Internalized HIV stigma and viral suppression: examining the mediating and moderating roles of substance use and social support

作者：Timothy N. Crawford, Torsten B. Neilands, Lydia N. Drumright, Rob J. Fredericksen, Mallory O. Johnson, Kenneth H. Mayer, Laura Bamford, Abigail Batchelder, Heidi M. Crane, Latesha Elopre, Richard D. Moore, A. Lina Rosengren, Katerina Christopoulos · 发表于：AIDS · 年份：2024 · DOI：10.1097/qad.0000000000003999 · 被引用次数：6 · 研究领域：HIV/AIDS Research and Interventions、HIV Research and Treatment、HIV-related health complications and treatments

OBJECTIVE: The aim of this study was to examine the effects of internalized HIV stigma on viral nonsuppression via depressive symptoms, alcohol use, illicit drug use, and medication adherence and investigate whether social support moderates these effects. DESIGN: Longitudinal observational clinical cohort of patients in HIV care in the US.Methods: Data from the CFAR Network for Integrated Clinical Systems (2016-2019) were used to conduct structural equation models (SEM) to test the indirect effects of internalized HIV stigma on viral nonsuppression through depressive symptoms, illicit drug use, alcohol use, and medication adherence. Moderated mediation with an interaction between social support and internalized HIV stigma was examined. RESULTS: Among 9574 individuals included in the study sample, 81.1% were men and 41.4% were black, non-Hispanic. The model demonstrated good fit (root mean square error of approximation = 0.028; standardized root means square residual = 0.067). The overall indirect effect was significant [b = 0.058; se = 0.020; β = 0.048; 95% confidence interval (95% CI) = 0.019-0.098], indicating that internalized HIV stigma's impact on viral nonsuppression was mediated by depressive symptoms, illicit drug use, and medication adherence. An interaction was observed between internalized HIV stigma and social support on alcohol use; however, there was no moderated mediation for any of the mediators. CONCLUSION: Internalized HIV stigma indirectly impacts viral non...