Clinical Scorecard: Exploring the Impact of Hidden Stigma Profiles on HIV Treatment and Care Outcomes in Women Living with HIV in the United States: An Intersectional Perspective

At a Glance

Key Highlights

• Three latent stigma profiles identified among WWH: high stigma (3%), low stigma (86%), and anticipated stigma (11%).
• High stigma profile is associated with Black and non-Black WWH who use drugs, suboptimal ART adherence, depression, stress, and PTSD.
• Suboptimal ART adherence mediates the relationship between stigma profiles and future viral nonsuppression.

Guideline-Based Recommendations

Diagnosis

• Assess stigma experiences including HIV-related, anticipated, and race-related stigma in healthcare settings among WWH.
• Screen for substance use and mental health conditions such as depression and PTSD in WWH.

Management

• Implement integrated care models addressing HIV treatment, substance use disorders, and mental health to reduce stigma impact.
• Tailor interventions to address intersectional stigma, especially for Black WWH and those who use drugs.
• Promote resilience-building strategies to mitigate stigma effects on HIV care engagement.

Monitoring & Follow-up

• Regularly monitor ART adherence with a target of ≥95% adherence to achieve viral suppression.
• Conduct longitudinal viral load testing to detect viral nonsuppression (HIV-1 RNA ≥20 copies/mL).
• Monitor psychosocial factors including stress, depression, and PTSD symptoms.

Risks

• High intersectional stigma increases risk of suboptimal ART adherence and viral nonsuppression.
• Substance use and mental health disorders exacerbate stigma-related barriers to HIV care.
• Racial discrimination and structural barriers contribute to disparities in HIV outcomes among Black WWH.

Patient & Prescribing Data

Women living with HIV in the US, including subgroups by race and substance use status

Suboptimal adherence (<95%) is more prevalent among WWH experiencing high stigma and those who use drugs; addressing stigma and integrating care improves adherence and viral suppression outcomes.

Clinical Best Practices

• Use latent profile analysis or similar tools to identify stigma profiles in clinical populations to tailor interventions.
• Integrate HIV care with substance use treatment and mental health services to address overlapping stigmas.
• Focus on culturally sensitive and intersectional approaches to reduce stigma and improve ART adherence.
• Regularly assess and address psychosocial stressors including depression and PTSD in WWH.
• Promote resilience and support systems to buffer the negative effects of stigma on HIV treatment outcomes.

References

• Women's Interagency HIV Study (WIHS)
• Intersectionality and HIV Care