Internalized Stigma, Depressive Symptoms, and Disclosure as it relates to HIV Medication Adherence in HIV-Infected African American Adolescent and Young Adult (AYA) Females Open Access

Abstract

Introduction : African American AYA females are disproportionately affected by HIV/AIDS (CDC, 2010a). Although antiretroviral treatment and adherence to treatment provide significant benefits to those infected, adherence is not common among this population ( Flynn et al., 2007; Murphy, Wilson, Durako, Muenz & Belzer, 2001 ). In order to examine factors related to adherence and address a gap in current research, this study proposed to examine the relationship between internalized stigma, depressive symptoms, and disclosure of HIV status and medication adherence.

Theoretical Framework : Socio-Ecological Model

Methods : Survey responses from 34 participants in a larger, primary study were analyzed through bivariate analyses and a multiple linear regression model. Participants included HIV-infected African American AYAs between the ages of 14 and 24 who were recruited from the Grady Ponce Family and Youth Clinic (PFYC) and the Grady Women's Infectious Disease Clinic (WIDC) in Atlanta, Georgia.

Results : Results concluded that internalized stigma was significantly associated with medication adherence, suggesting that as feelings of internalized stigma increased, adherence to antiretroviral medication decreased.

Conclusion : Participants' reports of internalized stigma significantly affected their medication adherence. As for future studies, research has found that group cognitive behavioral therapy targeting internalized stigma has significantly increased rates of adherence (Roe et al., 2014; Shimotsu et al., in press; Safren et al., 2000; Tsang, Fung & Chung, 2010). This form of therapy would be beneficial to examine among HIV-infected African American AYA females. Additionally, since internalized stigma has origin in enacted stigma, interventions targeting HIV-related stigma in broader populations are necessary.

Table of Contents

Table of Contents
Introduction 1
HIV among African American Women 1
HIV among African American Youth in the South 2
Treatment for HIV 3
HIV-Infection and Treatment in Adolescence 3
Factors Affecting Adherence 4
Theoretical Background 5
Purpose/Objective 7
Research Questions 7
Hypotheses 7
Internalized Stigma, Depressive Symptoms, and Disclosure as it relates to HIV Medication Adherence in HIV-Infected African American Adolescent and Young Adult (AYA) Females 9
HIV-Infected African American AYA Females 9
Importance of HAART and Adherence 9
HIV Medication Adherence among AYAs 10
Risky Sex in the Context of Adherence 11
Depressive Symptoms and Adherence 12
Disclosure and Adherence 13
Internalized Stigma and Adherence 14
Method 17
Participants 17
Procedure 17
Measures 18
Descriptive Information 18
Predictor Variables 19
Outcome Variable 20
Control Variables 21
Data Analysis 21
Results 22
Descriptive Information 22
Bivariate Analysis 23
Regression Analysis 23
Discussion 24
Implications for Intervention 26
Directions for Future Research 27
Limitations 28
Public Health Significance 28
Conclusion 29
References 30
Table 1 41
Table 2 42
Table 3 43

About this Master's Thesis

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School	Rollins School of Public Health
Department	Behavioral Sciences and Health Education
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Psychology, Behavioral
Keyword	medication adherence depression African American disclosure stigma adolescents female young adults HIV
Committee Chair / Thesis Advisor	Sales, Jessica, Emory University
Committee Members	Berg, Carla, Emory University Brown, Jennifer, Texas Tech University
Partnering Agencies	Emory University schools, faculty or affiliated programs Hospital or other health care provider

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