Doctor of Philosophy (PhD)
First Advisor's Name
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Second Advisor's Committee Title
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Fourth Advisor's Name
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Fifth Advisor's Name
Mario De La Rosa
Fifth Advisor's Committee Title
HIV, Stigma, Disparities, Continuum
Date of Defense
Background: Florida currently has one of the highest rates of new HIV infections in the U.S. As of 2019, Black and Hispanic HIV-positive individuals in Florida were significantly less likely to receive HIV care, remain in care, and achieve viral suppression than white HIV-positive individuals. Several studies have linked HIV-related stigma to poor outcomes among people living with HIV (PLWH). This study examined the impact of distinct HIV-related stigma subtypes on linkage to care, retention in care, and viral suppression among PLWH in Florida and if these associations differed across race/ethnicity.
Methods: Data from the 2015-2017 Florida Medical Monitoring Project (MMP) and the Enhanced HIV/AIDS Reporting Systems (eHARS) were utilized in the present cross-sectional study. Logistic regression models were used to examine associations between stigma and HIV care continuum outcomes (linkage to care, retention in care, and viral suppression). A weighted sample of 89,889 PLWH was examined (50.0% Blacks, 20.8% Hispanics, and 29.2% whites). Using multiple race/ethnicity x HIV stigma subtype interactions, we examined if race/ethnicity moderated the association between HIV-related stigma subtypes and HIV continuum of care outcomes. Logistic regression models were subsequently stratified by race/ethnicity for each HIV care outcome based on significant interactions.
Results: Findings indicated greater personalized stigma was associated with lower odds of being linked to care, while higher levels of negative self-image stigma and anticipated stigma were associated with a greater likelihood of being linked to care. Higher negative self-image stigma and anticipated stigma were associated with lower odds for retention in care and viral suppression. Conversely, greater personalized stigma was associated with increased odds of being retained in care and virally suppressed. Distinct associations between HIV-related stigma subtypes and HIV care continuum outcomes were evident among Black, White, and Hispanic participants.
Conclusion: Different forms of HIV-related stigma can distinctly impact HIV outcomes across the HIV care continuum and these associations may differ by race/ethnicity. Findings from this study lay the groundwork for a better understanding of the existing racial disparities along the HIV continuum of care. Future research is needed to understand the underlying mechanisms driving these associations.
Forney, Derrick James, "The Impact of HIV-Related Stigma on the Racial/Ethnic Disparities Across the HIV Care Continuum among Adults Living with HIV in Florida" (2021). FIU Electronic Theses and Dissertations. 4838.
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