HIV Stigma, Mental Health, and Alcohol Use Disorders among People Living with HIV/AIDS in New Orleans
HIV Stigma, Mental Health, and Alcohol Use Disorders among People Living with HIV/AIDS in New Orleans
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DOI：
10.1007/s11524-019-00390-0
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发表时间：
2019-12-01
影响因子：
6.6
通讯作者：
Theall, Katherine
中科院分区：
文献类型：
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作者：
Felker-Kantor, Erica A.;Wallace, Maeve E.;Theall, Katherine
有证据表明，与艾滋病毒有关的耻辱感是艾滋病毒感染者（PLWH）心理健康和药物使用问题的一个促成因素。然而，有限的研究，研究了不同的影响，多个耻辱结构，具体而言，预期，制定和内化的耻辱可能对精神健康和酒精使用障碍之间的PLWH。此外，还没有研究在城市生活压力源的更大背景下考察这种关系。本研究的目的是研究协会的整体艾滋病毒相关的耻辱措施和四个艾滋病毒耻辱分量表的抑郁，焦虑和危险饮酒之间的样本380 PLWH在新奥尔良。采用Log-Poisson模型和广义估计方程估计相对危险度（RR）和95%置信区间（CI）。互动测试被用来确定存在的影响修改城市生活的压力。总体而言，较高水平的艾滋病毒污名与抑郁症状（RR 1.67，95% CI 1.25，2.23），焦虑症状（RR 1.91，95% CI 1.17，3.12）和危险饮酒（RR 1.45，95% CI 1.02，2.05）相关。内化的艾滋病毒污名（使用负面自我形象分量表测量）与所有三个结果相关，并且在四个污名分量表中具有最高的量值点估计。城市生活压力源，测量城市生活压力量表（ULSS），修改艾滋病毒相关的耻辱和心理健康和酒精使用障碍之间的关联（P < 0.2），强调检查更大的城市环境背景的重要性。这项研究的结果可以为在个人和结构层面减少艾滋病毒相关污名的干预措施提供信息。
Evidence suggests that HIV-related stigma is a contributing factor to mental health and substance use problems among people living with HIV (PLWH). Limited research, however, has examined the differential effects that multiple stigma constructs, specifically, anticipated, enacted, and internalized stigma may have on mental health and alcohol use disorders among PLWH. Furthermore, no studies have examined this relationship within the larger context of urban life stressors. The purpose of this study was to examine associations of an overall HIV-related stigma measure and four HIV stigma subscales on depression, anxiety, and hazardous drinking among a sample of 380 PLWH in New Orleans. Log-Poisson models with generalized estimating equations were used to estimate relative risks (RR) and 95% confidence intervals (CI). A test of interaction was used to determine presence of effect modification by urban life stressors. Overall, higher levels of HIV-stigma were associated with depressive symptoms (RR 1.67, 95% CI 1.25, 2.23), anxiety symptoms (RR 1.91, 95% CI 1.17, 3.12), and hazardous drinking (RR 1.45, 95% CI 1.02, 2.05). Internalized HIV-stigma (measured using the negative self-image subscale) was associated with all three outcomes and had the highest magnitude point estimates across the four stigma subscales. Urban life stressors, measured by the Urban Life Stressors Scale (ULSS), modified the association between HIV-related stigma and mental health and alcohol use disorders (P < 0.2), highlighting the importance for examining the larger urban environmental context. Findings from this study may inform interventions to reduce HIV-related stigma operating at the individual and structural level.