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Household Food Insecurity as Mediator of the Association Between Internalized Stigma and Opportunistic Infections

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Abstract

Internalized HIV stigma can affect health outcomes, but the mechanism underlying this relationship is poorly understood. We investigated the potential pathways for the association between internalized stigma and opportunistic infections (OIs) among women living with HIV in rural India. We conducted a cross-sectional study involving in-person interviews with 600 participants. We modeled two outcome variables, total number of OIs and fungal dermatoses, which was the most frequently reported OI. Causal mediation analysis was performed to estimate the total effect, direct effect, and indirect effect through mediators while controlling for confounders. Food insecurity was a strong mediator of the association between internalized stigma and the number of OIs (70% of the total effect) and fungal dermatoses (83% of the total effect), while the indirect effect of stigma through adherence was minimal for both outcomes. Household food insecurity may be an important mediator of the impact of HIV-related stigma on opportunistic infections.

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Acknowledgements

We are thankful to the study participants who made this study possible. The authors acknowledge the following sources of support: National Institute of Mental Health (NIMH) R01MH098728 and the National Institute of Allergy and Infectious Diseases K01AI118559.

Funding

This study was funded by the National Institute of Mental Health (R01MH098728) and the National Institute of Allergy and Infectious Diseases (K01AI118559) of the U.S. National Institutes of Health (NIH).

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Correspondence to Adeline M. Nyamathi.

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 All procedures in this study were conducted in accordance with the ethical standards of the 1964 Helsinki declaration and its later amendments. This study was approved by the University of California Los Angeles Institutional Review Board, University of California Irvine Institutional Review Board, and the Ministry of Health Research Ethics Committee in India.

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Informed consent was obtained from all individual participants included in the study.

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Shin, S.S., Carpenter, C.L., Ekstrand, M.L. et al. Household Food Insecurity as Mediator of the Association Between Internalized Stigma and Opportunistic Infections. AIDS Behav 22, 3897–3904 (2018). https://doi.org/10.1007/s10461-018-2193-3

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