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

dc.contributor.coauthorNorcini-Pala, Andrea
dc.contributor.coauthorStringer, Kristi L.
dc.contributor.coauthorKempf, Mirjam-Colette
dc.contributor.coauthorKonkle-Parker, Deborah
dc.contributor.coauthorWilson, Tracey E.
dc.contributor.coauthorTien, Phyllis C
dc.contributor.coauthorWeiser, Sheri D.
dc.contributor.coauthorLogie, Carmen H.
dc.contributor.coauthorTopper, Elizabeth F.
dc.contributor.coauthorTuran, Janet M
dc.contributor.departmentDepartment of Psychology
dc.contributor.kuauthorTuran, Bülent
dc.contributor.schoolcollegeinstituteCollege of Social Sciences and Humanities
dc.date.accessioned2025-03-06T21:00:32Z
dc.date.issued2024
dc.description.abstractBackground: 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.
dc.description.indexedbyWOS
dc.description.indexedbyScopus
dc.description.indexedbyPubMed
dc.description.publisherscopeInternational
dc.description.sponsoredbyTubitakEuN/A
dc.identifier.doi10.1016/j.socscimed.2024.117643
dc.identifier.eissn1873-5347
dc.identifier.issn0277-9536
dc.identifier.quartileQ1
dc.identifier.scopus2-s2.0-85214232813
dc.identifier.urihttps://doi.org/10.1016/j.socscimed.2024.117643
dc.identifier.urihttps://hdl.handle.net/20.500.14288/27913
dc.identifier.volume366
dc.identifier.wos1413694900001
dc.keywordsIntersectional stigma
dc.keywordsAntiretroviral therapy adherence
dc.keywordsViral load
dc.keywordsWomen living with HIV
dc.keywordsLongitudinal study
dc.keywordsLatent transition analysis
dc.keywordsItem response theory
dc.keywordsHIV treatment outcomes
dc.keywordsHealth disparities
dc.keywordsSocial determinants of health
dc.language.isoeng
dc.publisherElsevier
dc.relation.ispartofSocial Science and Medicine
dc.subjectPublic, environmental and occupational health
dc.subjectSocial sciences, biomedical
dc.titleLongitudinal associations between intersectional stigmas, antiretroviral therapy adherence, and viral load among women living with HIV using multidimensional latent transition item response analysis
dc.typeJournal Article
dspace.entity.typePublication
local.contributor.kuauthorTuran, Bülent
local.publication.orgunit1College of Social Sciences and Humanities
local.publication.orgunit2Department of Psychology
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relation.isParentOrgUnitOfPublication3f7621e3-0d26-42c2-af64-58a329522794
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