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The Relationship Between Discrimination and Missed HIV Care Appointments Among Women Living with HIV

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Abstract

Receiving regular HIV care is crucial for maintaining good health among persons with HIV. However, racial and gender disparities in HIV care receipt exist. Discrimination and its impact may vary by race/ethnicity and gender, contributing to disparities. Data from 1578 women in the Women’s Interagency HIV Study ascertained from 10/1/2012 to 9/30/2016 were used to: (1) estimate the relationship between discrimination and missing any scheduled HIV care appointments and (2) assess whether this relationship is effect measure modified by race/ethnicity. Self-reported measures captured discrimination and the primary outcome of missing any HIV care appointments in the last 6 months. Log-binomial models accounting for measured sources of confounding and selection bias were fit. For the primary outcome analyses, women experiencing discrimination typically had a higher prevalence of missing an HIV care appointment. Moreover, there was no statistically significant evidence for effect measure modification by race/ethnicity. Interventions to minimize discrimination or its impact may improve HIV care engagement among women.

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Acknowledgements

Data in this manuscript were collected by the Women’s Interagency HIV Study (WIHS). The contents of this publication are solely the responsibility of the authors and do not represent the official views of the National Institutes of Health (NIH). WIHS (Principal Investigators): UAB-MS WIHS (Mirjam-Colette Kempf and Deborah Konkle-Parker), U01-AI-103401; Atlanta WIHS (Ighovwerha Ofotokun and Gina Wingood), U01-AI-103408; Bronx WIHS (Kathryn Anastos and Anjali Sharma), U01-AI-035004; Brooklyn WIHS (Howard Minkoff and Deborah Gustafson), U01-AI-031834; Chicago WIHS (Mardge Cohen and Audrey French), U01-AI-034993; Metropolitan Washington WIHS (Seble Kassaye), U01-AI-034994; Miami WIHS (Margaret Fischl and Lisa Metsch), U01-AI-103397; UNC WIHS (Adaora Adimora), U01-AI-103390; Connie Wofsy Women’s HIV Study, Northern California (Ruth Greenblatt, Bradley Aouizerat, and Phyllis Tien), U01-AI-034989; WIHS Data Management and Analysis Center (Stephen Gange and Elizabeth Golub), U01-AI-042590; Southern California WIHS (Joel Milam), U01-HD-032632 (WIHS I—WIHS IV). The WIHS is funded primarily by the National Institute of Allergy and Infectious Diseases (NIAID), with additional co-funding from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), the National Cancer Institute (NCI), the National Institute on Drug Abuse (NIDA), and the National Institute on Mental Health (NIMH). Targeted supplemental funding for specific projects is also provided by the National Institute of Dental and Craniofacial Research (NIDCR), the National Institute on Alcohol Abuse and Alcoholism (NIAAA), the National Institute on Deafness and other Communication Disorders (NIDCD), and the NIH Office of Research on Women’s Health. WIHS data collection is also supported by UL1-TR000004 (UCSF CTSA), UL1-TR000454 (Atlanta CTSA), P30-AI-050410 (UNC CFAR), and P30-AI-027767 (UAB CFAR).

Funding

This study was funded by the National Institutes of Health Grants U01-AI-103401, U01-AI-103408, U01-AI-035004, U01-AI-031834, U01-AI-034993, U01-AI-034994, U01-AI-103397, U01-AI-103390, U01-AI-034989, U01-AI-042590, U01-HD-032632, UL1-TR000004, UL1-TR000454, P30-AI-050410, and P30-AI-027767.

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Authors and Affiliations

  1. Department of Epidemiology, Centers for Epidemiology and Environmental Health, Brown University School of Public Health, 121 South Main Street, Providence, RI, 02912, USA

    Andrew E. Cressman & Chanelle J. Howe

  2. Department of Behavioral and Social Sciences, Center for Health Equity Research, Brown University School of Public Health, Providence, RI, USA

    Amy S. Nunn

  3. School of Medicine and UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapelhill, NC, USA

    Adaora A. Adimora

  4. Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA

    David R. Williams

  5. Department of African and African American Studies, Harvard University, Cambridge, MA, USA

    David R. Williams

  6. Schools of Nursing, Public Health, Medicine, University of Alabama at Birmingham, Birmingham, AL, USA

    Mirjam-Colette Kempf

  7. Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA

    Aruna Chandran & Eryka L. Wentz

  8. Montefiore and Albert Einstein College of Medicine, Bronx, NY, USA

    Oni J. Blackstock

  9. Department of Medicine, Georgetown University, Washington, DC, USA

    Seble G. Kassaye

  10. Department of Clinical Pharmacy, University of California, San Francisco, San Francisco, CA, USA

    Jennifer Cohen

  11. Departments of Medicine, Stroger Hospital and Rush University, Chicago, IL, USA

    Mardge H. Cohen

  12. Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA

    Gina M. Wingood & Lisa R. Metsch

  13. Lerner Center for Public Health Promotion, Mailman School of Public Health, Columbia University, New York, NY, USA

    Gina M. Wingood

  14. Department of Community Health Sciences, School of Public Health, State University of New York Downstate Medical Center, Brooklyn, NY, USA

    Tracey E. Wilson

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  1. Andrew E. Cressman
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  2. Chanelle J. Howe
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  4. Adaora A. Adimora
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  11. Jennifer Cohen
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  15. Tracey E. Wilson
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Correspondence to Chanelle J. Howe.

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Cressman, A.E., Howe, C.J., Nunn, A.S. et al. The Relationship Between Discrimination and Missed HIV Care Appointments Among Women Living with HIV. AIDS Behav 24, 151–164 (2020). https://doi.org/10.1007/s10461-019-02522-8

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