Supportive couple relationships buffer against the harms of HIV stigma on HIV treatment adherence
Abstract Introduction HIV stigma can impact couple relationships through stress or bring partners closer through shared experiences. Conversely, couple relationships may protect against the harms of stigma, including anticipated stigma on negative health outcomes. Yet few studies have assessed the p...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2023-09-01
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| Series: | BMC Public Health |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12889-023-16762-w |
| _version_ | 1797451182804828160 |
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| author | Sarah A. Gutin Allison Ruark Lynae A. Darbes Torsten B. Neilands James Mkandawire Amy A. Conroy |
| author_facet | Sarah A. Gutin Allison Ruark Lynae A. Darbes Torsten B. Neilands James Mkandawire Amy A. Conroy |
| author_sort | Sarah A. Gutin |
| collection | DOAJ |
| description | Abstract Introduction HIV stigma can impact couple relationships through stress or bring partners closer through shared experiences. Conversely, couple relationships may protect against the harms of stigma, including anticipated stigma on negative health outcomes. Yet few studies have assessed the potential link between HIV stigma, relationship dynamics, and antiretroviral therapy (ART) adherence. Using dyadic data from a cross-sectional study of Malawian couples living with HIV, we tested associations between anticipated stigma and: 1) relationship dynamics (e.g., trust, sexual satisfaction, communication) and partner support; and 2) self-reported ART adherence. Methods Heterosexual couples (211 couples, 422 individuals) with at least one partner on ART were recruited from clinics in Zomba, Malawi. Partners completed separate surveys on anticipated stigma, relationship dynamics, and ART adherence. Linear mixed models evaluated associations between anticipated stigma and relationship dynamics, and whether associations varied by gender. Generalized estimating equation models tested for associations between anticipated stigma and high ART adherence (90–100% vs. < 90%) at the individual level, and whether they were moderated by relationship dynamics at the couple level. Results Couples' relationship length averaged 12.5 years, 66.8% were HIV sero-concordant, and 95.6% reported high ART adherence. In multivariable models, sexual satisfaction (β = -0.22, 95%CI = -0.41;-0.03, p = 0.020) and partner social support (β = -0.02, 95%CI = -0.04;-0.01, p < 0.01) were negatively associated with anticipated stigma. Significant interaction effects showed that adherence is moderated in couples with higher partner support and sexual satisfaction such that adherence is lowest when anticipated stigma is high and social support is low, and that adherence is lowest when anticipated stigma is high and sexual satisfaction is low. Conclusions Increased anticipated stigma is most associated with lower ART non-adherence at lower levels of social support and sexual satisfaction. Conversely, supportive and fulfilling relationships may buffer the negative association between stigma and ART adherence. Couples’ interventions that focus on improving communication and support systems within couples could reduce the negative impacts of anticipated stigma on couples living with HIV. |
| first_indexed | 2024-03-09T14:51:07Z |
| format | Article |
| id | doaj.art-386dd6eef1d245909faaeecaf119bb47 |
| institution | Directory Open Access Journal |
| issn | 1471-2458 |
| language | English |
| last_indexed | 2024-03-09T14:51:07Z |
| publishDate | 2023-09-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Public Health |
| spelling | doaj.art-386dd6eef1d245909faaeecaf119bb472023-11-26T14:26:56ZengBMCBMC Public Health1471-24582023-09-0123111210.1186/s12889-023-16762-wSupportive couple relationships buffer against the harms of HIV stigma on HIV treatment adherenceSarah A. Gutin0Allison Ruark1Lynae A. Darbes2Torsten B. Neilands3James Mkandawire4Amy A. Conroy5Department Of Community Health Systems, School of Nursing, University of California, San Francisco (UCSF)Wheaton CollegeDepartment of Health Behavior and Biological Sciences, School of Nursing, University of MichiganDivision of Prevention Sciences, University of California, San Francisco (UCSF)Invest in KnowledgeDivision of Prevention Sciences, University of California, San Francisco (UCSF)Abstract Introduction HIV stigma can impact couple relationships through stress or bring partners closer through shared experiences. Conversely, couple relationships may protect against the harms of stigma, including anticipated stigma on negative health outcomes. Yet few studies have assessed the potential link between HIV stigma, relationship dynamics, and antiretroviral therapy (ART) adherence. Using dyadic data from a cross-sectional study of Malawian couples living with HIV, we tested associations between anticipated stigma and: 1) relationship dynamics (e.g., trust, sexual satisfaction, communication) and partner support; and 2) self-reported ART adherence. Methods Heterosexual couples (211 couples, 422 individuals) with at least one partner on ART were recruited from clinics in Zomba, Malawi. Partners completed separate surveys on anticipated stigma, relationship dynamics, and ART adherence. Linear mixed models evaluated associations between anticipated stigma and relationship dynamics, and whether associations varied by gender. Generalized estimating equation models tested for associations between anticipated stigma and high ART adherence (90–100% vs. < 90%) at the individual level, and whether they were moderated by relationship dynamics at the couple level. Results Couples' relationship length averaged 12.5 years, 66.8% were HIV sero-concordant, and 95.6% reported high ART adherence. In multivariable models, sexual satisfaction (β = -0.22, 95%CI = -0.41;-0.03, p = 0.020) and partner social support (β = -0.02, 95%CI = -0.04;-0.01, p < 0.01) were negatively associated with anticipated stigma. Significant interaction effects showed that adherence is moderated in couples with higher partner support and sexual satisfaction such that adherence is lowest when anticipated stigma is high and social support is low, and that adherence is lowest when anticipated stigma is high and sexual satisfaction is low. Conclusions Increased anticipated stigma is most associated with lower ART non-adherence at lower levels of social support and sexual satisfaction. Conversely, supportive and fulfilling relationships may buffer the negative association between stigma and ART adherence. Couples’ interventions that focus on improving communication and support systems within couples could reduce the negative impacts of anticipated stigma on couples living with HIV.https://doi.org/10.1186/s12889-023-16762-wAnticipated HIV stigmaHeterosexual couplesAntiretroviral therapyRelationship dynamicsSub-Saharan Africa |
| spellingShingle | Sarah A. Gutin Allison Ruark Lynae A. Darbes Torsten B. Neilands James Mkandawire Amy A. Conroy Supportive couple relationships buffer against the harms of HIV stigma on HIV treatment adherence BMC Public Health Anticipated HIV stigma Heterosexual couples Antiretroviral therapy Relationship dynamics Sub-Saharan Africa |
| title | Supportive couple relationships buffer against the harms of HIV stigma on HIV treatment adherence |
| title_full | Supportive couple relationships buffer against the harms of HIV stigma on HIV treatment adherence |
| title_fullStr | Supportive couple relationships buffer against the harms of HIV stigma on HIV treatment adherence |
| title_full_unstemmed | Supportive couple relationships buffer against the harms of HIV stigma on HIV treatment adherence |
| title_short | Supportive couple relationships buffer against the harms of HIV stigma on HIV treatment adherence |
| title_sort | supportive couple relationships buffer against the harms of hiv stigma on hiv treatment adherence |
| topic | Anticipated HIV stigma Heterosexual couples Antiretroviral therapy Relationship dynamics Sub-Saharan Africa |
| url | https://doi.org/10.1186/s12889-023-16762-w |
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