INTRODUCTION
METHODS
Participants and Data Collection
Measure of Internalized HIV Stigma
Measure of Access to Care
Regular Source of HIV Care
Measure of ART Adherence
Measure of Mental Health
Other Independent Variables
Data Analysis
RESULTS
Sample Characteristics
CHARACTERISTICS | |
---|---|
Predisposing Factors | |
Age % (n) | – |
18–35 | 20.0 (40) |
36–49 | 54.0 (109) |
50+ | 26.0 (53) |
Gender % (n) | – |
Male | 49.5 (100) |
Female | 49.0 (99) |
Female transgender | 1.5 (3) |
Race % (n) | – |
African American | 56.0 (112) |
White | 28.0 (56) |
Latino/a | 10.0 (20) |
Other | 6.0 (12) |
Education % (n) | – |
No / Some high school | 24.0 (48) |
Graduated from high school | 46.0 (92) |
College | 30.0 (60) |
Primary language English % (n) | 94.0 (191) |
Married / In a committed relationship % (n) | 27.2 (55) |
Sexual orientation % (n) | – |
Heterosexual | 69.3 (140) |
Homosexual / Bisexual | 30.7 (62) |
History of intravenous drug use (IDU) % (n) | 22.5 (43) |
Mental health composite score (mean + standard deviation) | 40.1 + 11.2 |
Enabling factors | |
Income below FPL* % (n) | 54.0 (109) |
No health insurance % (n) | 55.5 (111) |
Clinical need characteristics | |
Years since HIV diagnosis % (n) | – |
0–5 yrs | 22.2 (43) |
6–10 yrs | 26.3 (51) |
>10 yrs | 51.5 (100) |
Current CD4 cell count < 200 (cells/ul) % (n) | 15.8 (32) |
Currently taking antiretroviral therapy % (n) | 71.4 (142) |
Internalized HIV Stigma
Internal Stigma Scale items*
| Mean (SD) †
|
---|---|
Subscale 1 = Stereotypes of HIV | 48 (21) |
1. HIV is different than other diseases like cancer because people with HIV are judged | 66 (29) |
2. People assume I have done something bad to get HIV | 53 (32) |
3. Society looks down on people who have HIV | 59 (28) |
4. People think that if you have HIV then you got what you deserve | 43 (30) |
5. People blame me for having HIV | 43 (35) |
6. People assume I slept around because I have HIV | 54 (33) |
7. People think that if you have HIV you do not deserve to have children | 50 (34) |
8. People are afraid to let someone with HIV adopt a child | 57 (29) |
9. People think I am a bad person because I have HIV | 34 (32) |
10. Medical providers assume people with HIV sleep around | 38 (31) |
11. People lose their jobs because they have HIV | 46 (26) |
12. People think you can′t be a good parent if you have HIV | 42 (31) |
Subscale 2 = HIV Disclosure Concerns | 32 (27) |
13. I am concerned if I go to the HIV clinic someone I know might see me | 28 (33) |
14. I am concerned if I have physical changes from the HIV medicines people will know I have HIV | 33 (33) |
15. I am concerned if I go to an AIDS organization someone I know might see me | 30 (34) |
16. I am concerned people will find out I have HIV by looking at my medical paperwork | 32 (35) |
17. I am concerned that if I am sick people I know will find out about my HIV | 38 (35) |
Subscale 3 = Social Relationship Stigma | 29 (24) |
18. Nurses and doctors treat people who have HIV as if they are contagious | 30 (30) |
19. Nurses and doctors dislike caring for patients with HIV | 28 (28) |
20. I feel abandoned by family members because I have HIV | 24 (33) |
21. People treat me as less than human now that I have HIV | 29 (31) |
22. People avoid me because I have HIV | 24 (30) |
23. People I am close to are afraid they will catch HIV from me | 26 (32) |
24. I feel like I am an outsider because I have HIV | 41 (35) |
Subscale 4 = Self-Acceptance | 54 (25) |
25. I feel ashamed to tell other people that I have HIV | 45 (36) |
26. I am comfortable telling everyone I know that I have HIV‡
| 61 (35) |
27. My family is comfortable talking about my HIV‡
| 55 (33) |
28. It is important for a person to keep HIV a secret from co-workers | 56 (33) |
Overall Stigma Scale | 41 (19) |
Access to Care, Regular Source of HIV Care, and ART Adherence
Poor access to care items (n = 202) | Disagree responses (%)* |
---|---|
1. I am able to get medical care whenever I need it | 24.0 |
2. Places where I can get medical care are very conveniently located | 26.4 |
3. I have never gone without the medical care I needed because it is too expensive | 42.3 |
4. I have easy access to the medical specialists that I need | 22.4 |
5. It is easy for me to get medical care in an emergency | 40.3 |
6. If I need hospital care, I can get admitted without any trouble | 27.9 |
Overall: Reported poor access to 1 or more of the above items | 77.0 |
No regular source of HIV Care (n = 202)
|
No
|
Do you currently have a regular place to go for your HIV medical care? | 10.5 |
Suboptimal ART adherence (n = 142)
|
Less than all the time
†
|
How often during the past week were you able to take your antiretroviral medications exactly as your doctor or nurse told you to? | 42.5 |
Association of Internalized Stigma with Access, Regular Source of Care, and Adherence
Dependent variable (Reference group) | Poor self-reported access to care odds ratio (95% CI) (n = 202) | No regular source of HIV care odds ratio (95% CI) (n = 202) | Suboptimal ART adherence odds ratio (95% CI) (n = 142) |
---|---|---|---|
Predisposing factors
| |||
High internalized stigma (no) | – | – | – |
Yes | 4.97 (2.54–9.72) | 2.48 (1.00–6.19) | 2.45 (1.23–4.91) |
Mental health status | – | – | – |
Mental health composite score (10-point increase) | 1.73 (1.31–2.29) | 1.54 (1.03– 2.31) | 1.53 (1.12–2.09) |
Age | – | – | – |
18–35 | 4.87 (2.11–11.23) | 4.82 (1.87–12.41) | 2.72 (1.03–7.18) |
36–49 | 0.46 (0.26–0.81) | 0.59 (0.23–1.46) | 0.63 (0.32–1.25) |
50 and over | 0.85 (0.46–1.60) | 0.26 (0.06–1.17) | 0.80 (0.39–1.64) |
Gender (male) | – | – | – |
Female | 0.76 (0.44–1.32) | 1.11 (0.45–2.76) | 1.66 (0.87–3.19) |
Race / Ethnicity (white) | – | – | – |
African American | 1.06 (0.61–1.86) | 1.12 (0.45–2.80) | 1.32 (0.69–2.53) |
Latino/a | 1.44 (0.56–3.68) | 0.93 (0.20–4.36) | 1.91 (0.66–5.58) |
Other Race | 0.92 (0.29–2.95) | 0.76 (0.92–6.23) | 0.92 (0.24–3.50) |
Education (more than high school diploma) | – | – | – |
High school diploma | 0.86 (0.50–1.50) | 1.51 (0.65–4.00) | 1.11 (0.60–2.06) |
Less than high school | 1.25 (0.65–2.40) | 0.72 (0.23–2.24) | 1.68 (0.77–3.65) |
Sexual orientation (homosexual / bisexual) | – | – | – |
Heterosexual | 0.74 (0.43–1.30) | 1.63 (0.63–4.23) | 2.35 (1.23–4.50) |
History of IDU (no) | – | – | – |
Yes | 2.94 (1.41–6.11) | 2.40 (0.92–6.27) | 1.72 (0.79–3.73) |
Enabling Factors
| |||
Income (above FPL*) | – | – | – |
Below FPL | 1.96 (1.12–3.43) | 1.20 (0.48–2.99) | 1.01 (0.49–2.08) |
Insurance (yes) | – | – | – |
No | 0.53 (0.30–0.92) | 0.59 (0.24–1.46) | 1.05 (0.55–1.98) |
Clinical need characteristics
| |||
Yrs since HIV diagnosis (>5) | – | – | – |
Less than 5 yrs | 2.58 (1.26–5.32) | 2.49 (0.95–6.47) | 0.87 (0.36–2.06) |
CD4 count (above 200) | – | – | – |
Below 200 | 0.91 (0.43–1.94) | 0.52 (0.11–2.36) | 0.65 (0.26–1.61) |
Dependent Variable (Reference group) | Poor Self-Reported Access to Care Odds ratio (95% CI) (n = 202) | No Regular Source of HIV Care Odds ratio (95% CI) (n = 202) | Suboptimal ART Adherence Odds ratio (95% CI) (n = 142) |
---|---|---|---|
Predisposing Factors
| |||
High internalized stigma (no) | – | – | – |
Yes | 4.42 (1.88–10.37) | 2.25 (0.69–7.32) | 2.09 (0.81–5.39) |
Mental health status | – | – | – |
Mental Health Composite Score (10-point increase) | 1.22 (0.87–1.71) | 1.16 (0.68–1.99) | 1.50 (1.01–2.25) |
Age (50+) | – | – | – |
18–35 | 5.43 (1.52–19.43) | 7.39 (1.26–43.42) | 3.35 (0.90–12.45) |
36–49 | 0.71 (0.30–1.68) | 1.93 (0.36–10.41) | 0.64 (0.23–1.75) |
Gender (male) | – | – | – |
Female | 0.87 (0.38–1.99) | 0.97 (0.29–3.21) | 1.52 (0.61–3.81) |
Race / Ethnicity (white) | – | – | – |
African American | 1.34 (0.54–3.30) | 0.93 (0.25–3.48) | 1.42 (0.51–3.98) |
Latino/a | 1.65 (0.45–6.08) | 1.54 (0.22–10.79) | 3.34 (0.72–15.58) |
Other race | 1.30 (0.23–7.21) | 0.78 (0.06–9.73) | 0.88 (0.13–6.11) |
Education (more than high school) | – | – | – |
High school diploma | 1.01 (0.41–2.50) | 1.28 (0.34–4.82) | 1.21 (0.42–3.49) |
Less than high school | 1.47 (0.44– 4.93) | 0.51 (0.08–3.41) | 1.35 (0.35–5.20) |
Sexual orientation (homosexual / bisexual) | – | – | – |
Heterosexual | 0.56 (0.23–1.36) | 2.42 (0.67–8.78) | 2.92 (1.07– 7.98) |
History of IDU (no) | – | – | – |
Yes | 3.19 (1.24–8.20) | 1.89 (0.56–6.36) | 1.78 (0.66–4.84) |
Enabling factors
| |||
Income (above FPL*) | – | – | – |
Below FPL | 2.50 (1.10–5.68) | 1.27 (0.40–4.07) | 0.96 (0.38–2.40) |
Insurance (yes) | – | – | – |
No | 0.61 (0.29–1.30) | 0 .89 (0.29–2.72) | 1.50 (0.61–3.66) |
Clinical need characteristics
| |||
Yrs since HIV diagnosis (>5) | – | – | – |
Less than 5 yrs | 1.15 (0.44–3.00) | 1.98 (0.62–6.32) | 0.36 (0.12–1.09) |
CD4 count (above 200) | – | – | – |
Below 200 | 0.64 (0.25–1.64) | 0.42 (0.08–2.19) | 0.78 (0.25–2.37) |