The Influence of HIV-Related Stigma, Racial Discrimination and Gender Discrimination On Quality of Life Among HIV-Positive African Caribbean Black Women in Ontario, Canada
HIV-related stigma, racism, and sexism have been associated with health disparities. Less understood, however, is how these forms of stigma and discrimination converge to influence quality of life (QOL). The intersections of HIV-related stigma, racism and sexism are salient to examine as African and Caribbean Black (ACB) women are 7-fold overrepresented in new HIV infections in comparison with their white counterparts in Canada. This overrepresentation of ACB women in Canada’s HIV epidemic is in part due to social and structural factors such as stigma and discrimination that increase vulnerability to HIV infection while reducing access to care. Most studies have examined health effects of racism, sexism and HlV-related stigma separately. The objective of this study was to examine the influence of HIV-related stigma, racial discrimination and gender discrimination on QOL among HIV-positive ACB women in Ontario, Canada. The secondary objective was to explore the associations between resilient coping, social support and QOL.
We conducted a community-based multi-method study triangulating qualitative and quantitative methods. Building on qualitative findings regarding stigma and discrimination from 15 focus groups with HIV-positive women (n=104) in Ontario, we implemented a cross-sectional survey to a purposive sample of HIV-positive ACB women in four Ontario cities. Bivariate correlations and hierarchical block multiple linear regression (MLR) analyses were conducted to measure associations between independent (block 1: HIV-related stigma sub-scale scores—personalized stigma, disclosure, negative self-image, public attitudes; racial discrimination; gender discrimination; block 2: resilient coping; social support) and dependent (QOL) variables.
Survey participants (n=163; mean age=40.7 years, SD=8.8) reported frequent/everyday experiences of racial discrimination (29.4%) and gender discrimination (22.6%) and high HIV-related stigma (disclosure: 84.4%; personalized: 54.7%; public attitudes 40.4%; negative self-image: 27.6%). Approximately half of participants rated their overall quality of life as good/very good (47.9%), one quarter as neither poor/good (27.3%), and one-quarter as poor/very poor (24.8%). HIV-related stigma, racial discrimination and gender discrimination were significantly correlated with lower resilient coping, social support and QOL scores. In block 1 MLR analyses, HIV-related stigma, racial discrimination and gender discrimination were associated with lower QOL, adjusted R2=0.39, F(6,68)=8.95, p<0.001. In block 2, resilient coping and social support accounted for a significant variance of higher QOL, adjusted R2=0.52, F(2,66)=9.80, p<0.001, after controlling for the effects of HIV-related stigma, racial discrimination and gender discrimination.
HIV-positive ACB women in Ontario, Canada experience pervasive HIV-related stigma, racial discrimination, and gender discrimination associated with reduced QOL; social support and resilient coping were associated with higher QOL. Understanding the impact of stigma and discrimination based on HIV serostatus, gender and race/ethnicity can inform social work practice through highlighting the importance of multi-level interventions, including micro (e.g. coping), meso (e.g. social support) and structural (e.g. challenging stigma/discrimination) components. Social work research should further explore the influence of HIV-related and racial/gender discrimination on QOL among ACB women. An enhanced understanding of the potential roles that resilient coping and social support can play in promoting QOL can inform interventions to reduce stigma and discrimination and promote health equity among ACB women living with HIV.