HIV-related stigma, racial discrimination, and gender discrimination : Pathways to physical and mental health-related quality of life among a national cohort of women living with HIV
Copyright © 2017 Elsevier Inc. All rights reserved..
Social inequities compromise health-related quality of life (HR-QoL) among women living with HIV (WLWH). Little is known about health impacts of intersecting stigma based on HIV status, race and gender among WLWH or potential mechanisms to promote HR-QoL. We tested pathways from multiple types of stigma (HIV-related, racial, gender) to physical and mental HR-QoL utilizing baseline survey data from a national cohort of WLWH in Canada (2013-2015). Structural equation modeling was conducted using maximum likelihood estimation methods to test the direct effects of HIV-related stigma, racial discrimination, and gender discrimination on HR-QoL and indirect effects via social support and economic insecurity, adjusting for socio-demographic factors. Among 1425 WLWH (median age: 43years [IQR=35-50]), HIV-related stigma and gender discrimination had significant direct effects on mental HR-QoL. Social support mediated the relationship between HIV-related stigma and mental HR-QoL, accounting for 22.7% of the effect. Social support accounted for 41.4% of the effect of gender discrimination on mental HR-QoL. Economic insecurity accounted for 14.3% of the effect of HIV-related stigma, and 42.4% of the effect of racial discrimination, on physical HR-QoL. Fit indices suggest good model fit (χ2[1]=3.319, p=0.069; CFI=0.998; RMSEA=0.042 (90% CI: 0-0.069); SRMR=0.004). Findings reveal complex relationships between intersecting stigma and HR-QoL. Strategies that address intersecting stigma and economic insecurity among WLWH may prevent the harmful impacts of HIV-related stigma and gender discrimination on physical HR-QoL. Increasing social support may mitigate the impacts of stigma on mental health. Findings can inform multi-level interventions to promote health and wellbeing among WLWH.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2018 |
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| Erschienen: |
2018 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:107 |
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| Enthalten in: |
Preventive medicine - 107(2018) vom: 15. Feb., Seite 36-44 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Logie, Carmen H [VerfasserIn] |
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| Links: |
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| Themen: |
HIV |
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| Anmerkungen: |
Date Completed 14.01.2019 Date Revised 14.01.2019 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1016/j.ypmed.2017.12.018 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM279409931 |
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| 100 | 1 | |a Logie, Carmen H |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a HIV-related stigma, racial discrimination, and gender discrimination |b Pathways to physical and mental health-related quality of life among a national cohort of women living with HIV |
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| 520 | |a Copyright © 2017 Elsevier Inc. All rights reserved. | ||
| 520 | |a Social inequities compromise health-related quality of life (HR-QoL) among women living with HIV (WLWH). Little is known about health impacts of intersecting stigma based on HIV status, race and gender among WLWH or potential mechanisms to promote HR-QoL. We tested pathways from multiple types of stigma (HIV-related, racial, gender) to physical and mental HR-QoL utilizing baseline survey data from a national cohort of WLWH in Canada (2013-2015). Structural equation modeling was conducted using maximum likelihood estimation methods to test the direct effects of HIV-related stigma, racial discrimination, and gender discrimination on HR-QoL and indirect effects via social support and economic insecurity, adjusting for socio-demographic factors. Among 1425 WLWH (median age: 43years [IQR=35-50]), HIV-related stigma and gender discrimination had significant direct effects on mental HR-QoL. Social support mediated the relationship between HIV-related stigma and mental HR-QoL, accounting for 22.7% of the effect. Social support accounted for 41.4% of the effect of gender discrimination on mental HR-QoL. Economic insecurity accounted for 14.3% of the effect of HIV-related stigma, and 42.4% of the effect of racial discrimination, on physical HR-QoL. Fit indices suggest good model fit (χ2[1]=3.319, p=0.069; CFI=0.998; RMSEA=0.042 (90% CI: 0-0.069); SRMR=0.004). Findings reveal complex relationships between intersecting stigma and HR-QoL. Strategies that address intersecting stigma and economic insecurity among WLWH may prevent the harmful impacts of HIV-related stigma and gender discrimination on physical HR-QoL. Increasing social support may mitigate the impacts of stigma on mental health. Findings can inform multi-level interventions to promote health and wellbeing among WLWH | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Research Support, Non-U.S. Gov't | |
| 650 | 4 | |a HIV | |
| 650 | 4 | |a Health-related quality of life | |
| 650 | 4 | |a Intersectional | |
| 650 | 4 | |a Intersectionality | |
| 650 | 4 | |a Racism | |
| 650 | 4 | |a Sexism | |
| 650 | 4 | |a Stigma | |
| 650 | 4 | |a Wellbeing | |
| 650 | 4 | |a Women | |
| 700 | 1 | |a Wang, Ying |e verfasserin |4 aut | |
| 700 | 1 | |a Lacombe-Duncan, Ashley |e verfasserin |4 aut | |
| 700 | 1 | |a Wagner, Anne C |e verfasserin |4 aut | |
| 700 | 1 | |a Kaida, Angela |e verfasserin |4 aut | |
| 700 | 1 | |a Conway, Tracey |e verfasserin |4 aut | |
| 700 | 1 | |a Webster, Kath |e verfasserin |4 aut | |
| 700 | 1 | |a de Pokomandy, Alexandra |e verfasserin |4 aut | |
| 700 | 1 | |a Loutfy, Mona R |e verfasserin |4 aut | |
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