title: The association of stigma with self-reported access to medical care and antiretroviral therapy adherence in persons living with HIV/AIDS.
abstract: BACKGROUND
  The stigma of HIV-infection may profoundly affect the lives of persons living with HIV/AIDS (PLHA). However few studies have examined the association of HIV stigma with multiple components of HIV treatment and care.
  
  
  OBJECTIVE
  To estimate the association between HIV stigma and: self-reported access to care, regular source of HIV care, and antiretroviral therapy adherence; and to test whether mental health mediates these associations.
  
  
  METHODS
  Cross-sectional study.
  
  
  METHODS
  202 PLHA living in Los Angeles County in 2007.
  
  
  METHODS
  Participants completed an anonymous survey, assessing internalized HIV stigma (28-items, alpha = 0.93), self-reported access to medical care (six items, alpha = 0.75), regular source of HIV care, and antiretroviral therapy (ART) adherence.
  
  
  RESULTS
  One-third of participants reported high levels of stigma; 77% reported poor access to care; 42.5% reported suboptimal ART adherence; and 10.5% reported no regular source of HIV care. In unadjusted analysis, those reporting a high level of stigma were more likely to report poor access to care (OR = 4.97, 95% CI 2.54-9.72), regular source of HIV care (OR = 2.48, 95% CI 1.00-6.19), and ART adherence (OR = 2.45, 95% CI 1.23-4.91). In adjusted analyses, stigma was significantly associated with poor access to care (OR = 4.42, 95% CI 1.88-10.37), but not regular source of HIV care or ART adherence. Mental health mediated the relationship between stigma and ART adherence, but not poor access to care or regular source of HIV care.
  
  
  CONCLUSIONS
  The association of stigma with self-reported access to care and adherence suggests that efforts to improve these components of HIV care will require a better understanding of the possible effects of stigma and its mediators.
authors: Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at University of California-Los Angeles, 911 Broxton Ave., Los Angeles, CA 90024, USA. jsayles@mednet.ucla.edu
authors: Jennifer N
authors: JN
authors: Sayles
authors: Mitchell D
authors: MD
authors: Wong
authors: Janni J
authors: JJ
authors: Kinsler
authors: David
authors: D
authors: Martins
authors: William E
authors: WE
authors: Cunningham
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000523:psychology / Q000628:therapy; D000293:Adolescent; D000328:Adult; D023241:Antiretroviral Therapy, Highly Active / Q000523:psychology*; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000523:psychology / Q000628:therapy*; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance / Q000523:psychology; D012649:Self Concept; D013240:Stereotyping; D055815:Young Adult