WIHS), for 1,364 women with HIV who completed three study visits between 2015 and 2016. We used a sequential longitudinal design to assess the relationship between internalized HIV stigma at time 1 on pain at time 3 through depressive symptoms at time 2. Analyses revealed internalized HIV stigma was prospectively associated with greater pain, B = 5.30, 95% CI [2.84, 7.60]. The indirect effect through depressive symptoms supported mediation, B = 3.68, 95% CI [2.69, 4.79]. Depression is a modifiable risk factor that can be addressed to improve pain prevention and intervention for women with HIV.

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Funding

Data in this manuscript were collected by the Women’s Interagency HIV Study (WIHS). WIHS (Principal Investigators): UAB-MS WIHS (Mirjam-Colette Kempf and Deborah Konkle-Parker), U01-AI-103401; Atlanta WIHS (Ighovwerha Ofotokun, Anandi Sheth, and Gina Wingood), U01-AI-103408; Bronx WIHS (Kathryn Anastos and Anjali Sharma), U01-AI-035004; Brooklyn WIHS (Deborah Gustafson and Tracey Wilson), U01-AI-031834; Chicago WIHS (Mardge Cohen and Audrey French), U01-AI-034993; Metropolitan Washington WIHS (Seble Kassaye and Daniel Merenstein), U01-AI-034994; Miami WIHS (Maria Alcaide, Margaret Fischl, and Deborah Jones), U01-AI-103397; UNC WIHS (Adaora Adimora), U01-AI-103390; Connie Wofsy Women’s HIV Study, Northern California (Bradley Aouizerat and Phyllis Tien), U01-AI-034989; WIHS Data Management and Analysis Center (Stephen Gange and Elizabeth Golub), U01-AI-042590; Southern California WIHS (Joel Milam), U01-HD-032632 (WIHS I—WIHS IV). The WIHS is funded primarily by the National Institute of Allergy and Infectious Diseases (NIAID), with additional co-funding from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), the National Cancer Institute (NCI), the National Institute on Drug Abuse (NIDA), and the National Institute on Mental Health (NIMH). Targeted supplemental funding for specific projects is also provided by the National Institute of Dental and Craniofacial Research (NIDCR), the National Institute on Alcohol Abuse and Alcoholism (NIAAA), the National Institute on Deafness and other Communication Disorders (NIDCD), and the NIH Office of Research on Women’s Health. WIHS data collection is also supported by UL1-TR000004 (UCSF CTSA), P30-AI-050409 (Atlanta CFAR), P30-AI-050410 (UNC CFAR), and P30-AI-027767 (UAB CFAR). Additional support for software was provided by the National Institute on Minority Health and Health Disparities under Award Number U54MD000502. This research was also supported by K12HL143958, an NIH funded grant made possible through the NHLBI. The contents of this publication are solely the responsibility of the authors and do not represent the official views of the National Institutes of Health (NIH).

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Authors and Affiliations

  1. Department of Health Care Organization and Policy, School of Public Health, University of Alabama At Birmingham, 1665 University Blvd, Birmingham, AL, 35294-0022, USA

    Kaylee B. Crockett & Janet M. Turan

  2. School of Medicine, University of Alabama At Birmingham, Birmingham, AL, USA

    T. Alinea Esensoy & Mirjam-Colette Kempf

  3. Department of Medicine, University of California, San Francisco, San Francisco, CA, USA

    Mallory O. Johnson & Torsten B. Neilands

  4. Schools of Nursing and Public Health, University of Alabama At Birmingham, Birmingham, AL, USA

    Mirjam-Colette Kempf

  5. Department of Medicine/Infectious Diseases, University of Mississippi Medical Center, Jackson, MS, USA

    Deborah Konkle-Parker

  6. Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY, USA

    Gina Wingood

  7. Department of Medicine, Department of Veterans Affairs Medical Center, San Francisco and Medical Service, University of California, San Francisco, CA, USA

    Phyllis C. Tien

  8. Department of Medicine, Stroger Hospital of Cook County Bureau of Health and Hospital Systems, Chicago, IL, USA

    Mardge Cohen

  9. Department of Community Health Sciences, School of Public Health, State University of New York, Downstate Health Sciences University, Brooklyn, NY, USA

    Tracey E. Wilson

  10. Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada

    Carmen H. Logie

  11. Montefiore Health System, Bronx, NY, USA

    Oluwakemi Sosanya

  12. Department of Medicine, Division of Infectious Diseases, Georgetown University Medical Center, Washington, DC, USA

    Michael Plankey

  13. Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA

    Elizabeth Golub

  14. Division of Infectious Diseases, Department of Medicine, and Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    Adaora A. Adimora

  15. Mailman School of Public Health, Department of Sociomedical Sciences, Columbia University Miami Research Center, Miami, FL, USA

    Carrigan Parish

  16. Division of HIV, ID and Global Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA

    Sheri D. Weiser

  17. Department of Psychology, University of Alabama At Birmingham, Birmingham, AL, USA

    Bulent Turan

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  1. Kaylee B. Crockett
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  2. T. Alinea Esensoy
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  15. Adaora A. Adimora
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  16. Carrigan Parish
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  17. Sheri D. Weiser
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  18. Janet M. Turan
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  19. Bulent Turan
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Correspondence to Kaylee B. Crockett.

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Crockett, K.B., Esensoy, T.A., Johnson, M.O. et al. Internalized HIV Stigma and Pain among Women with HIV in the United States: The Mediating Role of Depressive Symptoms. AIDS Behav 24, 3482–3490 (2020). https://doi.org/10.1007/s10461-020-02919-w

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