Impact of Hidden Stigma Profiles on HIV Outcomes in US Women with HIV

Overview

This study identified three distinct stigma profiles among women with HIV (WWH) in the US and demonstrated that high stigma profiles are associated with suboptimal antiretroviral therapy (ART) adherence and viral nonsuppression. Black WWH who use drugs and those experiencing mental health challenges were more likely to be in the high stigma group, highlighting the intersectional nature of stigma affecting HIV treatment outcomes.

Background

Optimal adherence to ART is critical for achieving viral suppression and preventing HIV transmission. However, disparities persist among WWH, particularly Black women and those who use drugs, due to overlapping stigmas related to HIV status, race, and substance use. Intersectional stigma exacerbates barriers to care, leading to poorer HIV outcomes. Understanding distinct stigma profiles can inform targeted interventions to improve adherence and viral suppression in this population.

Data Highlights

Key Findings

• Three stigma profiles were identified: high stigma (3%), anticipated stigma (11%), and low stigma (86%).
• Black WWH who use drugs had significantly higher odds (aOR 3.6) of belonging to the high stigma profile.
• High stigma profile membership was strongly associated with mental health issues including depression (aOR 5.8) and PTSD (aOR 10.6).
• Suboptimal ART adherence was more prevalent in the high stigma group and predicted future viral nonsuppression.
• Low stigma profile participants had the lowest rates of suboptimal adherence and viral nonsuppression over time.

Clinical Implications

Clinicians should recognize the compounded impact of intersectional stigma on ART adherence and viral suppression among WWH, especially those who are Black and use drugs. Integrating HIV care with substance use and mental health services may reduce stigma and improve treatment outcomes. Tailored interventions addressing stigma and resilience are essential to enhance engagement in care and achieve viral suppression.

Conclusion

Distinct stigma profiles among US women with HIV significantly influence ART adherence and viral suppression, with high stigma linked to poorer outcomes. Addressing intersectional stigma through integrated care approaches is critical to improving health equity and HIV treatment success in this population.

References

1. Bogart et al. 2023 -- Exploring the Impact of Hidden Stigma Profiles on HIV Treatment and Care Outcomes in Women Living with HIV in the United States