Assessing the Association Between Internalized HIV Stigma and Cardiovascular Disease Risk in Women Living with HIV

评估艾滋病毒感染女性的内在艾滋病毒耻辱与心血管疾病风险之间的关联

• 批准号: 10547856
• 负责人: Jessica Page Sherman
• 金额: $ 3.2万
• 依托单位: OHIO STATE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-08-01 至 2023-05-05
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10547856
• 关键词: Acquired Immunodeficiency Syndrome; Address; Affect; Attenuated; Attitude; Belief; Black Populations; C-reactive protein; Cardiovascular Diseases; Chronic; Chronic stress; Clinic; Clinical; Complex; Cross-Sectional Studies; Data; Development; Disease; Dyslipidemias; Foundations; Goals; HIV; HIV Infections; HIV Seronegativity; Health; Health Promotion; Human immunodeficiency virus test; Hypertension; Individual; Inflammation; Intervention; Link; Logistic Regressions; Measures; Metabolic; Methodology; Modeling; Morbidity - disease rate; National Institute of Nursing Research; Neurobiology; Not Hispanic or Latino; Obesity; Outcome; Pathway interactions; Persons; Population; Poverty; Psychosocial Factor; Race; Reporting; Research; Research Personnel; Risk; Risk Factors; Sampling; Self Perception; Social Identification; Societies; Source; Stigmatization; Strategic Planning; Sympathetic Nervous System; System; Testing; Time; Training Programs; Woman; biological adaptation to stress; blood pressure control; burden of illness; cardiovascular disorder risk; cardiovascular risk factor; cohort; comorbidity; ethnic minority; experience; health disparity; health equity; high risk; hypothalamic-pituitary-adrenal axis; immune activation; improved; innovation; longitudinal analysis; longitudinal database; male; minority stress; modifiable risk; mortality; peer; population health; pre-doctoral; prospective; racial difference; racial disparity; racial minority; social factors; social health determinants; social stigma; substance use; systemic inflammatory response; women of color

Project Summary/Abstract Cardiovascular disease (CVD) is among the leading causes of morbidity and mortality in women living with HIV (WLWH). WLWH show elevated CVD risk compared to both their male counterparts and HIV negative women. Additionally, within WLWH there are racial disparities in CVD risk. Controlling for HIV-specific factors, traditional risk factors, and social factors like poverty and substance use only partially attenuates the elevated CVD risk in WLWH. This indicates that additional factors, such as internalized HIV stigma, may contribute to CVD risk in WLWH. Internalized HIV stigma, defined as incorporating the negative societal attitudes and beliefs about HIV as part of one’s self-image, is widespread among WLWH and unduly affects women and racial and ethnic minorities. Internalized HIV stigma is a form of minority stress, and previous research has linked minority stress to poor health outcomes and suggest a pathway through which internalized HIV stigma could contribute to elevated CVD risk. Briefly, sustained experiences of stigma may contribute to chronically elevated systemic inflammation, and metabolic excitation, which are associated with elevated CVD risk. Moreover, women of color living with HIV may experience stigma from multiple sources that could have a synergistic effect leading to racial differences in the relationship between internalized HIV stigma and CVD. The link between internalized HIV stigma and CVD risk in WLWH remains vastly understudied, which is unfortunate as identifying key risk factors would allow for the development of targeted interventions that address CVD risk and improve the overall health of this population. This study will address this by assessing the association between internalized HIV stigma and CVD risk in WLWH and testing if this relationship is moderated by race. Using data from the Center for AIDS Research Network of Integrated Clinic Systems (CNICS) the study will: (1) determine if internalized HIV stigma is associated with increased odds of hypertension, dyslipidemia, and obesity in WLWH and assess the temporal link between internalized HIV stigma and these outcomes, (2) determine if internalized HIV stigma is associated with elevated systemic inflammation among WLWH, and (3) determine if these relationships are different for women of color living with HIV. CNICS is a longitudinal database that tracks long term clinical outcomes among a diverse cohort of people living with HIV and added a validated measure of internalized HIV stigma in 2016. The analytic sample will be comprised of women who completed at least one internalized HIV stigma measure from 2016 to 2021 (n=2090). We will conduct both cross-sectional and longitudinal analysis to address the aims above. This study aligns well with the National Institute of Nursing Research’s new strategic plan, which prioritizes innovative and rigorous research that addresses health equity, social determinants of health, and health promotion. The proposed pre-doctoral training program in this application will provide the applicant with the theoretical and methodological foundation to become a productive and independent researcher.

项目摘要/摘要 心血管疾病（CVD）是居住女性发病和死亡率的主要原因之一 与艾滋病毒（WLWH）。与男性同行相比，WLWH显示CVD风险升高 女性。此外，在WLWH中，CVD风险存在种族差异。控制HIV特异性因素， 传统的危险因素以及贫困和物质使用等社会因素仅部分削弱了升高 CVD风险在WLWH中。这表明其他因素（例如内在的HIV污名）可能有助于 CVD风险在WLWH中。内部化的艾滋病毒污名定义为影响负面的社会出勤率，并相信 关于艾滋病毒，作为一个人的自我形象的一部分，在WLWH中广泛影响，而Undose则影响了妇女和种族， 少数民族。内部化的艾滋病毒污名是少数族裔压力的一种形式，以前的研究已将少数族裔联系在一起 压力不良的健康结果，并提出了一种内在化的艾滋病毒污名可以贡献的途径 提高CVD风险。简而言之，持续的污名经历可能会导致长期升高的全身性 炎症和代谢兴奋与CVD风险升高有关。而且，有色女人 患艾滋病毒的生活可能会遇到来自多种可能产生协同作用的污名 内部艾滋病毒污名与CVD之间关系的差异。内在艾滋病毒之间的联系 WLWH中的污名和CVD风险仍然非常了解，这很不幸地确定了关键的风险因素 将允许开发针对CVD风险并改善整体健康的目标干预措施 这个人口。这项研究将通过评估内部化的HIV污名与 CVD风险WLWH和测试是否通过种族调节。使用艾滋病中心的数据 综合诊所系统（CNIC）研究网络研究将：（1）确定是否内在的HIV污名 与WLWH中高血压，血脂异常和肥胖的几率增加有关并评估临时性 内部化的HIV污名与这些结果之间的联系，（2）确定内部化的HIV污名是否相关 WLWH之间的全身性炎症升高，（3）确定这些关系是否不同 有艾滋病毒的有色妇女。 CNIC是一个纵向数据库，可跟踪长期临床结果 2016年，一群患有艾滋病毒的人群，并增加了对内部艾滋病毒污名的验证。 分析样本将完成至少一项内部化HIV污名测量的妇女 从2016年到2021年（n = 2090）。我们将进行横截面和纵向分析以解决目标 多于。这项研究与美国国家护理研究所的新战略计划非常吻合，该计划 优先考虑针对健康公平，卫生社会决定者以及 健康促进。本申请中拟议的博士前培训计划将为应用程序提供 理论和方法论基础，成为一名富有成效的独立研究人员。