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Does the Relationship Between HIV Stigma Subtypes and Viral Suppression Differ by Age?: A Stratified Analysis of Data from the Florida Medical Monitoring Project

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Abstract

HIV-related stigma is recognized as a top barrier to achieve viral suppression in the United States, but data describing who is most affected by HIV stigma is limited. The study sought to (1) identify the relationships between HIV-related stigma and unsuppressed viral load and (2) examine whether the association between HIV stigma subtypes and unsuppressed viral load differ by age group (i.e., 18–34, 35–49, and 50+ years-old) using surveillance data from the Florida Medical Monitoring Project (n = 1195). Most participants were 50+ years-old (55%), male (71%), and Black (51%). Enacted stigma was significantly associated with unsuppressed viral loads among the 18–34-year-old age group (OR 1.68, CI 1.09–2.60). After adjusting for potential confounders, only enacted stigma was independently associated with unsuppressed viral load in the 18–34-year-old age group. Results highlight the need for targeted interventions to reduce enacted stigma among younger persons with HIV to achieve viral suppression.

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Data Availability

De-identified data are available from the authors upon reasonable request and with permission from the Florida Department of Health and all necessary institutional approval.

Code Availability

All analyses were conducted in SAS version 9.4 (SAS Institute, Cary, NC, USA). SAS code may be made available upon request.

References

  1. Florida Department of Health. HIV data center [Internet]. 2019. Available from: http://www.floridahealth.gov/diseases-and-conditions/aids/surveillance/index.html.

  2. Fauci AS, Redfield RR, Sigounas G, Weahkee MD, Giroir BP. Ending the HIV epidemic: a plan for the United States. JAMA. 2019;321(9):844–5.

    Article  PubMed  Google Scholar 

  3. Evidence of HIV treatment and viral suppression in preventing the sexual transmission of HIV [Internet]. Available from: https://www.cdc.gov/hiv/risk/art/evidence-of-hiv-treatment.html

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

    Google Scholar 

  5. Earnshaw VA, Chaudoir SR. From conceptualizing to measuring HIV stigma: a review of HIV stigma mechanism measures. AIDS Behav. 2009;13(6):1160–77.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Turan B, Hatcher AM, Weiser SD, Johnson MO, Rice WS, Turan JM. Framing mechanisms linking HIV-related stigma, adherence to treatment, and health outcomes. Am J Public Health. 2017;107(6):863–9.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Link BG. Understanding labeling effects in the area of mental disorders: an assessment of the effects of expectations of rejection. Am Sociol Rev. 1987;52(1):96–112.

    Article  Google Scholar 

  8. Markowitz F. The effects of stigma on the psychological well-being and life satisfaction of persons with mental illness. J Health Soc Behav. 1998;39(4):335–347.

    Article  CAS  PubMed  Google Scholar 

  9. Scambler G, Hopkins A. Being epileptic: coming to terms with stigma. Sociol Health Illn. 1986;8(1):26–43.

    Article  Google Scholar 

  10. Baugher AR, Beer L, Fagan JL, Mattson CL, Freedman M, Skarbinski J, et al. Prevalence of internalized HIV-related stigma among HIV-infected adults in care, United States, 2011–2013. AIDS Behav. 2017;21(9):2600–8.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Tobias C, Cunningham WE, Cunningham CO, Pounds MB. Making the connection: the importance of engagement and retention in HIV medical care. AIDS Patient Care STDs. 2007;21(s1):S-3-S−8.

    Article  Google Scholar 

  12. Kemp CG, Lipira LL, Huh D, Nevin PE, Turan J, Simoni JM, et al. HIV stigma and viral load among African-American women receiving treatment for HIV: a longitudinal analysis. AIDS Lond Engl. 2019;33(9):1511–9.

    Article  Google Scholar 

  13. Quinn K, Voisin DR, Bouris A, Jaffe K, Kuhns L, Eavou R, et al. Multiple dimensions of stigma and health related factors among young Black men who have sex with men. AIDS Behav. 2017;21(1):207–16.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Baugher AR, Beer L, Bradley HM, Evans ME, Luo Q, Shouse RL. Behavioral and clinical characteristics of American Indian/Alaska Native adults in HIV care—Medical Monitoring Project, United States, 2011–2015. Morb Mortal Wkly Rep. 2019;67(5152):1405–9.

    Article  Google Scholar 

  15. Beer L, Tie Y, McCree DH, Demeke HB, Marcus R, Padilla M, et al. HIV stigma among a national probability sample of adults with diagnosed HIV—United States, 2018–2019. AIDS Behav. 2021. https://doi.org/10.1007/s10461-021-03414-6.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Centers for Disease Control and Prevention. 2015–2017 MMP Protocol [Internet]. 2019 [cited 2019 Aug 25]. Available from: https://www.cdc.gov/hiv/pdf/statistics/systems/mmp/CDC-HIV-MMP-Protocol-and-Appendices-2015.pdf.

  17. Algarin AB, Sheehan DM, Varas-Diaz N, Fennie K, Zhou Z, Spencer EC, et al. Enacted HIV-related stigma’s association with anxiety & depression among people living with HIV (PLWH) in Florida. AIDS Behav. 2021;25(1):93–103.

    Article  PubMed  PubMed Central  Google Scholar 

  18. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Wright K, Naar-King S, Lam P, Templin T, Frey M. Stigma scale revised: reliability and validity of a brief measure of stigma for HIV+ youth. J Adolesc Health. 2007;40(1):96–8.

    Article  PubMed  Google Scholar 

  20. Williams R, Cook R, Brumback B, Cook C, Ezenwa M, Spencer E, et al. The relationship between individual characteristics and HIV-related stigma in adults living with HIV: Medical Monitoring Project, Florida, 2015–2016. BMC Public Health. 2020;20(1):723.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Parcesepe A, Tymejczyk O, Remien R, Gadisa T, Kulkarni SG, Hoffman S, et al. HIV-related stigma, social support, and psychological distress among individuals initiating ART in Ethiopia. AIDS Behav. 2018;22(12):3815–25.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Scott A. Rao-Scott corrections and their impact. Available from: http://www.asasrms.org/Proceedings/y2007/Files/JSM2007-000874.pdf.

  23. Emlet CA, Brennan DJ, Brennenstuhl S, Rueda S, Hart TA, Rourke SB. The impact of HIV-related stigma on older and younger adults living with HIV disease: does age matter? AIDS Care. 2015;27(4):520–8.

    Article  PubMed  Google Scholar 

  24. Swendeman D, Rotheram-Borus MJ, Comulada S, Weiss R, Ramos ME. Predictors of HIV-related stigma among young people living with HIV. Health Psychol. 2006;25(4):501–9.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Williams DR, Mohammed SA. Discrimination and racial disparities in health: evidence and needed research. J Behav Med. 2009;32(1):20.

    Article  PubMed  Google Scholar 

  26. Department of Health & Human Services. HIV national strategic plan 2021–2025. Available from: https://files.hiv.gov/s3fs-public/HIV-National-Strategic-Plan-2021-2025.pdf.

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Acknowledgements

The authors want to thank the Florida Department of Health HIV/AIDS Section for their contributions and collaboration on this project. We also acknowledge the contributions of the Southern HIV and Alcohol Research Consortium (SHARC) Stigma Working Group and the National Institute of Drug Abuse Multidisciplinary Substance Use Training Program (T32DA045734; PI: Dr. Sabita Roy).

Funding

This study was funded by the Florida Department of Health HIV/AIDS Section (AWD04074) and the National Institute on Alcoholism and Alcohol Abuse (T32AA025877). ES, the surveillance program manager of the HIV/AIDS section, offered substantial revisions, comments, and critiques to the manuscript.

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Authors and Affiliations

  1. School of Nursing and Health Studies, University of Miami, 5030 Brunson Dr, Coral Gables, FL, 33146, USA

    Renessa S. Williams

  2. Department of Epidemiology, College of Public Health and Health Professions & College of Medicine, University of Florida, 2055 Mowry Rd, Gainesville, FL, USA

    Zhi Zhou & Robert L. Cook

  3. Department of Nursing Systems, College of Nursing, University of Central Florida, 12201 Research Pkwy Suite 300, Orlando, FL, USA

    Christa Cook

  4. School of Nursing, University of California, Los Angeles, 700 Tiverton Dr, Los Angeles, CA, USA

    Robert Lucero

  5. Bureau of Communicable Disease, Florida Department of Health, 4052 Bald Cypress Way, Tallahassee, FL, USA

    Emma C. Spencer

Authors
  1. Renessa S. Williams
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  2. Zhi Zhou
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  3. Christa Cook
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  4. Robert Lucero
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  5. Emma C. Spencer
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  6. Robert L. Cook
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Contributions

All authors contributed to the study conception and design. Data analysis and literature search were performed by RSW and ZZ. RSW, ZZ, CC, RL, ECS, and RLC contributed to interpreting the data. The first draft of the manuscript was written by RSW and ZZ, CC, RL, ECS, and RLC contributed to critically reviewing the first draft and offered substantial revisions of subsequent drafts of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Renessa S. Williams.

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Competing Interests

The authors declare that they have no competing interests.

Ethical Approval

The Institutional Review Board of the Florida Department of Health and the University of Florida approved the analysis of this study. 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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Informed consent was obtained from all participants.

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Williams, R.S., Zhou, Z., Cook, C. et al. Does the Relationship Between HIV Stigma Subtypes and Viral Suppression Differ by Age?: A Stratified Analysis of Data from the Florida Medical Monitoring Project. AIDS Behav 27, 1879–1885 (2023). https://doi.org/10.1007/s10461-022-03919-8

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