title: A Structural Equation Model of Factors Contributing to Quality of Life Among African and Caribbean Women Living with HIV in Ontario, Canada.
abstract: African and Caribbean Black (ACB) women in Canada are disproportionately impacted by new HIV infections. ACB women's HIV vulnerability is shaped by contexts of stigma and discrimination. HIV-related stigma compromises quality of life (QOL) among women living with HIV (WLWH), yet scant research has examined concomitant effects of racial discrimination and HIV-related stigma on QOL. We used data from a cross-sectional survey with ACB WLWH in Ontario (n = 173) to test a conceptual model of pathways between HIV-related stigma, racial discrimination, depression, social support, and QOL. We conducted structural equation modeling using maximum likelihood estimation to test the model. In independent models, HIV-related stigma was associated with lower QOL, and depression partially mediated the association between HIV-related stigma and QOL. In the simultaneous model, HIV-related stigma had significant direct effects on depression, social support, and an indirect effect on QOL. When social support was added as a mediator, the direct effect between HIV-related stigma and QOL was no longer significant, suggesting mediation. Racial discrimination had significant direct effects on HIV-related stigma, depression, and social support and an indirect effect on QOL. QOL was associated with higher social support and lower depression scores. The model fit the data well: χ2= 203.266, degrees of freedom (DF): 112, p < .0001; Comparative Fit Index (CFI): 0.929, Tucker-Lewis Index (TLI): 0.912, Root-Mean Square Error of Approximation (RMSEA): 0.071. We found racial discrimination was associated with increased HIV-related stigma, and HIV-related stigma and racial discrimination compromised QOL. Findings suggest the need for multilevel interventions to reduce stigma and discrimination, address depression, and build social support to improve QOL among ACB WLWH.
authors.affiliation: 1 Factor-Inwentash Faculty of Social Work, University of Toronto , Toronto, Canada .|2 Women's College Research Institute, Women's College Hospital , Toronto, Canada .
authors.forename: Carmen H
authors.initials: CH
authors.lastname: Logie
authors.affiliation: 1 Factor-Inwentash Faculty of Social Work, University of Toronto , Toronto, Canada .
authors.forename: Uzma
authors.initials: U
authors.lastname: Ahmed
authors.affiliation: 3 Women's Health in Women's Hands Community Health Centre , Toronto, Canada .
authors.forename: Wangari
authors.initials: W
authors.lastname: Tharao
authors.affiliation: 2 Women's College Research Institute, Women's College Hospital , Toronto, Canada .
authors.forename: Mona R
authors.initials: MR
authors.lastname: Loutfy
mesh_terms: D000328:Adult; D044383:Black People; D002170:Canada; D003430:Cross-Sectional Studies; D003863:Depression; D005260:Female; D015658:HIV Infections / Q000523:psychology*; D006801:Humans; D016013:Likelihood Functions; D008875:Middle Aged; D009864:Ontario; D011788:Quality of Life; D063505:Racism / Q000523:psychology; D057545:Social Stigma; D012944:Social Support
keywords: Blacks; HIV/AIDS; health disparities; mental health; quality of life; social stigma; women