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Perceived HIV Treatment Norms Modify the Association Between HIV-Related Stigma and Adherence to Antiretroviral Therapy Among Persons Living with HIV in Baltimore, Maryland

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Abstract

Adherence to antiretroviral therapy (ART) is associated with reduced HIV-related morbidity/mortality and ongoing transmission; however, the extent to which this association is modified by perceived HIV treatment norms is unknown. 270 PLWH completed a survey to assess demographics, risk behaviors, stigma, ART adherence, and perceived HIV treatment norms (Baltimore, 2014–2017). We used modified Poisson regression to examine effect modification by perceived HIV treatment norms. The association between HIV-related stigma and ART adherence was modified by perceived HIV treatment norms. Among individuals who perceived that friends/family were sub-optimally adherent, HIV-related stigma was negatively associated with ART adherence (Adjusted Risk Ratio [ARR] = 0.36; 95%CI 0.15–0.87). Among those who perceived optimal adherence among friends/family, the relationship between HIV-related stigma and ART adherence was not statistically significant (ARR = 1.07; 95%CI 0.65–1.76). Interventions to improve ART adherence among those who are sub-optimally adherent could focus on increasing perceptions of ART adherence among their friends/family.

Resumen

La adherencia al tratamiento antirretroviral está asociada con la reducción de la morbilidad y mortalidad relacionada con el VIH y su transmisión; sin embargo, no se sabe hasta qué punto esta asociación se modificada por las normas percibidas sobre el tratamiento del VIH. 270 personas que viven con el VIH completaron una encuesta para evaluar las características demográficas, los comportamientos de riesgo, el estigma, la adherencia a los tratamientos antiretrovirales y las normas percibidas sobre el tratamiento del VIH (Baltimore, 2014–2017). Se utilizó una regresión de Poisson modificada para examinar la modificación del efecto por las normas percibidas sobre el tratamiento del VIH. La asociación entre el estigma relacionada con el VIH y la adherencia al tratamiento antirretroviral fue modificada por las normas percibidas de tratamiento del VIH. Entre los individuos que percibían que sus amigos/familiares no se adhirieron al tratamiento antirretroviral de manera óptima, el estigma relacionada con el VIH se asoció negativamente con la adherencia al tratamiento antirretroviral (Razón de riesgo ajustada [RRA] = 0.36; IC 95%:0.15–0.87). Entre los que percibían que sus amigos(as)/familiares se adhirieron al tratamiento del VIH de manera óptima, la asociación entre el estigma relacionada con el VIH y la adherencia al tratamiento antirretroviral no fue estadísticamente significativa (RRA = 1.07; IC 95%:0.65–1.76). Las intervenciones para mejorar la adherencia al tratamiento antirretroviral para aquellos que no se adhieren al tratamiento de manera óptima podrían centrarse en mejorar las normas percibidas sobre la adherencia al tratamiento antirretroviral entre sus amigos(as) y familiares.

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Data Availability

Data are available upon request, pending approval of a data use agreement and certification of training in Human Subjects Research.

Code Availability

We provide STATA code in the Supplementary Materials.

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This work was supported by grants K01 DA033879 to investigator Abby E. Rudolph and R01 DA032217 to investigator Carl Latkin from the National Institute on Drug Abuse and grant R21 AI131979 to investigator Abby E. Rudolph from the National Institutes of Allergy and Infectious Diseases. This publication also resulted (in part) from research supported by the Johns Hopkins University Center for AIDS Research, an NIH funded program (1P30AI094189), which is supported by the following NIH Co-Funding and Participating Institutes and Centers: NIAID, NCI, NICHD, NHLBI, NIDA, NIA, NIGMS, NIDDK, NIMHD. Dr. Dembo’s efforts were supported by T32HD007489 and U54 HD090256 from the Eunice Kennedy Shriver National Institute of Child Health & Human Development of the National Institutes of Health and the University of Wisconsin-Madison. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. Any findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the view of the organizations or agencies that provided support for this project.

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Authors and Affiliations

  1. Department of Epidemiology and Biostatistics, Temple University College of Public Health, 1301 Cecil B Moore Avenue, Ritter Annex 905, Philadelphia, PA, 19122, USA

    Abby E. Rudolph

  2. Waisman Center, University of Wisconsin-Madison, 1500 Highland Ave., Madison, WI, 53705, USA

    Robert S. Dembo

  3. Department of Health, Behavior, and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA

    Karin Tobin & Carl Latkin

Authors
  1. Abby E. Rudolph
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  2. Robert S. Dembo
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  3. Karin Tobin
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  4. Carl Latkin
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Contributions

AER and RSD conceptualized the research question and study design. RSD authored the Stata post-estimation code and the corresponding tutorial for computing accurate strata-specific confidence intervals in the Appendix. AER reviewed the literature, wrote the initial manuscript draft, and reviewed multiple versions of the supplementary material. AER supervised the analytic plan and analyzed the data together with RSD, including replication of findings in SAS. RSD reviewed multiple manuscript drafts. CL and KT oversaw data collection activities. All authors reviewed and approved the final version of the manuscript.

Corresponding author

Correspondence to Abby E. Rudolph.

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Conflict of interest

No conflicts of interest declared.

Ethical Approval

The study protocol and data collection instruments were approved by the institutional review board at Johns Hopkins University Bloomberg School of Public Health.

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All participants provided written informed consent to participate in the study and the study protocol and data collection instruments were approved by the institutional review board at Johns Hopkins University Bloomberg School of Public Health.

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Only de-identified and aggregate data are presented in this paper.

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Rudolph, A.E., Dembo, R.S., Tobin, K. et al. Perceived HIV Treatment Norms Modify the Association Between HIV-Related Stigma and Adherence to Antiretroviral Therapy Among Persons Living with HIV in Baltimore, Maryland. AIDS Behav 26, 537–548 (2022). https://doi.org/10.1007/s10461-021-03409-3

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