Income Inequality, HIV Stigma, and Preventing HIV Disease Progression in Rural Communities. View Full Text


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Article Info

DATE

2019-04-06

AUTHORS

Seth Kalichman, Bruno Shkembi, Dominica Hernandez, Harold Katner, Katherine R Thorson

ABSTRACT

Antiretroviral therapies (ART) suppress HIV replication, thereby preventing HIV disease progression and potentially preventing HIV transmission. However, there remain significant health disparities among people living with HIV, particularly for women living in impoverished rural areas. A significant contributing factor to HIV-related disparities is a stigma. And yet, the relative contributions of stigma, gender, socio-economics, and geography in relation to health outcomes are understudied. We examined the associations of internalized stigma and enacted stigma with community-level income inequality and HIV viral suppression-the hallmark of successful ART-among 124 men and 74 women receiving care from a publicly funded HIV clinic serving rural areas with high-HIV prevalence in the southeastern US. Participants provided informed consent, completed computerized interviews, and provided access to their medical records. Gini index was collected at the census tract level to estimate community-level income inequality. Individual-level and multilevel models controlled for point distance that patients lived from the clinic and quality of life, and included participant gender as a moderator. We found that for women, income inequality, internalized stigma, and enacted stigma were significantly associated with HIV suppression. For men, there were no significant associations between viral suppression and model variables. The null findings for men are consistent with gender-based health disparities and suggest the need for gender-tailored prevention interventions to improve the health of people living with HIV in rural areas. Results confirm and help to explain previous research on the impact of HIV stigma and income inequality among people living with HIV in rural settings. More... »

References to SciGraph publications

  • 2010-12. Efficacy of HIV Prevention Interventions in Latin American and Caribbean Nations, 1995–2008: A Meta-Analysis in AIDS AND BEHAVIOR
  • 2013-05. Perceived Discrimination and Physical Health Among HIV-Positive Black and Latino Men Who Have Sex with Men in AIDS AND BEHAVIOR
  • 2017-01. Understanding HIV-Related Stigma Among Women in the Southern United States: A Literature Review in AIDS AND BEHAVIOR
  • 2017-01. How Does Stigma Affect People Living with HIV? The Mediating Roles of Internalized and Anticipated HIV Stigma in the Effects of Perceived Community Stigma on Health and Psychosocial Outcomes in AIDS AND BEHAVIOR
  • 2009-12. Size Matters: Community Size, HIV Stigma, & Gender Differences in AIDS AND BEHAVIOR
  • 2017-07. Population Density and AIDS-Related Stigma in Large-Urban, Small-Urban, and Rural Communities of the Southeastern USA in PREVENTION SCIENCE
  • 2016-12. Visual analogue scale (VAS) measurement of antiretroviral adherence in people living with HIV (PLWH): a meta-analysis in JOURNAL OF BEHAVIORAL MEDICINE
  • 2009-12. From Conceptualizing to Measuring HIV Stigma: A Review of HIV Stigma Mechanism Measures in AIDS AND BEHAVIOR
  • 2015-08. Depressive Symptoms Mediate the Effect of HIV-Related Stigmatization on Medication Adherence Among HIV-Infected Men Who Have Sex with Men in AIDS AND BEHAVIOR
  • 2014-06. HIV-Related Stigma Among African-American Youth in the Northeast and Southeast US in AIDS AND BEHAVIOR
  • 2016-01. The Association of HIV-Related Stigma to HIV Medication Adherence: A Systematic Review and Synthesis of the Literature in AIDS AND BEHAVIOR
  • 2013-06. HIV Stigma Mechanisms and Well-Being Among PLWH: A Test of the HIV Stigma Framework in AIDS AND BEHAVIOR
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    http://scigraph.springernature.com/pub.10.1007/s11121-019-01013-5

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    http://dx.doi.org/10.1007/s11121-019-01013-5

    DIMENSIONS

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    PUBMED

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    42 schema:description Antiretroviral therapies (ART) suppress HIV replication, thereby preventing HIV disease progression and potentially preventing HIV transmission. However, there remain significant health disparities among people living with HIV, particularly for women living in impoverished rural areas. A significant contributing factor to HIV-related disparities is a stigma. And yet, the relative contributions of stigma, gender, socio-economics, and geography in relation to health outcomes are understudied. We examined the associations of internalized stigma and enacted stigma with community-level income inequality and HIV viral suppression-the hallmark of successful ART-among 124 men and 74 women receiving care from a publicly funded HIV clinic serving rural areas with high-HIV prevalence in the southeastern US. Participants provided informed consent, completed computerized interviews, and provided access to their medical records. Gini index was collected at the census tract level to estimate community-level income inequality. Individual-level and multilevel models controlled for point distance that patients lived from the clinic and quality of life, and included participant gender as a moderator. We found that for women, income inequality, internalized stigma, and enacted stigma were significantly associated with HIV suppression. For men, there were no significant associations between viral suppression and model variables. The null findings for men are consistent with gender-based health disparities and suggest the need for gender-tailored prevention interventions to improve the health of people living with HIV in rural areas. Results confirm and help to explain previous research on the impact of HIV stigma and income inequality among people living with HIV in rural settings.
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