Internalized stigma, depressive symptoms, and the modifying role of antiretroviral therapy: A cohort study in rural Uganda

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dc.contributor.authorBebell, Lisa M.
dc.contributor.authorKembabazi, Annet
dc.contributor.authorMusinguzi, Nicholas
dc.contributor.authorMartin, Jeffrey N.
dc.contributor.authorHunt, Peter W.
dc.contributor.authorBoum, Yap
dc.contributor.authorO'Laughlin, Kelli N.
dc.contributor.authorMuzoora, Conrad
dc.contributor.authorHaberer, Jessica E.
dc.contributor.authorMwebesa, Bosco Bwana
dc.contributor.authorBangsberg, David R.
dc.contributor.authorSiedner, Mark J.
dc.contributor.authorTsai, Alexander C.
dc.date.accessioned2022-01-31T14:53:06Z
dc.date.available2022-01-31T14:53:06Z
dc.date.issued2021
dc.description.abstractDepression affects over 40% of people with HIV (PHIV) in low- and middle-income countries, and over half of PHIV report HIV related internalized stigma. However, few longitudinal studies of PHIV have examined the relationship between HIV-related stigma and depression. Data were analyzed from the 2007-15 Uganda AIDS Rural Treatment Outcomes (UARTO) Study, a cohort of 454 antiretroviral therapy (ART)-naïve PHIV (68% women) starting ART. Our primary outcome was depression symptom severity over the first two years of ART, measured using a locally adapted version of the Hopkins Symptom Checklist; our primary exposure was the 6-item Internalized AIDS-Related Stigma Scale. Both scores were measured at enrollment and at quarterly follow-up visits. We fit linear generalized estimating equations (GEE) regression models to estimate the association between stigma and depression symptom severity, adjusting for potential confounders. We included a stigma timeproduct term to assess the modifying effect of ART on the association between internalized stigma and depression symptom severity. UARTO participants had a median age of 32 years and median enrollment CD4 count of 217 cells/mm3. Both depression symptom severity and internalized stigma declined on ART, particularly during the first treatment year. In multivariable regression models, depression symptom severity was positively associated with internalized stigma (b ¼ 0.03; 95% confidence interval [CI], 0.02 to 0.04) and negatively associated with ART duration >6 months (b ¼ 0.16; 95% CI, 0.19 to 0.13). The estimated product term coefficient was negative and statistically significant (P ¼ 0.004), suggesting that the association between internalized stigma and depression symptom severity weakened over time on ART. Thus, in this large cohort of PHIV initiating ART in rural Uganda, depression symptom severity was associated with internalized stigma but the association declined with time on ART. These findings underscore the potential value of ART as a stigma reduction intervention for PHIV, particularly during early treatment.en_US
dc.identifier.citationBebell, L. M., Kembabazi, A., Musinguzi, N., Martin, J. N., Hunt, P. W., Boum II, Y., ... & Tsai, A. C. (2021). Internalized stigma, depressive symptoms, and the modifying role of antiretroviral therapy: A cohort study in rural Uganda. SSM-Mental Health, 1, 100034. https://doi.org/10.1016/j.ssmmh.2021.100034en_US
dc.identifier.urihttps://doi.org/10.1016/j.ssmmh.2021.100034
dc.identifier.urihttps://nru.uncst.go.ug/xmlui/handle/123456789/1685
dc.language.isoenen_US
dc.publisherSSM-Mental Healthen_US
dc.subjectAntiretroviral therapyen_US
dc.subjectDepressionen_US
dc.subjectDiscriminationen_US
dc.subjectHIVen_US
dc.subjectMental healthen_US
dc.subjectPrejudiceen_US
dc.subjectStigmaen_US
dc.subjectSub-saharan africaen_US
dc.subjectUgandaen_US
dc.titleInternalized stigma, depressive symptoms, and the modifying role of antiretroviral therapy: A cohort study in rural Ugandaen_US
dc.typeArticleen_US
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