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Pathways from multiple stigmas to ART adherence among transgender women and men who have sex with men newly diagnosed with HIV in India: a prospective cohort study

Title
Pathways from multiple stigmas to ART adherence among transgender women and men who have sex with men newly diagnosed with HIV in India: a prospective cohort study
Presenter
Viraj V. Patel
Authors
V.V. Patel * (1), V. Chakrapani (2), A. Gupta (3), F. Gulfam (3), J. Kaur (4), N. Chopra (1), J. Ross (1), J. Rendina (5), A. Ahalawat (3), S. Reddy (3), S.A. Safren (6), S.A. Golub (7)
Institutions
(1) Albert Einstein College of Medicine, Montefiore Health System, General Internal Medicine, Bronx, United States, (2) Centre for Sexuality and Health Research and Policy (C-SHaRP), Chennai, India, (3) Alliance India (India HIV/AIDS Alliance), New Delhi, India, (4) Post Graduate Institute of Medical Education & Research, Chandigarh, India, (5) Whitman-Walker Institute, Washington D.C., United States, (6) University of Miami, Psychology, Coral Gables, United States, (7) Hunter College, City University of New York, Hunter HIV/AIDS Research Team, Department of Psychology, New York, United States

BACKGROUND: Stigma remains a major barrier to ART adherence among persons newly diagnosed with HIV. However, little research exists on the impact of multiple stigmas on treatment outcomes for transgender women (TGW) or men who have sex with men (MSM) living with HIV in South Asia. Guided by the Health Stigma Discrimination Framework, we conducted a longitudinal study among Indian TGW/MSM to understand how multiple stigmas (enacted, anticipated, and internalized) related to HIV and either gender (for TGW) or sexuality (for MSM) may influence ART adherence.
METHODS: Between 2020-2021, 140 TGW and 227 MSM from 11 Indian states ('¥18 years, diagnosed with HIV in past six-months) completed interviews at baseline, three- and six-months. Using mediational analyses, we tested the associations of baseline stigma scores (HIV- and gender-identity for TGW, or sexual-identity for MSM) stigmas with past 30-day self-reported ART adherence (0-100) at six-months, and the indirect effects of stigma on ART adherence through three-month depression, anxiety, and alcohol use scores.
RESULTS: Among TGW, mean age was 31.1 years and 23% were illiterate. At six-months, 92% of TGW had been prescribed ART; mean (sd) adherence was 77.9±17.1. Mediational analysis (Fig.1a) revealed a significant direct-effect of anticipated HIV-stigma in healthcare on adherence and indirect-effect of enacted HIV-stigma via alcohol use. Among MSM, mean age was 33.3 years and 18.5% were illiterate. At six-months, 98% of MSM were prescribed ART; mean (sd) adherence was 74.9±20.1. Mediational analysis (Fig.1b) revealed significant direct-effects from internalized MSM-stigma and enacted community HIV-stigma on adherence and indirect-effects of enacted HIV-stigma in healthcare via alcohol use.


CONCLUSIONS: Adherence was suboptimal and distinct forms of stigmas, either directly or indirectly differentially influenced ART-adherence among TGW and MSM. For both TGW and MSM, interventions to reduce stigma faced in healthcare settings and beyond and by addressing alcohol use could improve ART adherence.