THE ASSOCIATION BETWEEN HIV-RELATED STIGMA AND ART ADHERENCE ON CARDIOVASCULAR DISEASE RISK IN PEOPLE LIVING WITH HIV

Abstract

Introduction: In Sub-Saharan Africa, HIV/AIDS remains a leading cause of morbidity and mortality. While HIV/AIDS emerged to the public’s awareness in the early 1980s, HIV-related stigma remains a major problem owing to fear of transmission, misperceptions, and misinformation concerning HIV. HIV stigma and discrimination may limit adherence to antiretroviral treatment (ART), thus increasing viremia, inflammation, and cardiovascular disease (CVD) risk. This study aims to investigate the association between stigma and ART adherence on CVD risk among PLWH. Methods: A longitudinal study was conducted among 325 participants living with HIV, from the Ndlovu Cohort Study in Limpopo province, South Africa (2014 to 2017). A 12-item short-version HIV stigma scale questionnaire was used to measure HIV-related stigma. Pulse wave velocity (PWV, CVD risk predictor) measurements and laboratory assessment of viral load (VL) were performed at 12 and 36 months. VL was considered a surrogate marker of ART adherence. Poor/no adherence = High viremia (viral load, VL) > 1000 copies, suboptimal adherence = low viremia (VL 50-1000 copies), and good adherence = undetectable viral load (<50 copies). Multiple linear regression was used to assess the relationship between stigma, ART adherence, and CVD risk. Beta coefficients with a 95% confidence interval were used to determine the strength and direction of the association, with a p-value of 0.05 declared as statistically significant. Results: Of the 325 participants living with HIV, 67% were females. Mean age was 42.1 [SD (10.2)] years. Participants with VL in the undetectable, low, and high categories were 78%, 15%, and 7%, respectively. Overall stigma [-0.05 (-0.14_ 0.04), p=0.27] and high VL [-0.33 (-0.88_0.21), p=0.23] were not associated with PWV. However, low VL [1.06 (0.37_1.84), p=0.003] was significantly associated with PWV. PWV did not increase over the 36-month follow-up period [-0.12 ( -0.33_0.08), p=0.24]. Conclusion: In this study, suboptimal ART adherence was associated with higher PWV. Overall stigma was low and not associated with PWV.