Anticipated Stigma and Medication Adherence Among People Living with HIV: the Mechanistic Roles of Medication Support and ART Self-efficacy

Overview

Journal AIDS Care

Publisher Informa Healthcare

Specialty Infectious Diseases

Date 2020 Apr 28

PMID 32336130

Citations 20

Authors

Chengbo Zeng

Xiaoming Li

Shan Qiao

Xueying Yang

Zhiyong Shen

Yuejiao Zhou

Affiliations

Soon will be listed here.

Abstract

This study aimed to examine the relationship between anticipated stigma and medication adherence as well as the mechanistic roles of medication support and ART self-efficacy. Data were derived from the baseline assessment of a prospective cohort study in Guangxi, China. A total of 1198 PLWH were recruited and assessed on their sociodemographic characteristics, medication adherence, anticipated stigma, medication support, and ART self-efficacy. Path analysis was used to examine the direct effect from anticipated stigma to medication adherence and indirect effects through medication support and ART self-efficacy. Path model revealed that the indirect effect from anticipated stigma to medication adherence was statistically significant while the direct effect was not significant. Anticipated stigma could influence medication adherence through ART self-efficacy but not through medication support. The serial mediating effect of medication support and ART self-efficacy on the relationship between anticipated stigma and medication adherence was significant. Anticipated stigma affects medication adherence among PLWH through its adverse impact on medication support and ART self-efficacy. Tailored interventions promoting medication support and ART self-efficacy may alleviate the negative influence of anticipated stigma on medication adherence among PLWH. Additionally, policy efforts aiming to reduce stigma against PLWH and increasing medication support are warranted to improve medication adherence among PLWH.

Citing Articles

Correlates of internalized stigma and antiretroviral therapy adherence among people living with HIV in the Volta region of Ghana.

Ouner J, Thompson R, Dey N, Alhassan R, Gyamerah A BMC Public Health. 2025; 25(1):342.

PMID: 39871213 PMC: 11773945. DOI: 10.1186/s12889-025-21500-5.

Associations of stigma, loneliness, and treatment self-regulation with HIV medication adherence among individuals with substance use disorder using a mobile health application.

Tarfa A, Verinumbe T, Yang F, Shiyanbola O, Liebert C, Dietz S Front Public Health. 2024; 12:1440807.

PMID: 39564363 PMC: 11573518. DOI: 10.3389/fpubh.2024.1440807.

Adaptation and validation of the Adherence Barriers Questionnaire for HIV Patients on Antiretroviral Therapy (ABQ-HIV) for the Brazilian context.

Pereira M, Mueller S, Santos V Cad Saude Publica. 2024; 40(8):e00006324.

PMID: 39292129 PMC: 11405021. DOI: 10.1590/0102-311XEN006324.

Adherence to antiretroviral therapy among cisgender gay, bisexual and other men who have sex with men in Brazil: Evaluating the role of HIV-related stigma dimensions.

Matos V, Torres T, Luz P PLoS One. 2024; 19(8):e0308443.

PMID: 39116156 PMC: 11309385. DOI: 10.1371/journal.pone.0308443.

Stigma and fear of getting sick in the care of people living with HIV: an exploratory systematic review.

Jaimes Y, Lozada-Martinez I, Rosas Tosas M, Tiraboschi J Infez Med. 2024; 32(2):168-182.

PMID: 38827831 PMC: 11142417. DOI: 10.53854/liim-3202-6.

References

DiMatteo M . Social support and patient adherence to medical treatment: a meta-analysis. Health Psychol. 2004; 23(2):207-18. DOI: 10.1037/0278-6133.23.2.207. View

Loeys T, Moerkerke B, Vansteelandt S . A cautionary note on the power of the test for the indirect effect in mediation analysis. Front Psychol. 2015; 5:1549. PMC: 4290592. DOI: 10.3389/fpsyg.2014.01549. View

Ortego C, Huedo-Medina T, Llorca J, Sevilla L, Santos P, Rodriguez E . Adherence to highly active antiretroviral therapy (HAART): a meta-analysis. AIDS Behav. 2011; 15(7):1381-96. DOI: 10.1007/s10461-011-9942-x. View

Shao Y . AIDS epidemic at age 25 and control efforts in China. Retrovirology. 2006; 3:87. PMC: 1702549. DOI: 10.1186/1742-4690-3-87. View

Shrestha R, Altice F, Copenhaver M . HIV-Related Stigma, Motivation to Adhere to Antiretroviral Therapy, and Medication Adherence Among HIV-Positive Methadone-Maintained Patients. J Acquir Immune Defic Syndr. 2018; 80(2):166-173. PMC: 6331231. DOI: 10.1097/QAI.0000000000001891. View

Earnshaw V, Smith L, Chaudoir S, Amico K, Copenhaver M . HIV stigma mechanisms and well-being among PLWH: a test of the HIV stigma framework. AIDS Behav. 2013; 17(5):1785-95. PMC: 3664141. DOI: 10.1007/s10461-013-0437-9. View

Valente M, Gonzalez O, Miocevic M, MacKinnon D . A Note on Testing Mediated Effects in Structural Equation Models: Reconciling Past and Current Research on the Performance of the Test of Joint Significance. Educ Psychol Meas. 2016; 76(6):889-911. PMC: 5098906. DOI: 10.1177/0013164415618992. View

Nieuwkerk P, Oort F . Self-reported adherence to antiretroviral therapy for HIV-1 infection and virologic treatment response: a meta-analysis. J Acquir Immune Defic Syndr. 2005; 38(4):445-8. DOI: 10.1097/01.qai.0000147522.34369.12. View

Raffa J, Tossonian H, Grebely J, Petkau A, DeVlaming S, Conway B . Intermediate highly active antiretroviral therapy adherence thresholds and empirical models for the development of drug resistance mutations. J Acquir Immune Defic Syndr. 2008; 47(3):397-9. DOI: 10.1097/qai.0b013e31815b0d35. View

10.

DiIorio C, McCarty F, DePadilla L, Resnicow K, McDonnell Holstad M, Yeager K . Adherence to antiretroviral medication regimens: a test of a psychosocial model. AIDS Behav. 2007; 13(1):10-22. PMC: 3104939. DOI: 10.1007/s10461-007-9318-4. View

11.

Simoni J, Kurth A, Pearson C, Pantalone D, Merrill J, Frick P . Self-report measures of antiretroviral therapy adherence: A review with recommendations for HIV research and clinical management. AIDS Behav. 2006; 10(3):227-45. PMC: 4083461. DOI: 10.1007/s10461-006-9078-6. View

12.

Sun X, Lu F, Wu Z, Poundstone K, Zeng G, Xu P . Evolution of information-driven HIV/AIDS policies in China. Int J Epidemiol. 2010; 39 Suppl 2:ii4-13. PMC: 2992621. DOI: 10.1093/ije/dyq217. View

13.

Turan B, Fazeli P, Raper J, Mugavero M, Johnson M . Social support and moment-to-moment changes in treatment self-efficacy in men living with HIV: Psychosocial moderators and clinical outcomes. Health Psychol. 2016; 35(10):1126-1134. PMC: 5033657. DOI: 10.1037/hea0000356. View

14.

Risser J, Jacobson T, Kripalani S . Development and psychometric evaluation of the Self-efficacy for Appropriate Medication Use Scale (SEAMS) in low-literacy patients with chronic disease. J Nurs Meas. 2008; 15(3):203-19. DOI: 10.1891/106137407783095757. View

15.

Zhou G, Li X, Qiao S, Shen Z, Zhou Y . Influence of Side Effects on ART Adherence Among PLWH in China: The Moderator Role of ART-Related Knowledge. AIDS Behav. 2017; 22(3):961-970. DOI: 10.1007/s10461-017-1791-9. View

16.

Nafradi L, Nakamoto K, Schulz P . Is patient empowerment the key to promote adherence? A systematic review of the relationship between self-efficacy, health locus of control and medication adherence. PLoS One. 2017; 12(10):e0186458. PMC: 5645121. DOI: 10.1371/journal.pone.0186458. View

17.

Zhang L, Li X, Lin Z, Jacques-Tiura A, Xu J, Zhou Y . Side effects, adherence self-efficacy, and adherence to antiretroviral treatment: a mediation analysis in a Chinese sample. AIDS Care. 2016; 28(7):919-26. PMC: 6065505. DOI: 10.1080/09540121.2015.1124984. View

18.

Rao D, Feldman B, Fredericksen R, Crane P, Simoni J, Kitahata M . A structural equation model of HIV-related stigma, depressive symptoms, and medication adherence. AIDS Behav. 2011; 16(3):711-6. PMC: 3314086. DOI: 10.1007/s10461-011-9915-0. View

19.

Zeng C, Li L, Hong Y, Zhang H, Babbitt A, Liu C . A structural equation model of perceived and internalized stigma, depression, and suicidal status among people living with HIV/AIDS. BMC Public Health. 2018; 18(1):138. PMC: 5769512. DOI: 10.1186/s12889-018-5053-1. View

20.

Simoni J, Frick P, Huang B . A longitudinal evaluation of a social support model of medication adherence among HIV-positive men and women on antiretroviral therapy. Health Psychol. 2006; 25(1):74-81. PMC: 5096446. DOI: 10.1037/0278-6133.25.1.74. View