Internalized HIV stigma, ART initiation and HIV-1 RNA suppression in South Africa

exploring avoidant coping as a longitudinal mediator

Valerie A. Earnshaw, Laura M. Bogart, Jean Philippe Laurenceau, Brian T. Chan, Brendan G. Maughan-Brown, Janan J. Dietrich, Ingrid Courtney, Gugulethu Tshabalala, Catherine Orrell, Glenda E. Gray, David Bangsberg, Ingrid T. Katz

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

INTRODUCTION: Cross-sectional evidence suggests that internalized HIV stigma is associated with lower likelihoods of antiretroviral therapy (ART) initiation and HIV-1 RNA suppression among people living with HIV (PLWH). This study examined these associations with longitudinal data spanning the first nine months following HIV diagnosis and explored whether avoidant coping mediates these associations.

METHODS: Longitudinal data were collected from 398 South African PLWH recruited from testing centres in 2014 to 2015. Self-report data, including internalized stigma and avoidant coping (denying and distracting oneself from stressors), were collected one week and three months following HIV diagnosis. ART initiation at six months and HIV-1 RNA at nine months were extracted from the South Africa National Health Laboratory Service database. Two path analyses were estimated, one testing associations between internalized stigma, avoidant coping and ART initiation, and the other testing associations between internalized stigma, avoidant coping and HIV-1 RNA suppression.

RESULTS: Participants were 36 years old, on average, and 63% identified as female, 18% as Zulu and 65% as Xhosa. The two path models fit the data well (ART initiation outcome: X2 (7) = 8.14, p = 0.32; root mean square error of approximation (RMSEA) = 0.02; comparative fit index (CFI) = 0.92; HIV-1 RNA suppression outcome: X2 (7)  = 6.58, p = 0.47; RMSEA = 0.00; CFI = 1.00). In both models, internalized stigma one week after diagnosis was associated with avoidant coping at three months, controlling for avoidant coping at one week. In turn, avoidant coping at three months was associated with lower likelihood of ART initiation at six months in the first model and lower likelihood of HIV-1 RNA suppression at nine months in the second model. Significant indirect effects were observed between internalized stigma with ART non-initiation and unsuppressed HIV-1 RNA via the mediator of avoidant coping.

CONCLUSIONS: Internalized stigma experienced soon after HIV diagnosis predicted lower likelihood of ART initiation and HIV-1 RNA suppression over the first year following HIV diagnosis. Avoidant coping played a role in these associations, suggesting that PLWH who internalize stigma engage in greater avoidant coping, which in turn worsens medication- and health-related outcomes. Interventions are needed to address internalized stigma and avoidant coping soon after HIV diagnosis to enhance treatment efforts during the first year after HIV diagnosis.

Original languageEnglish (US)
Pages (from-to)e25198
JournalJournal of the International AIDS Society
Volume21
Issue number10
DOIs
StatePublished - Oct 1 2018

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South Africa
HIV-1
HIV
RNA
Therapeutics
National Health Programs
Self Report
Databases
Health

Keywords

  • HIV
  • antiretroviral therapy
  • coping
  • South Africa
  • stigma

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health
  • Infectious Diseases

Cite this

Earnshaw, V. A., Bogart, L. M., Laurenceau, J. P., Chan, B. T., Maughan-Brown, B. G., Dietrich, J. J., ... Katz, I. T. (2018). Internalized HIV stigma, ART initiation and HIV-1 RNA suppression in South Africa: exploring avoidant coping as a longitudinal mediator. Journal of the International AIDS Society, 21(10), e25198. https://doi.org/10.1002/jia2.25198

Internalized HIV stigma, ART initiation and HIV-1 RNA suppression in South Africa : exploring avoidant coping as a longitudinal mediator. / Earnshaw, Valerie A.; Bogart, Laura M.; Laurenceau, Jean Philippe; Chan, Brian T.; Maughan-Brown, Brendan G.; Dietrich, Janan J.; Courtney, Ingrid; Tshabalala, Gugulethu; Orrell, Catherine; Gray, Glenda E.; Bangsberg, David; Katz, Ingrid T.

In: Journal of the International AIDS Society, Vol. 21, No. 10, 01.10.2018, p. e25198.

Research output: Contribution to journalArticle

Earnshaw, VA, Bogart, LM, Laurenceau, JP, Chan, BT, Maughan-Brown, BG, Dietrich, JJ, Courtney, I, Tshabalala, G, Orrell, C, Gray, GE, Bangsberg, D & Katz, IT 2018, 'Internalized HIV stigma, ART initiation and HIV-1 RNA suppression in South Africa: exploring avoidant coping as a longitudinal mediator', Journal of the International AIDS Society, vol. 21, no. 10, pp. e25198. https://doi.org/10.1002/jia2.25198
Earnshaw, Valerie A. ; Bogart, Laura M. ; Laurenceau, Jean Philippe ; Chan, Brian T. ; Maughan-Brown, Brendan G. ; Dietrich, Janan J. ; Courtney, Ingrid ; Tshabalala, Gugulethu ; Orrell, Catherine ; Gray, Glenda E. ; Bangsberg, David ; Katz, Ingrid T. / Internalized HIV stigma, ART initiation and HIV-1 RNA suppression in South Africa : exploring avoidant coping as a longitudinal mediator. In: Journal of the International AIDS Society. 2018 ; Vol. 21, No. 10. pp. e25198.
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abstract = "INTRODUCTION: Cross-sectional evidence suggests that internalized HIV stigma is associated with lower likelihoods of antiretroviral therapy (ART) initiation and HIV-1 RNA suppression among people living with HIV (PLWH). This study examined these associations with longitudinal data spanning the first nine months following HIV diagnosis and explored whether avoidant coping mediates these associations.METHODS: Longitudinal data were collected from 398 South African PLWH recruited from testing centres in 2014 to 2015. Self-report data, including internalized stigma and avoidant coping (denying and distracting oneself from stressors), were collected one week and three months following HIV diagnosis. ART initiation at six months and HIV-1 RNA at nine months were extracted from the South Africa National Health Laboratory Service database. Two path analyses were estimated, one testing associations between internalized stigma, avoidant coping and ART initiation, and the other testing associations between internalized stigma, avoidant coping and HIV-1 RNA suppression.RESULTS: Participants were 36 years old, on average, and 63{\%} identified as female, 18{\%} as Zulu and 65{\%} as Xhosa. The two path models fit the data well (ART initiation outcome: X2 (7) = 8.14, p = 0.32; root mean square error of approximation (RMSEA) = 0.02; comparative fit index (CFI) = 0.92; HIV-1 RNA suppression outcome: X2 (7)  = 6.58, p = 0.47; RMSEA = 0.00; CFI = 1.00). In both models, internalized stigma one week after diagnosis was associated with avoidant coping at three months, controlling for avoidant coping at one week. In turn, avoidant coping at three months was associated with lower likelihood of ART initiation at six months in the first model and lower likelihood of HIV-1 RNA suppression at nine months in the second model. Significant indirect effects were observed between internalized stigma with ART non-initiation and unsuppressed HIV-1 RNA via the mediator of avoidant coping.CONCLUSIONS: Internalized stigma experienced soon after HIV diagnosis predicted lower likelihood of ART initiation and HIV-1 RNA suppression over the first year following HIV diagnosis. Avoidant coping played a role in these associations, suggesting that PLWH who internalize stigma engage in greater avoidant coping, which in turn worsens medication- and health-related outcomes. Interventions are needed to address internalized stigma and avoidant coping soon after HIV diagnosis to enhance treatment efforts during the first year after HIV diagnosis.",
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T1 - Internalized HIV stigma, ART initiation and HIV-1 RNA suppression in South Africa

T2 - exploring avoidant coping as a longitudinal mediator

AU - Earnshaw, Valerie A.

AU - Bogart, Laura M.

AU - Laurenceau, Jean Philippe

AU - Chan, Brian T.

AU - Maughan-Brown, Brendan G.

AU - Dietrich, Janan J.

AU - Courtney, Ingrid

AU - Tshabalala, Gugulethu

AU - Orrell, Catherine

AU - Gray, Glenda E.

AU - Bangsberg, David

AU - Katz, Ingrid T.

PY - 2018/10/1

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N2 - INTRODUCTION: Cross-sectional evidence suggests that internalized HIV stigma is associated with lower likelihoods of antiretroviral therapy (ART) initiation and HIV-1 RNA suppression among people living with HIV (PLWH). This study examined these associations with longitudinal data spanning the first nine months following HIV diagnosis and explored whether avoidant coping mediates these associations.METHODS: Longitudinal data were collected from 398 South African PLWH recruited from testing centres in 2014 to 2015. Self-report data, including internalized stigma and avoidant coping (denying and distracting oneself from stressors), were collected one week and three months following HIV diagnosis. ART initiation at six months and HIV-1 RNA at nine months were extracted from the South Africa National Health Laboratory Service database. Two path analyses were estimated, one testing associations between internalized stigma, avoidant coping and ART initiation, and the other testing associations between internalized stigma, avoidant coping and HIV-1 RNA suppression.RESULTS: Participants were 36 years old, on average, and 63% identified as female, 18% as Zulu and 65% as Xhosa. The two path models fit the data well (ART initiation outcome: X2 (7) = 8.14, p = 0.32; root mean square error of approximation (RMSEA) = 0.02; comparative fit index (CFI) = 0.92; HIV-1 RNA suppression outcome: X2 (7)  = 6.58, p = 0.47; RMSEA = 0.00; CFI = 1.00). In both models, internalized stigma one week after diagnosis was associated with avoidant coping at three months, controlling for avoidant coping at one week. In turn, avoidant coping at three months was associated with lower likelihood of ART initiation at six months in the first model and lower likelihood of HIV-1 RNA suppression at nine months in the second model. Significant indirect effects were observed between internalized stigma with ART non-initiation and unsuppressed HIV-1 RNA via the mediator of avoidant coping.CONCLUSIONS: Internalized stigma experienced soon after HIV diagnosis predicted lower likelihood of ART initiation and HIV-1 RNA suppression over the first year following HIV diagnosis. Avoidant coping played a role in these associations, suggesting that PLWH who internalize stigma engage in greater avoidant coping, which in turn worsens medication- and health-related outcomes. Interventions are needed to address internalized stigma and avoidant coping soon after HIV diagnosis to enhance treatment efforts during the first year after HIV diagnosis.

AB - INTRODUCTION: Cross-sectional evidence suggests that internalized HIV stigma is associated with lower likelihoods of antiretroviral therapy (ART) initiation and HIV-1 RNA suppression among people living with HIV (PLWH). This study examined these associations with longitudinal data spanning the first nine months following HIV diagnosis and explored whether avoidant coping mediates these associations.METHODS: Longitudinal data were collected from 398 South African PLWH recruited from testing centres in 2014 to 2015. Self-report data, including internalized stigma and avoidant coping (denying and distracting oneself from stressors), were collected one week and three months following HIV diagnosis. ART initiation at six months and HIV-1 RNA at nine months were extracted from the South Africa National Health Laboratory Service database. Two path analyses were estimated, one testing associations between internalized stigma, avoidant coping and ART initiation, and the other testing associations between internalized stigma, avoidant coping and HIV-1 RNA suppression.RESULTS: Participants were 36 years old, on average, and 63% identified as female, 18% as Zulu and 65% as Xhosa. The two path models fit the data well (ART initiation outcome: X2 (7) = 8.14, p = 0.32; root mean square error of approximation (RMSEA) = 0.02; comparative fit index (CFI) = 0.92; HIV-1 RNA suppression outcome: X2 (7)  = 6.58, p = 0.47; RMSEA = 0.00; CFI = 1.00). In both models, internalized stigma one week after diagnosis was associated with avoidant coping at three months, controlling for avoidant coping at one week. In turn, avoidant coping at three months was associated with lower likelihood of ART initiation at six months in the first model and lower likelihood of HIV-1 RNA suppression at nine months in the second model. Significant indirect effects were observed between internalized stigma with ART non-initiation and unsuppressed HIV-1 RNA via the mediator of avoidant coping.CONCLUSIONS: Internalized stigma experienced soon after HIV diagnosis predicted lower likelihood of ART initiation and HIV-1 RNA suppression over the first year following HIV diagnosis. Avoidant coping played a role in these associations, suggesting that PLWH who internalize stigma engage in greater avoidant coping, which in turn worsens medication- and health-related outcomes. Interventions are needed to address internalized stigma and avoidant coping soon after HIV diagnosis to enhance treatment efforts during the first year after HIV diagnosis.

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KW - antiretroviral therapy

KW - coping

KW - South Africa

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