April 14, 2015

New research to study effects of stigma on women’s adherence and outcomes in HIV care

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janet turanWomen diagnosed with HIV have been found to have worse adherence to antiretroviral therapy and higher morbidity and mortality than men. New research from the University of Alabama at Birmingham looks to identify barriers to adherence and to develop responsive interventions.

The National Institute of Mental Health of the National Institutes of Health has awarded a $2.7 million R01 grant to fund “Mechanisms and Longitudinal Effects of Stigma on Women’s Adherence and Outcomes,” led by Janet M. Turan, Ph.D., associate professor in the UAB Department of Health Care Organization and Policy. The research team also includes UAB faculty members Mirjam-Colette Kempf, Ph.D., in the UAB School of Nursing and Bulent Turan, Ph.D., in the UAB College of Arts and Sciences.

It is estimated that only 32 percent of the 88 percent of women diagnosed with HIV have the virus under control, according to the Centers for Disease Control and Prevention.

“Following HIV treatment recommendations, which includes adherence to antiretroviral therapy and coming in for HIV care visits, is essential for anyone living with HIV to achieve health, longevity and an undetectable viral load,” Turan said. “In addition to HIV-infected women’s having worse adherence than men, compared to white women, women of color are at higher risk of acquiring HIV and have worse health outcomes once infected.”

Turan says the need to identify barriers women are facing, particularly among minority women, is urgent. HIV-related stigma is the first barrier Turan wants to address.

“Studies suggest that stigma and discrimination not only threaten quality of life for persons living with HIV, but also are associated with worse ART and visit adherence, with negative effects on health outcomes,” Turan said.

The field of HIV-care, Turan says, still has a limited understanding of various factors that could affect women’s adherence:

  • the causal/temporal relationships between stigma, adherence and health outcomes
  • the dimensions of HIV-related stigma that influence these outcomes
  • the causal mechanisms through which stigma may adversely affect health — potentially both through biological mechanisms (e.g., chronic stress processes) and through treatment adherence
  • the intersection of HIV-related stigma with other forms of stigma and discrimination due to race/ethnicity, gender, and socioeconomic status (SES)
“Studies suggest that stigma and discrimination not only threaten quality of life for persons living with HIV, but also are associated with worse ART and visit adherence, with negative effects on health outcomes.”

To address these gaps in knowledge, Turan’s team will leverage the resources of the national Women’s Interagency HIV Study, 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 analyzing data from the national WIHS cohort to elucidate the longitudinal associations between internalized HIV-related stigma, adherence to HIV treatment, and corresponding immunologic and virologic outcomes, we will conduct a yearly supplementary visit at three WIHS sites in different parts of the country — the Deep South, the Southeast and California,” Turan said. “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).”

Study findings, Turan says, will have important theoretical implications, as well as provide crucial information for policies and programs striving to improve outcomes for women living with HIV.

Collaborating institutions are the University of California–San Francisco, Emory University, the University of Mississippi Medical Center and the University of Colorado–Denver. Funding for the study continues through December 2019.