Social Network Characteristics Moderate the Association Between Stigmatizing Attributions About HIV and Non-adherence Among Black Americans Living with HIV: a Longitudinal Assessment

Abstract

Background: Stigma may contribute to HIV-related disparities among HIV-positive Black Americans.

Purpose: We examined whether social network characteristics moderate stigma's effects.

Methods: At baseline and 6 months post-baseline, 147 HIV-positive Black Americans on antiretroviral treatment completed egocentric social network assessments, from which we derived a structural social support capacity measure (i.e., ability to leverage support from the network, represented by the average interaction frequency between the participant and each alter). Stigma was operationalized with an indicator of whether any social network member had expressed stigmatizing attributions of blame or responsibility about HIV. Daily medication adherence was monitored electronically.

Results: In a multivariate regression, baseline stigma was significantly related to decreased adherence over time. The association between stigma and non-adherence was attenuated among participants who increased the frequency of their interactions with alters over time.

Conclusions: Well-connected social networks have the potential to buffer the effects of stigma.

Keywords: Adherence; African American/Black; Discrimination; Disparities; HIV/AIDS; Social networks; Stigma.

Figures

Figure 1. Moderating Effect of Alter Interaction Frequency on the Association between Alter Stigma and Medication Adherence

The y-axis shows the predicted probabilities of optimal adherence (i.e., ≥85% of doses taken as prescribed) at four points representing different levels of alter stigma and change in alter interaction frequency. The x-axis indicates the presence in the network of any alter expressing stigmatizing attributions. The lines show the moderating effect of increased average interaction with alters over 6 months on the association between alter stigma and adherence. The dark grey line shows the significant negative relationship between stigma and adherence in the presence of a below-average change (i.e., decrease to one standard deviation below the population mean) in average alter interaction frequency, and the light grey line shows the non-significant association between stigma and adherence in the presence of an above-average change (i.e., increase to one standard deviation above the population mean) in average alter interaction frequency.