Longitudinal associations between intersectional stigmas, antiretroviral therapy adherence, and viral load among women living with HIV using multidimensional latent transition item response analysis

Abstract

Background: In the US, Women, especially Black and Latina women living in disadvantaged environments, are disproportionally affected by HIV. Women living with HIV (WLHIV) have higher rates of suboptimal antiretroviral therapy (ART) adherence, and detectable viral load (VL). Experiences of intersectional poverty, HIV, gender, and racial stigmas may increase the rates of detectable VL through suboptimal ART adherence. Aims: To explore longitudinal associations between intersectional stigmas, ART adherence, and detectable VL using multidimensional latent transition item response analysis. Participants: WLHIV (N = 459) in the [masked] sub-study of the [masked], from sites in Birmingham, AL, Jackson, MS, Atlanta, GA, and San Francisco, CA. Assessment: Experienced poverty, HIV, gender, and racial stigma, self-report ART adherence, and VL were assessed at four yearly follow-ups between 2016 and 2020. Results: We identified five classes of WLHIV with different combinations of experienced intersectional stigmas. Longitudinally, WLHIV with higher levels of poverty, gender, and racial stigma had higher odds of suboptimal ART adherence (<90%) (OR = 3.59, p < 0.001) and detectable VL (OR = 2.08, p = 0.028) compared to WLHIV with lower/moderately low stigmas levels. WLHIV in the highest stigma classes had higher odds of detectable VL, independently of ART adherence (Class 3: OR = 1.38, p = 0.016;Class 5: OR = 1.31, p = 0.046). These findings underscore the compounded effects of intersectional stigmas on HIV treatment outcomes. Conclusion: Intersecting experiences of HIV, racial, gender, and poverty stigmas can increase detectable VL risk through suboptimal ART adherence, although other mechanisms may also be involved. Recognizing the complexity of intersectional stigmas is essential for developing approaches to improve WLHIV's HIV treatment outcomes.