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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.
Prev Med. 2018 02; 107:36-44.PM

Abstract

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.

Authors+Show Affiliations

Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, Toronto, ON M5S 1V4, Canada; Women's College Research Institute, Women's College Hospital, 76 Grenville Street, Toronto, ON M5S 1B2, Canada. Electronic address: carmen.logie@utoronto.ca.Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, Toronto, ON M5S 1V4, Canada. Electronic address: yings.wang@mail.utoronto.ca.Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, Toronto, ON M5S 1V4, Canada. Electronic address: ashley.lacombe.duncan@utoronto.ca.Department of Psychology, Ryerson University, 350 Victoria Street, Toronto, ON M5B 2K3, Canada. Electronic address: anne.wagner@arts.ryerson.ca.Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC V5A 1S6, Canada. Electronic address: angela_kaida@sfu.ca.Women's College Research Institute, Women's College Hospital, 76 Grenville Street, Toronto, ON M5S 1B2, Canada.Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC V5A 1S6, Canada.Department of Family Medicine, McGill University, 5858 chemin de la Côte-des-Neiges, Montreal, QC H3S 1Z1, Canada; Chronic Viral Illness Service, McGill University Health Centre, 3801 University Street, Montreal, QC H3A 2B4, Canada. Electronic address: alexandra.depokomandy@mcgill.ca.Women's College Research Institute, Women's College Hospital, 76 Grenville Street, Toronto, ON M5S 1B2, Canada; Department of Medicine, University of Toronto, 190 Elizabeth Street, Toronto, ON M5G 2C4, Canada. Electronic address: Mona.Loutfy@wchospital.ca.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

29277410

Citation

Logie, Carmen H., et al. "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." Preventive Medicine, vol. 107, 2018, pp. 36-44.
Logie CH, Wang Y, Lacombe-Duncan A, et al. 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. Prev Med. 2018;107:36-44.
Logie, C. H., Wang, Y., Lacombe-Duncan, A., Wagner, A. C., Kaida, A., Conway, T., Webster, K., de Pokomandy, A., & Loutfy, M. R. (2018). 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. Preventive Medicine, 107, 36-44. https://doi.org/10.1016/j.ypmed.2017.12.018
Logie CH, et al. 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. Prev Med. 2018;107:36-44. PubMed PMID: 29277410.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - 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. AU - Logie,Carmen H, AU - Wang,Ying, AU - Lacombe-Duncan,Ashley, AU - Wagner,Anne C, AU - Kaida,Angela, AU - Conway,Tracey, AU - Webster,Kath, AU - de Pokomandy,Alexandra, AU - Loutfy,Mona R, Y1 - 2017/12/22/ PY - 2017/07/11/received PY - 2017/11/02/revised PY - 2017/12/19/accepted PY - 2017/12/27/pubmed PY - 2019/1/15/medline PY - 2017/12/27/entrez KW - HIV KW - Health-related quality of life KW - Intersectional KW - Intersectionality KW - Racism KW - Sexism KW - Stigma KW - Wellbeing KW - Women SP - 36 EP - 44 JF - Preventive medicine JO - Prev Med VL - 107 N2 - 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. SN - 1096-0260 UR - https://www.unboundmedicine.com/medline/citation/29277410/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_ DB - PRIME DP - Unbound Medicine ER -