Poverty stigma is associated with suboptimal HIV care and treatment outcomes among women living with HIV in the U.S.

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Objective:To examine whether experienced poverty stigma is associated with worse HIV care and treatment outcomes.Design:We analyzed cross-sectional data from 433 women living with HIV enrolled in the Women's Adherence and Visit Engagement (WAVE) sub-study of the Women's Interagency HIV Study (WIHS).Methods:Exposure was experienced poverty stigma, measured using the Perceived Stigma of Poverty Scale. Outcomes were viral suppression, CD4 cell count ≥350 cells/mm3, and attending all HIV care visits in the past six months. Multivariable logistic regression models adjusted for income, age, race/ethnicity, education, substance use, months taking ART, number of antiretroviral pills in ART regimen, unstable housing, relationship status, and exchanging sex for money, drugs or shelter. We also explored whether self-reported ≥ 95% ART adherence mediated the relationship between poverty stigma and viral suppression and CD4 cell count ≥350 cells/mm3.Results:Experienced poverty stigma was associated with lower adjusted odds of viral suppression (adjusted odds ratio (aOR): 0.76; 95% Confidence Interval (CI): 0.61, 0.96), CD4 cell count ≥350 cells/mm3 (aOR: 0.69; 95% CI: 0.52, 0.91), and attending all HIV care visits (aOR: 0.73; 95% CI: 0.54, 0.98). Exploratory mediation analysis suggests that ≥ 95% ART adherence significantly mediates the relationship between experienced poverty stigma and viral suppression and CD4 cell count ≥350 cells/mm3.Conclusion:Longitudinal research should assess these relationships over time. Findings support interventions and policies that seek to reduce poverty stigma among people living with HIV.

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