Lack of virologic suppression is associated with lower HIV-related disclosure stigma in people living with HIV

ABSTRACT

Stigma remains a leading barrier to HIV care. To determine the influence of disclosure stigma (DS), fear of disclosing one’s serostatus, on virologic suppression, a cross-sectional study was performed at the largest publicly-funded HIV clinic in South Texas. A survey was administered to participants who were: ≥18 years old, living with HIV, and receiving antiretroviral therapy. Surveys included demographics, adherence questionnaire, and a validated HIV-stigma scale with DS as the sum of 10 items ranked 0–3, with score of 30 indicating highest stigma. The primary outcome was lack of virologic suppression (LOVS): most recent HIV-1 RNA > 20 copies/ml. A bivariate analyses examined predictors of DS, dichotomized at the median. Depression score, perceived stress, and lack of friend/family support were associated with DS. Logistic regression models examined the relationship between DS, as a continuous variable, and LOVS. For 275 participants (69% Hispanic), median DS score was 18.5. DS was significantly inversely associated with LOVS (aOR 0.94 per 1 scale point; CI 0.89, 0.99) after adjustment for age, gender/sexual orientation, race/ethnicity, and drug use. The unanticipated inverse association between DS and LOVS highlights the complexity of this relationship. However, the balance of data in this cohort demonstrate an overall negative impact of DS.

KEYWORDS:

• Disclosure stigma
• virologic suppression
• medication adherence
• HIV

Acknowledgements

We deeply appreciate the support of Yvonne Venegas, Director, and Dr Delia Bullock, Medical Director, the entire staff of the FFACTS Clinic, and University Health System. We gratefully acknowledge the time the participants gave to answer the survey, and the support of the Infectious Diseases Division at UT Health and the Institute for Health Disparities Research at UTSA.

Disclosure statement

No potential conflict of interest was reported by the authors.

Data availability

A de-identified dataset for these analyses in the form of a csv file can be made available to interested parties upon request.

Additional information

Funding

This work was not supported by any funding agency or grant.