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Adherence to antiretroviral therapy among cisgender gay, bisexual and other men who have sex with men in Brazil: Evaluating the role of HIV-related stigma dimensions

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  • Victor C Matos
  • Thiago S Torres
  • Paula M Luz

Abstract

Background: In Brazil, ~35% of people living with HIV (PLHIV) have poor adherence to antiretroviral therapy (ART). HIV-related stigma is associated with worst continuum of care outcomes, however evidence from Brazil is scarce. We explored pathways between HIV-related stigma dimensions and ART adherence among Brazilian cisgender gay, bisexual and other men who have sex with men (MSM) living with HIV. Methods: A sample of MSM ≥18 years was recruited online between February/March 2020 through advertisements on Hornet, a location-based dating app. Validated scales were used to assess ART adherence and HIV-related stigma. Indirect and direct pathways between HIV-related stigma dimensions and ART adherence were estimated using structural equation models while considering socio-demographic and substance use related variables. Models were estimated using mean- and variance-adjusted weighted least squares, and goodness of fit indices were calculated. Findings: Among 1,719 MSM living with HIV who reported starting ART, 70% were adherent. There was evidence of indirect effects of concerns about public attitudes (standardized coefficient (SC) = -0.095, 95% confidence interval (95%CI) = -0.172 - -0.017) and personalized HIV-stigma (SC = -0.022, 95%CI = -0.043 - -0.001) on ART adherence mediated through negative self-image. Personalized HIV stigma and concerns about public attitudes were both positively associated with negative self-image (SC = 0.129, 95%CI = 0.066–0.193; SC = 0.549, 95%CI = 0.494–0.603), and concerns about public attitudes was associated with HIV disclosure concerns (SC = 0.522, 95%CI = 0.463–0.581). However, the direct paths from personalized HIV stigma and concerns about public attitudes to ART adherence were not significant. Interpretation: Our research underscores the critical need for multifaceted interventions to eliminate HIV-related stigma at both individual and societal levels. At the individual level, psychotherapeutic interventions to improve self-image might helpful. Additionally, public policy should aim to dismantle structural stigma with awareness campaigns on various media channels, integration of anti-stigma curriculum into schools, and training for professionals.

Suggested Citation

  • Victor C Matos & Thiago S Torres & Paula M Luz, 2024. "Adherence to antiretroviral therapy among cisgender gay, bisexual and other men who have sex with men in Brazil: Evaluating the role of HIV-related stigma dimensions," PLOS ONE, Public Library of Science, vol. 19(8), pages 1-20, August.
    • Handle: RePEc:plo:pone00:0308443
    DOI: 10.1371/journal.pone.0308443
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    References listed on IDEAS

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    1. Turan, B. & Hatcher, A.M. & Weiser, S.D. & Johnson, M.O. & Rice, W.S. & Turan, J.M., 2017. "Framing mechanisms linking HIV-related stigma, adherence to treatment, and health outcomes," American Journal of Public Health, American Public Health Association, vol. 107(6), pages 863-869.
    2. repec:aph:ajpbhl:10.2105/ajph.2017.303744_4 is not listed on IDEAS
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