In North America, HIV disproportionately impacts Black women of African Caribbean descent. This is particularly true in Canada, where Black women have HIV infection rates seven times higher than the general female population. This heighted HIV risk among Black women underscores the salience of understanding socio-structural factors driving the HIV epidemic. Stigma and discrimination present barriers to HIV prevention, treatment and care. Stigmatizing processes involve devaluing, labeling, and stereotyping that are manifested in the loss of status, unfair and unjust treatment, and social isolation of individuals or groups. HIV-related stigma, sexism and racism have been associated with higher rates of depression; however most studies have examined the mental health effects of HIV-related stigma, racism and sexism separately. The objective of this study was to examine the influence of perceived racism, perceived sexism and HIV-related stigma on depression among HIV-positive Black women in Ontario, Canada. The secondary objective was to explore the associations between resilient coping, social support and depression.
Methods
A multi-methods approach, triangulating qualitative and quantitative methods, was employed to investigate stigma experienced by HIV-positive women. Formative research, including fifteen focus groups with HIV-positive women (n=104) across Ontario and community consultations, was conducted to develop a cross-sectional survey to examine perceived racism, perceived sexism, HIV-related stigma, social support, resilient coping and depression. Peer research assistants administered the survey to a purposive sample of HIV-positive Black women in four cities in Ontario. Bivariate correlations and hierarchical block regression analyses were conducted using SPSS 17 to measure associations between independent (perceived racism, perceived sexism, HIV-related stigma, resilient coping, social support) and dependent (depression) variables. Block 1 analyses examined associations between perceived racism, perceived sexism, HIV-related stigma and depression; block 2 analyses examined associations between resilient coping, social support and depression.
Results
Survey participants (n=163; mean age=41 years) reported experiences of perceived racism, perceived sexism and HIV-related stigma. Over one third of participants (39.1%) reported moderate/severe depression scores. Perceived racism, perceived sexism, and HIV-related stigma scores were significantly correlated with higher depression scores and lower resilient coping and social support scores. In block 1 MLR analyses, perceived racism, perceived sexism and HIV-related stigma predicted higher depression scores, adjusted R2=0.22, F(3,89)=9.73, p<0.001. In block 2, resilient coping and social support predicted lower depression scores, adjusted R2=0.27, R2 change=0.06, F(2,87)=3.81, p<0.05.
Conclusions
Perceived racism, perceived sexism and HIV-related stigma are associated with higher rates of depression among HIV-positive Black women in Ontario, Canada. Understanding the influence of racism, sexism, and HIV-related stigma on depression informs social work practice by highlighting the importance of multi-level interventions, including micro (e.g. mental health assessments, building resilient coping skills), meso (e.g. social support groups/networks) and structural (e.g. challenging racism, sexism, HIV-related stigma) initiatives. Social work research should further explore the influence of racism, sexism and HIV-related stigma on depression among HIV-positive women. An enhanced understanding of the potential roles that resilient coping and social support can play in facilitating mental health can inform interventions to reduce the negative impact of stigma and promote health among HIV-positive women.
