ABSTRACT
This analysis used data from a randomly selected cross-sectional sample of HIV infected outpatient adults in New York City to assess HIV-related stigma and examine gender-specific differences among factors associated with HIV-related stigma. Data was collected by conducting participant interviews and medical records abstraction. HIV-related stigma was assessed using the internalized AIDS-related stigma scale (IA-RSS). Exploratory factor analysis of the IA-RSS indicated that the scale consisted of two factors: (1) internalized stigma and (2) anticipated stigma. Of the 447 sampled participants 23.9% had a higher level of internalized stigma and 38.3% had a higher level of anticipated stigma. Multivariate analysis indicated that among females, internalized stigma was associated with being diagnosed HIV positive after the introduction of HAART in 1996 (adjusted prevalence ratio [PR]: 1.9; 95% CI: 1.2, 3.1; P < 0.01) and a diagnosis of depression (adjusted PR: 1.9; 95% CI: 1.2, 2.9; P < 0.01). Among males, anticipated stigma was associated with younger age (18 and 39 years) (adjusted PR: 1.7; 95% CI: 1.3, 2.2; P < 0.001) and use of non-injection drugs (adjusted PR: 0.60; 95% CI: 0.41, 0.86; P < 0.01). Findings suggest that there may be gender-specific differences among factors associated with different dimensions of HIV-related stigma.
Subject(s)
Depressive Disorder/epidemiology , HIV Infections/psychology , Social Stigma , Adolescent , Adult , Age Factors , Ambulatory Care , Cross-Sectional Studies , Depressive Disorder/psychology , Factor Analysis, Statistical , Female , Humans , Interviews as Topic , Male , Middle Aged , New York City , Prevalence , Sex Factors , Socioeconomic Factors , Surveys and Questionnaires , Young AdultSubject(s)
HIV Infections/diagnosis , HIV , Population Surveillance/methods , Acute Disease , Adolescent , Adult , Aged , Cooperative Behavior , Data Collection/methods , Delivery of Health Care, Integrated , Female , HIV Infections/epidemiology , Humans , Male , Middle Aged , New York City/epidemiology , Young AdultABSTRACT
BACKGROUND: Monitoring of the uptake and efficacy of ART in a population often relies on cross-sectional data, providing limited information that could be used to design specific targeted intervention programs. Using repeated measures of viral load (VL) surveillance data, we aimed to estimate and characterize the proportion of persons living with HIV/AIDS (PLWHA) in New York City (NYC) with sustained high VL (SHVL) and durably suppressed VL (DSVL). METHODS/PRINCIPAL FINDINGS: Retrospective cohort study of all persons reported to the NYC HIV Surveillance Registry who were alive and ≥12 years old by the end of 2005 and who had ≥2 VL tests in 2006 and 2007. SHVL and DSVL were defined as PLWHA with 2 consecutive VLs ≥100,000 copies/mL and PLWHA with all VLs ≤400 copies/mL, respectively. Logistic regression models using generalized estimating equations were used to model the association between SHVL and covariates. There were 56,836 PLWHA, of whom 7% had SHVL and 38% had DSVL. Compared to those without SHVL, persons with SHVL were more likely to be younger, black and have injection drug use (IDU) risk. PLWHA with SHVL were more likely to die by 2007 and be younger by nearly ten years, on average. CONCLUSIONS/SIGNIFICANCE: Nearly 60% of PLWHA in 2005 had multiple VLs, of whom almost 40% had DSVL, suggesting successful ART uptake. A small proportion had SHVL, representing groups known to have suboptimal engagement in care. This group should be targeted for additional outreach to reduce morbidity and secondary transmission. Measures based on longitudinal analyses of surveillance data in conjunction with cross-sectional measures such as community viral load represent more precise and powerful tools for monitoring ART effectiveness and potential impact on disease transmission than cross-sectional measures alone.
