Internalized HIV stigma, ART initiation and HIV-1 RNA suppression in South Africa: exploring avoidant coping as a longitudinal mediator.
Internalized HIV stigma, ART initiation and HIV-1 RNA suppression in South Africa: exploring avoidant coping as a longitudinal mediator.
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DOI：
10.1002/jia2.25198
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发表时间：
2018-10
影响因子：
6
通讯作者：
Katz IT
中科院分区：
文献类型：
--
作者：
Earnshaw VA;Bogart LM;Laurenceau JP;Chan BT;Maughan-Brown BG;Dietrich JJ;Courtney I;Tshabalala G;Orrell C;Gray GE;Bangsberg DR;Katz IT
横断面证据表明，内化的艾滋病毒污名与艾滋病毒感染者（PLWH）开始抗逆转录病毒治疗（ART）和HIV-1 RNA抑制的可能性较低有关。本研究探讨了这些协会与纵向数据跨越艾滋病毒诊断后的前九个月，并探讨是否回避应对调解这些协会。纵向数据收集自2014年至2015年从测试中心招募的398名南非PLWH。自我报告数据，包括内化的耻辱和回避应对（否认和分散自己的压力源），收集了艾滋病毒诊断后一周和三个月。从南非国家卫生实验室服务数据库中提取了6个月时开始ART和9个月时的HIV-1 RNA。估计了两个路径分析，一个测试内在耻辱，回避应对和ART启动之间的关联，另一个测试内在耻辱，回避应对和HIV-1 RNA抑制之间的关联。参与者的平均年龄为36岁，63%被确定为女性，18%为祖鲁人，65%为科萨人。两个路径模型很好地拟合了数据（ART启动结果：X 2（7）= 8.14，p = 0.32;近似均方根误差（RMSEA）= 0.02;比较拟合指数（CFI）= 0.92; HIV-1 RNA抑制结果：X 2（7）= 6.58，p = 0.47; RMSEA = 0.00; CFI = 1.00）。在这两个模型中，诊断后一周的内化耻辱与三个月的回避应对相关，一周的回避应对控制。反过来，在第一个模型中，三个月时的回避应对与六个月时开始ART的可能性较低有关，在第二个模型中，九个月时HIV-1 RNA抑制的可能性较低。通过回避应对的中介，观察到非ART启动的内化污名与未抑制的HIV-1 RNA之间存在显着的间接影响。在艾滋病毒诊断后不久经历的内在耻辱感预测了艾滋病毒诊断后第一年开始ART和HIV-1 RNA抑制的可能性较低。回避应对在这些关联中发挥了作用，这表明PLWH谁内化耻辱从事更大的回避应对，这反过来又会影响药物和健康相关的结果。需要采取干预措施，以解决艾滋病毒诊断后不久的内在耻辱和逃避应对，以加强艾滋病毒诊断后第一年的治疗工作。
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. 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. 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: X 2(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: X 2(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. 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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影响因子：
4.4
作者：
Blake Helms C;Turan JM;Atkins G;Kempf MC;Clay OJ;Raper JL;Mugavero MJ;Turan B
通讯作者：
Turan B
影响因子：
3.1
作者：
Eaton LA;Earnshaw VA;Maksut JL;Thorson KR;Watson RJ;Bauermeister JA
通讯作者：
Bauermeister JA
影响因子：
158.5
作者：
Danel, Christine;Moh, Raoul;Anglaret, Xavier
通讯作者：
Anglaret, Xavier
影响因子：
4.4
作者：
Maluccio, John A.;Wu, Fan;Kadiyala, Suneetha
通讯作者：
Kadiyala, Suneetha
影响因子：
4.4
作者：
Bogart, Laura M.;Landrine, Hope;Galvan, Frank H.;Wagner, Glenn J.;Klein, David J.
通讯作者：
Klein, David J.