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A Structural Equation Model of HIV-Related Stigma, Racial Discrimination, Housing Insecurity and Wellbeing among African and Caribbean Black Women Living with HIV in Ontario, Canada

View Article: PubMed Central - PubMed

ABSTRACT

African and Caribbean Black women in Canada have new HIV infection rates 7 times higher than their white counterparts. This overrepresentation is situated in structural contexts of inequities that result in social, economic and health disparities among African and Caribbean Black populations. Economic insecurity is a distal driver of HIV vulnerability, reducing access to HIV testing, prevention and care. Less is known about how economic insecurity indicators, such as housing security, continue to influence the lives of women living with HIV following HIV-positive diagnoses. The aim of this study was to test a conceptual model of the pathways linking HIV-related stigma, racial discrimination, housing insecurity, and wellbeing (depression, social support, self-rated health). We implemented a cross-sectional survey with African and Caribbean Black women living with HIV in 5 Ontario cities, and included 157 participants with complete data in the analyses. We conducted structural equation modeling using maximum likelihood estimation to evaluate the hypothesized conceptual model. One-fifth (22.5%; n = 39) of participants reported housing insecurity. As hypothesized, racial discrimination had significant direct effects on: HIV-related stigma, depression and social support, and an indirect effect on self-rated health via HIV-related stigma. HIV-related stigma and housing insecurity had direct effects on depression and social support, and HIV-related stigma had a direct effect on self-rated health. The model fit the data well: χ2 (45, n = 154) = 54.28, p = 0.387; CFI = 0.997; TLI = 0.996; RMSEA = 0.016. Findings highlight the need to address housing insecurity and intersecting forms of stigma and discrimination among African and Caribbean Black women living with HIV. Understanding the complex relationships between housing insecurity, HIV-related stigma, racial discrimination, and wellbeing can inform multi-level interventions to reduce stigma and enhance health.

No MeSH data available.


Tested conceptual model of the relationship between HIV-related stigma, racial discrimination, housing insecurity and wellbeing among African and Caribbean women living with HIV in Ontario.Fig 1 depicts hypothesized relationships between variables analyzed in the model. Solid lines represent hypothesized direct effects. Ovals represent latent variables, and rectangles represent observed variables.
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pone.0162826.g001: Tested conceptual model of the relationship between HIV-related stigma, racial discrimination, housing insecurity and wellbeing among African and Caribbean women living with HIV in Ontario.Fig 1 depicts hypothesized relationships between variables analyzed in the model. Solid lines represent hypothesized direct effects. Ovals represent latent variables, and rectangles represent observed variables.

Mentions: The purpose of this study was to extend prior research on stigma and health correlates of housing insecurity among WLWH by examining pathways between a) forms of social inequities (racial discrimination → HIV-related stigma; racial discrimination and HIV-related stigma → housing insecurity), and b) social inequities (HIV-related stigma, racial discrimination, housing insecurity) and indicators of wellbeing (depression, social support, self-rated health). We developed a conceptual model building on prior research, depicted in Fig 1. As illustrated in the model, we hypothesized that a) racial discrimination would increase HIV-related stigma; b) HIV-related stigma and racial discrimination would be associated with increased housing insecurity; c) racial discrimination, HIV-related stigma, and housing insecurity would contribute to reduced wellbeing, specifically higher depression, lower social support and lower self-rated health.


A Structural Equation Model of HIV-Related Stigma, Racial Discrimination, Housing Insecurity and Wellbeing among African and Caribbean Black Women Living with HIV in Ontario, Canada
Tested conceptual model of the relationship between HIV-related stigma, racial discrimination, housing insecurity and wellbeing among African and Caribbean women living with HIV in Ontario.Fig 1 depicts hypothesized relationships between variables analyzed in the model. Solid lines represent hypothesized direct effects. Ovals represent latent variables, and rectangles represent observed variables.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5036880&req=5

pone.0162826.g001: Tested conceptual model of the relationship between HIV-related stigma, racial discrimination, housing insecurity and wellbeing among African and Caribbean women living with HIV in Ontario.Fig 1 depicts hypothesized relationships between variables analyzed in the model. Solid lines represent hypothesized direct effects. Ovals represent latent variables, and rectangles represent observed variables.
Mentions: The purpose of this study was to extend prior research on stigma and health correlates of housing insecurity among WLWH by examining pathways between a) forms of social inequities (racial discrimination → HIV-related stigma; racial discrimination and HIV-related stigma → housing insecurity), and b) social inequities (HIV-related stigma, racial discrimination, housing insecurity) and indicators of wellbeing (depression, social support, self-rated health). We developed a conceptual model building on prior research, depicted in Fig 1. As illustrated in the model, we hypothesized that a) racial discrimination would increase HIV-related stigma; b) HIV-related stigma and racial discrimination would be associated with increased housing insecurity; c) racial discrimination, HIV-related stigma, and housing insecurity would contribute to reduced wellbeing, specifically higher depression, lower social support and lower self-rated health.

View Article: PubMed Central - PubMed

ABSTRACT

African and Caribbean Black women in Canada have new HIV infection rates 7 times higher than their white counterparts. This overrepresentation is situated in structural contexts of inequities that result in social, economic and health disparities among African and Caribbean Black populations. Economic insecurity is a distal driver of HIV vulnerability, reducing access to HIV testing, prevention and care. Less is known about how economic insecurity indicators, such as housing security, continue to influence the lives of women living with HIV following HIV-positive diagnoses. The aim of this study was to test a conceptual model of the pathways linking HIV-related stigma, racial discrimination, housing insecurity, and wellbeing (depression, social support, self-rated health). We implemented a cross-sectional survey with African and Caribbean Black women living with HIV in 5 Ontario cities, and included 157 participants with complete data in the analyses. We conducted structural equation modeling using maximum likelihood estimation to evaluate the hypothesized conceptual model. One-fifth (22.5%; n = 39) of participants reported housing insecurity. As hypothesized, racial discrimination had significant direct effects on: HIV-related stigma, depression and social support, and an indirect effect on self-rated health via HIV-related stigma. HIV-related stigma and housing insecurity had direct effects on depression and social support, and HIV-related stigma had a direct effect on self-rated health. The model fit the data well: χ2 (45, n = 154) = 54.28, p = 0.387; CFI = 0.997; TLI = 0.996; RMSEA = 0.016. Findings highlight the need to address housing insecurity and intersecting forms of stigma and discrimination among African and Caribbean Black women living with HIV. Understanding the complex relationships between housing insecurity, HIV-related stigma, racial discrimination, and wellbeing can inform multi-level interventions to reduce stigma and enhance health.

No MeSH data available.