Exploring the Impact of Experiences with Everyday and Major Discrimination and HIV-Related Stigma on Engagement in HIV Care Among Older African Americans Living with HIV.

Abstract

The purpose of this pilot study was to explore the effect of HIV-related stigma and everyday major experiences of discrimination on medication and clinic visit adherence among older African Americans living with HIV in Ohio. We collected data from 53 individuals who were living with HIV in Ohio, ≥ 50years of age, and who identified as Black or African American. We conducted logistic regression models to examine the impact of HIV-related stigma and experiences of discrimination on medication and visit adherence. Each model controlled for age, time since diagnosis, and sexual orientation. The average age was 53.6 ± 2.1years and 94.3% were men. Almost half (49.1%) of the participants reported poor medication adherence and almost a third (31.4%) reported poor visit adherence. HIV-related stigma (adjusted odds ratio (aOR) = 1.39; 95% confidence interval (CI) = 1.02-1.89) and major experiences of discrimination (aOR = 1.70; 95% CI = 1.11-2.60) were associated with a greater odds of poor medication adherence. Additionally, major experiences of discrimination were associated with a threefold increase in the odds of poor visit adherence (aOR = 3.24; 95% CI = 1.38-7.64). HIV-related stigma and major experiences of discrimination impede optimal medication and HIV clinic visit adherence for older African Americans living with HIV. To reduce the impact of stigma and discrimination on HIV care engagement, our first step must be in understanding how intersecting forms of stigma and discrimination impact engagement among older African Americans living with HIV.