Mechanisms and longitudinal effects of stigma on women's adherence and outcomes

 描述（由申请人提供）：坚持艾滋病毒治疗建议，包括坚持抗逆转录病毒治疗（ART）和艾滋病毒护理访视，对于艾滋病毒感染者实现健康，长寿和不可检测的病毒载量至关重要。 一些研究发现，妇女坚持抗逆转录病毒疗法的情况比男子差，发病率和死亡率也比男子高。与白色妇女相比，有色人种妇女感染艾滋病毒的风险更高，一旦感染，健康状况更差。因此，迫切需要查明艾滋病毒感染妇女，特别是少数群体妇女坚持治疗的障碍和相关的临床结果，并制定相应的干预措施。一个潜在的重要障碍是与艾滋病毒有关的耻辱感。横断面和定性研究表明，污名化和歧视不仅威胁到艾滋病毒感染者的生活质量，而且还与抗逆转录病毒治疗和就诊依从性下降有关，对健康结果产生负面影响。然而，该领域对以下方面的理解有限：1）耻辱感、坚持和健康结果之间的因果/时间关系; 2）影响这些结果的艾滋病毒相关耻辱感的维度; 3）耻辱感可能通过生物机制（例如，慢性压力过程）和通过治疗依从性，以及4）艾滋病毒相关的耻辱与其他形式的耻辱和歧视，由于种族/民族，性别和社会经济地位（SES）的交叉。为了解决这些知识差距，我们将利用国家妇女机构间艾滋病毒研究（WIHS）的资源，该研究20年来一直在收集有关艾滋病毒感染妇女的治疗依从性，心理健康以及免疫学和病毒学结果的数据。参加WIHS的感染艾滋病毒的妇女面临着坚持的挑战，在美国南部，新加入WIHS的妇女面临的障碍似乎更大。除了支持继续在国家WIHS数据收集的内部化的耻辱和披露的措施，我们建议每年在3个WIHS网站在该国的不同地区，深南部，东南部和加州的补充访问。在这些访问中，我们将评估艾滋病毒相关的耻辱，假设的中介机制，交叉耻辱（由于艾滋病毒，种族/民族，性别和SES），和慢性应激反应（头发皮质醇水平）的理论上的重要方面。我们将阐明在全国WIHS队列中内化的HIV相关污名、坚持HIV治疗以及相应的免疫学和病毒学结果之间的纵向关联。我们将使用在3个WIHS站点收集的数据来检查a）HIV相关污名的其他维度与治疗依从性和健康结果的关联，B）HIV相关污名的维度可能对依从性和健康结果产生不利影响的潜在机制，以及c）交叉污名与使用混合方法研究的依从性之间的联系。研究结果将具有重要的理论意义，并为努力改善感染艾滋病毒妇女的结果的政策和方案提供关键信息。

 DESCRIPTION (provided by applicant): Adherence to HIV treatment recommendations including adherence to antiretroviral therapy (ART) and HIV care visits is essential for persons living with HIV to achieve health, longevity, and an undetectable viral load. Some studies have found that women have worse adherence to ART and higher morbidity and mortality than men. Compared to White women, women of color are at higher risk of acquiring HIV, and have worse health outcomes once infected. Thus, there is an urgent need to identify barriers to adherence and associated clinical outcomes among women living with HIV, particularly among minority women, and to develop responsive interventions. One potentially important barrier is HIV-related stigma. Cross-sectional and qualitative studies suggest that stigma and discrimination not only threaten quality of life for persons living with HIV, but are alo associated with worse ART and visit adherence, with negative effects on health outcomes. However, the field has limited understanding of 1) the causal/temporal relationships between stigma, adherence, and health outcomes, 2) the dimensions of HIV-related stigma that influence these outcomes, 3) the causal mechanisms through which stigma may adversely affect health potentially both through biological mechanisms (e.g., chronic stress processes) and through treatment adherence, and 4) the intersection of HIV-related stigma with other forms of stigma and discrimination due to race/ethnicity, gender, and socio-economic status (SES). To address these gaps in knowledge, we will leverage the resources of the national Women's Interagency HIV Study (WIHS), which has been collecting data on HIV-infected women's treatment adherence, mental health, and immunologic and virologic outcomes for 20 years. HIV-infected women enrolled in WIHS face challenges to adherence, and the barriers appear to be even greater for women being newly recruited into WIHS in the southern United States. In addition to supporting continuation of measures of internalized stigma and disclosure in national WIHS data collection, we propose a yearly supplementary visit at 3 WIHS sites in different parts of the country the Deep South, the Southeast, and California. In these visits we will assess theoretically important dimensions of HIV-related stigma, hypothesized mediating mechanisms, intersectional stigma (due to HIV, race/ethnicity, gender, and SES), and chronic stress responses (hair cortisol levels). We will elucidate the longitudinal associations between internalized HIV-related stigma, adherence to HIV treatment, and corresponding immunologic and virologic outcomes in the national WIHS cohort. We will use data collected at 3 WIHS sites to examine a) the associations of other dimensions of HIV-related stigma with treatment adherence and health outcomes, b) potential mechanisms through which dimensions of HIV-related stigma may adversely affect adherence and health outcomes, and c) the link between intersectional stigma and adherence using mixed methods research. Findings will have important theoretical implications, as well as provide crucial information for policies and programs striving to improve outcomes for women living with HIV.