CROI 2015 Program and Abstracts

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Poster Abstracts

Table 1. Bivariate associations between mean internalized stigma and behavioral and clinical outcomes - United States, 2011 (n=4385) Conclusions: Among HIV-infected adults in care in the U.S., internalized stigma was associated with depression and binge drinking. Moreover, stigma was associated with lack of disclosure of HIV status to sex partners, but was not related to certain factors associated with transmission risk such as viral load and sex without a condom. Targeted interventions to reduce internalized stigma may be beneficial for HIV-infected adults, including older persons, heterosexuals, foreign-born persons, those with health insurance gaps and those recently diagnosed. 1058 Association Between Enacted Stigma and HIV-Related Risk Behavior Among MSM, National HIV Behavioral Surveillance System, 2011 Alexandra B. Balaji ; Justin C. Smith; Kristina Bowles; Gabriela Paz-Bailey US Centers for Disease Control and Prevention (CDC), Atlanta, GA, US Background: Men who have sex with men (MSM) bear a disproportionate burden of the HIV epidemic. Enacted stigma (overt negative actions against sexual minorities) may play an important role in increasing HIV risk among this population. We report data on the association between measures of enacted stigma and HIV-related sexual risk behaviors among MSM in 2011. Methods: We examined data from 20 cities that participated in the 2011 National HIV Behavioral Surveillance System (NHBS) among MSM. Venue-based, time-space sampling was used to recruit men for interview and HIV testing. We analyzed data frommen who reported ≥ 1 male sex partner in the past 12 months and who did not self-report to be HIV-positive. We used separate GEE models with a robust error variance procedure to estimate prevalence ratios and confidence intervals for the independent associations between three measures of enacted stigma (verbal harassment, discrimination, physical assault) and engagement in each of three sexual risk behaviors in the past 12 months as outcomes: condom-less anal intercourse, ≥ 4male sex partners, and exchange sex. Models were adjusted for demographic and behavioral characteristics associated with the outcomes. Results: Of 8922 MSM, 2883 (32.3%) experienced verbal harassment in the past 12 months, 2113 (23.7%) experienced discrimination, and 754 (8.5%) experienced physical assault. MSM who experienced the three measures of enacted stigma were more likely to report the three HIV-related risk behaviors. Condom-less anal intercourse was associated with verbal harassment (adjusted prevalence ratio [aPR] 1.08, 95% confidence interval [CI] 1.03-1.14), discrimination (aPR 1.09, CI 1.05-1.14), and physical assault (aPR 1.09, CI 1.02-1.16). Having ≥ 4 male sex partners was associated with verbal harassment (aPR 1.14, CI 1.09-1.19), discrimination (aPR 1.14, CI 1.07-1.21), and physical assault (aPR 1.13, CI 103-1.24). Exchange sex was associated with verbal harassment (aPR 1.40, CI 1.21-1.61), discrimination (aPR 1.55, CI 1.28-1.88), and physical assault (aPR, CI 1.46-2.08). Conclusions: These findings indicate that a sizable proportion of MSM report occurrences of enacted stigma and suggest that these experiences may be associated with HIV- related risk behavior. Taken together, these data indicate a need for interventions that increase the acceptance of sexual minorities in the larger society and facilitate coping with experiences of enacted stigma. 1059 Has Antiretroviral Treatment Scale-Up in Sub-Saharan Africa Reduced HIV-Related Stigma in the General Population? A Cross-Country Analysis Brian T. Chan 1 ; AlexanderTsai 2 ; Mark Siedner 2 1 Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, US; 2 Massachusetts General Hospital, Harvard Medical School, Boston, MA, US Background: HIV-related stigma is associated with reduced uptake of HIV testing, increased risk-taking behavior, decreased adherence to anti-retroviral therapy (ART), and reduced HIV status disclosure. The extent to which ART scale-up in sub-Saharan Africa has resulted in population-level changes in HIV-related stigma remains unclear. To help answer this question, we examined trends in stigma during ART scale-up in sub-Saharan Africa (2003-2013), using population-based data on ART coverage from the Joint United Nations Programme on HIV/AIDS (UNAIDS) and on HIV-related stigma from the Demographic and Health Surveys (DHS) and AIDS Indicator Surveys (AIS). Methods: We constructed a composite indicator for HIV-related stigma in the general population, defined as the percentage of men and women aged 15-49 in the DHS and AIS who responded positively to at least one of four standardized questions related to stigmatizing attitudes and fears about disclosure. We limited our analysis to countries with at least two datasets in which this composite stigma variable was included. We fitted two linear regression models with country fixed effects, with percentage of men or women reporting HIV-related stigma as the dependent variable, and the percentage of people living with HIV on ART as the explanatory variable. Results: We analyzed data from 18 sub-Saharan African countries. The median percentage of the general population reporting HIV-related stigma was 89% (IQR, 75-92%) for women and 81% for men (IQR, 66-86%). For each 1% increase in ART coverage, we observed a statistically significant decline in the percentage of women ( b =-0.238; 95% CI, -0.394 to -0.082) and men ( b =-0.288; 95% CI, -0.488 to -0.089) in the general population reporting HIV-related stigma. This corresponds to a decrease in population reported HIV- related stigma of approximately 2% for each 10% increase in ART coverage. Conclusions: We observed a significant association between increasing ART coverage and declining HIV-related stigma in the general population. Our findings suggest that an important benefit of ART scale-up may be the diminution of HIV-related stigma in the general population. However, given that stigma remained high in all of the countries under study despite ART expansion, further study of interventions that effectively target HIV-related stigma is warranted.

Poster Abstracts

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CROI 2015