HIV / STI
Modeling the Mediating Effects of Multidimensional HIV-related Stigma on Antiretroviral Therapy Adherence and Viral Suppression among Diverse Racial/Ethnic Minority Women with HIV in the Miami-Dade County Ryan-White Program, Florida Mary Jo Trepka* Ekpereka Nawfal Diana M. Sheehan Gladys Ibañez
Background. This study examined the mediating effects of HIV-related stigma types on the
relationship between race/ethnicity and antiretroviral therapy (ART) adherence and viral
suppression among women with HIV (WHIV).
Methods. We included a cohort of 542 racial/ethnic minority WHIV (non-Hispanic, non-Haitian
Black; Haitian; and Hispanic). Structural equation modeling was conducted with the latent
constructs of HIV-related stigma dimensions (anticipated, internalized, and enacted) as
mediators, using diagonally weighted least squares to test the direct and indirect effects of
race/ethnicity on > 95% antiretroviral adherence and viral suppression (<200 copies/ml),
adjusting for covariates. All paths from race/ethnicity to the mediators and outcomes were
estimated with comparison to means for all race/ethnic groups or sample proportions.
Bootstrapping with 5,000 replications were used to obtain the 95% bias-corrected confidence
interval (CI).
Results. Final model fit indices indicated excellent fit (Comparative Fit Index = 0.978, Tucker-
Lewis Index = 0.987, Root Mean Square Error of Approximation = 0.024). The direct effect of
race/ethnicity on viral suppression was significant with Haitian WHIV less likely to be virally
suppressed (β = -0.48, 95%CI: -0.90, -0.14) and Hispanic WHIV more likely (β = 0.43, 95%CI:
0.15, 0.85) compared to the overall sample proportion of viral suppression. We found
nonsignificant mediating effects on viral suppression for all HIV-related stigma types. However,
Haitian WHIV (β = 0.33, 95%CI: 0.19, 0.46) reported increased anticipated stigma compared to
average level among the race/ethnic groups.
Conclusion. Haitian WHIV experience anticipated stigma and are less virally suppressed.
Concerted efforts to improve HIV-health outcomes should prioritize understanding the unique
cultural beliefs and perceptions about HIV that influence HIV-related stigma prevalent in this
community to inform and strengthen HIV-stigma reduction intervention
