The Influence of Intersectional Stigma and Social Support on Medication Adherence, Care Engagement, and Quality of Life Among Older People Living with HIV and Other Chronic Health Conditions

About This Grant

Over half of people living with HIV (PLH) are over age 50, and it is predicted that by 2035, 74% of PLH in the U.S. will be aged 50+. Other chronic health conditions (OCCs) such as diabetes, hypertension, and dyslipidemia (high cholesterol) are very common among older PLH (OPLH), and their prevalence has been increasing over time. Although medication adherence and care engagement are essential for avoiding adverse health outcomes and improving quality of life, OPLH often have difficulty achieving consistently good adherence and engagement in care for both HIV and OCCs. Identifying factors influencing HIV/OCC health outcomes is key to designing interventions to improve health outcomes related to both HIV and OCCs. One factor that may influence these health outcomes is stigma. However, little research has explored how stigma influences adherence, care engagement, and quality of life (QOL) among OPLH with OCCs, or the mechanisms by which stigma may impact health outcomes. This research, conducted in collaboration with a community advisory board of OPLH, will use mixed methods to explore the impact of stigma on HIV and OCC engagement in care and medication adherence as well as QOL among OPLH. We will recruit PLH aged 50+ with diabetes, hypertension, and/or dyslipidemia who live in the Southern U.S., a region disproportionately impacted by HIV, to participate in interviews (N = 30), surveys (N = 300), and community listening sessions (N = 48). In-depth interviews will explore (1) the influence of aging with HIV on experienced stigma, social support, multi-medication adherence, health care engagement, and QOL; (2) the interplay between adherence and care engagement for HIV and OCCs and barriers and facilitators to multi-medication adherence and care engagement across conditions; and (3) impacts of stigma on medication adherence, care engagement, and QOL. Surveys will assess (1) the impact of stigma on HIV and OCC medication adherence and care engagement and QOL and (2) potential mechanisms by which stigma may impact HIV and OCC outcomes and QOL. Path models will test indirect effects of stigma on outcomes via social support, depressive symptoms, perceived stress, self-efficacy, and health care provider trust. A mixed methods analysis will bring together qualitative and quantitative data for comprehensive analysis. Mixed methods data will be shared in community listening sessions, during which participants will aid in data interpretation and identify opportunities for intervention. As the population of PLH ages, adherence to ART and engagement in HIV care need to be considered in the context of OCCs, polypharmacy, and competing healthcare demands. By exploring the impact of stigma on HIV and OCC adherence, care engagement, and QOL, results of this study will inform intervention development for OPLH, a population of growing size and significance, and contribute to efforts to improve health outcomes and end the HIV epidemic in the U.S.