Latent Healthcare Stigma Profiles and Their Association With Human Immunodeficiency Virus (HIV) Treatment and Care Outcomes Among Women With HIV in the United States: An Intersectional Analysis

Abstract

Background. Stigma is a barrier to human immunodeficiency virus (HIV) care among women with HIV (WWH) in the United States (US). We estimated associations between latent stigma profiles and HIV outcomes among WWH in the Women’s Interagency HIV Study. Methods. From 2018 to 2019, participants (N = 1407) completed semi-annual assessments on sociodemographics, substance use, HIV-related, anticipated, and race-related stigma in healthcare, and suboptimal antiretroviral therapy adherence (<95%), and underwent HIV RNA testing. Latent profile analysis and multinomial logistic regression were used to examine adjusted associations between profiles and several covariates. Structural equation modeling estimated longitudinal associations between profiles, suboptimal adherence, and viral nonsuppression (HIV-1 RNA ≥20 copies/mL). Results. We identified 3 profiles: high stigma (3%), low stigma (86%), and anticipated stigma (11%). Membership in the high stigma profile was greater for Black WWH who use drugs (adjusted odds ratio [aOR], 3.6 [95% confidence interval {CI}, 1.1–12.1]), non-Black WWH who use drugs (aOR, 4.8 [95% CI, 1.3–18]), and those who reported suboptimal adherence (aOR, 2.2 [95% CI, 1–4.8]), drug use (aOR, 2.6 [95% CI, 1.3–5.1]), noninjection drug use (aOR, 2.2 [95% CI, 1.1–4.4]), opioid use treatment (aOR, 4.07 [95% CI, 1.47–11.26]), depression (aOR, 5.8 [95% CI, 2.8–11.9]), stress (aOR, 1.09 [95% CI, 1.05–1.1]), and high post-traumatic stress disorder (aOR, 10.6 [95% CI, 4.3–25.7]). In the longitudinal model, suboptimal adherence was lowest for the low stigma profile and predicted future viral nonsuppression. Conclusions. Reducing stigma and integrating HIV, substance use, and mental health treatment is crucial for improving health outcomes among US WWH.