Emotion regulation as a potential moderator of the association between HIV stigma and nonadherence to antiretroviral therapy among youth living with HIV

Bibliographic Data

ID21444569
AuthorsJohn Mark Wiginton (0000-0001-9358-7899, Department of Medicine, Division of Infectious Diseases and Global Public Health University of California–San Diego La Jolla California USA, corresponding author), K Rivet Amico (0000-0002-4458-6934, Department of Health Behavior and Health Education, School of Public Health University of Michigan Ann Arbor Michigan USA), Lisa Hightow‐Weidman (0000-0002-2421-923X, Institute on Digital Health and Innovation, College of Nursing Florida State University Tallahassee Florida USA), Patrick S Sullivan (0000-0002-7728-0587, Emory University), Patrick Sullivan (0000-0002-6910-9827, Department of Epidemiology, Rollins School of Public Health Emory University Atlanta Georgia USA), Keith J Horvath (0000-0001-7569-2839, Department of Psychology San Diego State University San Diego California USA)
Year2024
Volume96
Issue5
Pages1048-1064
Publication date2024-07-01
Open AccessYes
TypeARTICLE
VenueJournal of Adolescence (JOURNAL)
Journal identifiersISSN: 0140-1971 • E-ISSN: 1095-9254
PublisherWiley (PUBLISHER • GB)
DOI10.1002/jad.12315
PMID38488698
OpenAlexW4392885012
LanguageEN
Citations received3
References cited54

INTRODUCTION: Human immunodeficiency virus (HIV)-related stigma affects adherence to antiretroviral therapy (ART) for youth living with HIV. Emotion regulation strategies such as cognitive reappraisal (reinterpreting adversity to mitigate emotional impact) and expressive suppression (inhibiting emotion-expressive behavior activated by adversity) may moderate the HIV stigma-ART adherence relationship in this group. METHODS: Using baseline data from 208 youth living with HIV aged 15-24 years enrolled in an mHealth ART-adherence intervention, we performed modified Poisson regressions with robust variance between HIV stigma (internalized, anticipated, enacted) and ART nonadherence. We tested for multiplicative interaction via product terms between HIV stigma and emotion regulation scores, and additive interaction via relative excess risk due to interaction and attributable proportion using dichotomous HIV stigma and emotion regulation variables. RESULTS: Mean age was 21 years; ≥50% of participants were cisgender male, non-Hispanic Black, and gay-identifying; 18% reported ART nonadherence. Confounder-adjusted regressions showed positive associations between each HIV stigma variable and ART nonadherence. Internalized HIV stigma and cognitive reappraisal negatively, multiplicatively interacted (as internalized HIV stigma increased, ART nonadherence increased for those with low cognitive reappraisal). High internalized HIV stigma positively, additively interacted with low cognitive reappraisal and low expressive suppression (when high internalized HIV stigma and low levels of either emotion regulation strategy were present, ART nonadherence increased dramatically). CONCLUSION: Cognitive reappraisal and expressive suppression may protect against internalized HIV stigma's harmful association with ART nonadherence. These modifiable emotion regulation strategies may be targeted to potentially buffer the effects of internalized HIV stigma and support ART adherence for youth living with HIV.

Cognition · Cognitive reappraisal · Moderation · Psychiatry · Stigma (botany) · Adolescent Sexual and Reproductive Health · Clinical Psychology · HIV Research and Treatment · HIV/AIDS Research and Interventions · Psychology · Social Psychology

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