HIV-related stigma, antiretroviral adherence, and viral suppression among women with HIV: the role of anxiety and patient-provider relationship.

OBJECTIVES

We examined the mediating effect of anxiety on the associations between HIV-related stigma dimensions (anticipated, enacted, and internalized) and antiretroviral therapy (ART) adherence and viral suppression among women with HIV (WHIV), and the moderating effect of patient-provider relationship on the anxiety-mediated effects.

DESIGN

A cross-sectional study.

METHODS

Mediation and moderated-mediation analyses were conducted using data collected between June 2021 and March 2022 from WHIV enrolled in the Miami-Dade County Ryan White program ( N  = 561). We applied the Monte Carlo method with 20 000 replications to obtain robust 95% confidence intervals.

RESULTS

Of 561 WHIV, 342 (61.5%) were adherent to ART, and 463 (91.1%) were virally suppressed. In the mediation model, only the indirect effect of internalized stigma on ART adherence was significantly mediated by anxiety [ β  = -0.087, 95% confidence interval (CI): -0.1796, -0.0014], indicating that internalized stigma was associated with higher levels of anxiety symptoms ( β  = 2.823, 95% CI: 2.0099, 3.6359), which in turn was associated with decreased adherence to ART ( β  = -0.031, 95% CI: -0.0616, -0.0002). The indirect effects of all the HIV-related stigma domains on viral suppression through anxiety were not significant. The moderated-mediation index was not significant, suggesting that the patient-provider relationship did not moderate the anxiety-mediated effect on the association between internalized stigma and ART adherence.

CONCLUSION

Our findings suggest that interventions focused on addressing both HIV-related stigma, particularly internalized stigma, and anxiety symptoms among WHIV could substantially mitigate the adverse effects of HIV-related stigma on ART adherence.