Assessing the Association Between Internalized HIV Stigma and Cardiovascular Disease Risk in Women Living with HIV

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Project Summary/Abstract Cardiovascular disease (CVD) is among the leading causes of morbidity and mortality in women living with HIV (WLWH). WLWH show elevated CVD risk compared to both their male counterparts and HIV negative women. Additionally, within WLWH there are racial disparities in CVD risk. Controlling for HIV-specific factors, traditional risk factors, and social factors like poverty and substance use only partially attenuates the elevated CVD risk in WLWH. This indicates that additional factors, such as internalized HIV stigma, may contribute to CVD risk in WLWH. Internalized HIV stigma, defined as incorporating the negative societal attitudes and beliefs about HIV as part of one’s self-image, is widespread among WLWH and unduly affects women and racial and ethnic minorities. Internalized HIV stigma is a form of minority stress, and previous research has linked minority stress to poor health outcomes and suggest a pathway through which internalized HIV stigma could contribute to elevated CVD risk. Briefly, sustained experiences of stigma may contribute to chronically elevated systemic inflammation, and metabolic excitation, which are associated with elevated CVD risk. Moreover, women of color living with HIV may experience stigma from multiple sources that could have a synergistic effect leading to racial differences in the relationship between internalized HIV stigma and CVD. The link between internalized HIV stigma and CVD risk in WLWH remains vastly understudied, which is unfortunate as identifying key risk factors would allow for the development of targeted interventions that address CVD risk and improve the overall health of this population. This study will address this by assessing the association between internalized HIV stigma and CVD risk in WLWH and testing if this relationship is moderated by race. Using data from the Center for AIDS Research Network of Integrated Clinic Systems (CNICS) the study will: (1) determine if internalized HIV stigma is associated with increased odds of hypertension, dyslipidemia, and obesity in WLWH and assess the temporal link between internalized HIV stigma and these outcomes, (2) determine if internalized HIV stigma is associated with elevated systemic inflammation among WLWH, and (3) determine if these relationships are different for women of color living with HIV. CNICS is a longitudinal database that tracks long term clinical outcomes among a diverse cohort of people living with HIV and added a validated measure of internalized HIV stigma in 2016. The analytic sample will be comprised of women who completed at least one internalized HIV stigma measure from 2016 to 2021 (n=2090). We will conduct both cross-sectional and longitudinal analysis to address the aims above. This study aligns well with the National Institute of Nursing Research’s new strategic plan, which prioritizes innovative and rigorous research that addresses health equity, social determinants of health, and health promotion. The proposed pre-doctoral training program in this application will provide the applicant with the theoretical and methodological foundation to become a productive and independent researcher.