A longitudinal study of associations between HIV-related stigma, recent violence and depression among women living with HIV in a Canadian cohort study

被引：34

作者：

Logie, Carmen H. ^{[1
,2
]}

Marcus, Natania ^{[3
]}

Wang, Ying ^{[1
]}

Kaida, Angela ^{[4
]}

O'Campo, Patricia ^{[5
,6
]}

Ahmed, Uzma ^{[1
]}

O'Brien, Nadia ^{[7
,33
,46
]}

Nicholson, Valerie ^{[4
,14
]}

Conway, Tracey ^{[2
,25
]}

de Pokomandy, Alexandra ^{[7
,8
]}

Fernet, Mylene ^{[9
,48
]}

Loutfy, Mona ^{[2
,10
]}

Anema, Aranka ^{[11
]}

Becker, Denise ^{[12
]}

Brotto, Lori ^{[11
]}

Carter, Allison ^{[13
,14
]}

Cardinal, Claudette ^{[14
]}

Colley, Guillaume ^{[13
]}

Ding, Erin ^{[15
]}

Duddy, Janice ^{[16
]}

Gataric, Nada ^{[13
]}

Hogg, Robert S. ^{[13
,14
]}

Howard, Terry ^{[12
]}

Jabbari, Shahab ^{[15
]}

Jones, Evin ^{[16
]}

Kestler, Mary ^{[17
]}

Langlois, Andrea ^{[16
]}

Lima, Viviane ^{[13
]}

Lloyd-Smith, Elisa ^{[18
]}

Medjuck, Melissa ^{[19
]}

Miller, Cari ^{[14
]}

Money, Deborah ^{[20
]}

Ogilvie, Gina ^{[21
]}

Patterson, Sophie ^{[14
]}

Pick, Neora ^{[17
]}

Roth, Eric ^{[22
]}

Salters, Kate ^{[14
]}

Sanchez, Margarite ^{[23
]}

Sas, Jacquie ^{[24
]}

Sereda, Paul ^{[13
]}

Summers, Marcie ^{[19
]}

Tom, Christina ^{[14
]}

Wang, Lu ^{[15
]}

Webster, Kath ^{[14
]}

Zhang, Wendy ^{[13
]}

Angel, Jonathan ^{[26
]}

Barry, Fatimatou ^{[25
]}

Bauer, Greta ^{[27
]}

Beaver, Kerrigan ^{[25
]}

Benoit, Anita ^{[25
]}

机构：

[1] Univ Toronto, Factor Inwentash Fac Social Work, Toronto, ON, Canada

[2] Womens Coll Hosp, Womens Coll Res Inst, Toronto, ON, Canada

[3] Univ Toronto, Dept Appl Psychol & Human Dev, Toronto, ON, Canada

[4] Simon Fraser Univ, Fac Hlth Sci, Vancouver, BC, Canada

[5] St Michaels Hosp, Toronto, ON, Canada

[6] Univ Toronto, Dalla Lana Sch Publ Hlth, Toronto, ON, Canada

[7] McGill Univ, Dept Family Med, Montreal, PQ, Canada

[8] McGill Univ, Ctr Hlth, Chron Viral Illness Serv, Montreal, PQ, Canada

[9] Univ Quebec, Dept Sexol, Montreal, PQ, Canada

[10] Univ Toronto, Dept Med, Toronto, ON, Canada

[11] Univ British Columbia, Vancouver, BC, Canada

[12] Posit Living Soc British Columbia, Vancouver, BC, Canada

[13] British Columbia Ctr Excellence HIV AIDS, Toronto, ON, Canada

[14] Simon Fraser Univ, Burnaby, BC, Canada

[15] British Columbia Ctr Excellence, Vancouver, BC, Canada

[16] Pacific AIDS Network, Vancouver, BC, Canada

[17] BC Womens Hosp & Hlth Ctr, Oak Tree Clin, Vancouver, BC, Canada

[18] Providence Hlth Care, Vancouver, BC, Canada

[19] Posit Womens Network, Vancouver, BC, Canada

[20] Womens Hlth Res Inst, Vancouver, BC, Canada

[21] British Columbia Ctr Dis Control, Vancouver, BC, Canada

[22] Univ Victoria, Victoria, BC, Canada

[23] Posit Living Soc British Columbia, ViVA, Vancouver, BC, Canada

[24] CIHR Canadian HIV Trials Network, Vancouver, BC, Canada

[25] Womens Coll Res Inst, Toronto, ON, Canada

[26] Ottawa Hosp Res Inst, Ottawa, ON, Canada

[27] Univ Western Ontario, London, ON, Canada

[28] Childrens Hosp Eastern Ontario, Ottawa, ON, Canada

[29] Ontario HIV Treatment Network, Toronto, ON, Canada

[30] Windsor Reg Hosp, Windsor, ON, Canada

[31] McMaster Univ, Hamilton, ON, Canada

[32] Ryerson Univ, Toronto, ON, Canada

[33] McGill Univ, Hlth Ctr, Montreal, PQ, Canada

[34] Univ Ottawa, Ottawa, ON, Canada

[35] Univ Toronto, Toronto, ON, Canada

[36] Womens Hlth Womens Hands, Toronto, ON, Canada

[37] Toronto East Gen Hosp, Toronto, ON, Canada

[38] Sunnybrook Hlth Sci Ctr, Toronto, ON, Canada

[39] St Josephs Hlth Care, London, ON, Canada

[40] CAMH, Toronto, ON, Canada

[41] Haven Clin, Sherwood Pk, AB, Canada

[42] Toronto Gen Res Inst, Toronto, ON, Canada

[43] Kingston Univ, Kingston, ON, Canada

[44] Native Youth Sexual Hlth Network, Toronto, ON, Canada

[45] St Michaels Hosp, Quebec City, PQ, Canada

[46] Univ Montreal, Montreal, PQ, Canada

[47] Univ Concordia, Montreal, PQ, Canada

[48] Univ Quebec, Montreal, PQ, Canada

[49] McGill Univ, Montreal, PQ, Canada

[50] COCQ SIDA, Toronto, ON, Canada

来源：

JOURNAL OF THE INTERNATIONAL AIDS SOCIETY | 2019年 / 22卷 / 07期

基金：

加拿大健康研究院;

关键词：

women; violence; HIV; stigma; gender; depression; INTIMATE PARTNER VIOLENCE; COMMUNITY-BASED RESEARCH; GENDER-BASED VIOLENCE; QUALITY-OF-LIFE; SUBSTANCE-ABUSE; RACIAL-DISCRIMINATION; INTERSECTIONAL STIGMA; REPRODUCTIVE HEALTH; FUTURE-RESEARCH; POSITIVE WOMEN;

D O I：

10.1002/jia2.25341

中图分类号：

R392 [医学免疫学]; Q939.91 [免疫学];

学科分类号：

100102 ;

摘要：

Introduction Women living with HIV (WLHIV) experience stigma and elevated exposure to violence in comparison with HIV-negative women. We examined the mediating role of experiencing recent violence in the relationship between stigma and depression among WLHIV in Canada. Methods We conducted a cohort study with WLHIV in three Canadian provinces. Recent violence was assessed through self-reported experiences of control, physical, sexual or verbal abuse in the past three months. At Time 1 (2013-2015) three forms of stigma were assessed (HIV-related, racial, gender) and at Time 2 (2015-2017) only HIV-related stigma was assessed. We conducted structural equation modelling (SEM) using the maximum likelihood estimation method with Time 1 data to identify direct and indirect effects of gender discrimination, racial discrimination and HIV-related stigma on depression via recent violence. We then conducted mixed effects regression and SEM using Time 1 and Time 2 data to examine associations between HIV-related stigma, recent violence and depression. Results At Time 1 (n = 1296), the direct path from HIV-related stigma (direct effect: beta = 0.200, p < 0.001; indirect effect: beta = 0.014, p < 0.05) to depression was significant; recent violence accounted for 6.5% of the total effect. Gender discrimination had a significant direct and indirect effect on depression (direct effect: beta = 0.167, p < 0.001; indirect effect: beta = 0.050, p < 0.001); recent violence explained 23.15% of the total effect. Including Time 1 and Time 2 data (n = 1161), mixed-effects regression results indicate a positive relationship over time between HIV-related stigma and depression (Acoef: 0.04, 95% CI: 0.03, 0.06, p < 0.001), and recent violence and depression (Acoef: 1.95, 95% CI: 0.29, 4.42, p < 0.05), controlling for socio-demographics. There was a significant interaction between HIV-related stigma and recent violence with depression (Acoef: 0.04, 95% CI: 0.01, 0.07, p < 0.05). SEM analyses reveal that HIV-related stigma had a significant direct and indirect effect on depression over time (direct effect: beta = 0.178, p < 0.001; indirect effect: beta = 0.040, p < 0.001); recent violence experiences accounted for 51% of the total effect. Conclusions Our findings suggest that HIV-related stigma is associated with increased experiences of recent violence, and both stigma and violence are associated with increased depression among WLHIV in Canada. There is an urgent need for trauma-informed stigma interventions to address stigma, discrimination and violence.

引用

页数：12

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