Discrimination and HIV Treatment Adherence Among Latinx Sexual Minority Men Living with HIV: Coping As a Mediator

Background and Purpose: Latinx sexual minority men are disproportionately impacted by HIV in the United States. Stigma and discrimination based on different de-valued identities such as sexual orientation, race/ethnicity, and HIV serostatus are thought to contribute to health inequities. Perceived discrimination is associated with antiretroviral therapy (ART) nonadherence and poor mental and physical health among people living with HIV. Mediating factors, or factors that expalin observed associations, may present a potential lever to address critical HIV outcomes. We examined the extent to which coping with discrimination mediates the association between discrimination and ART nonadherence among HIV-positive Latinx sexual minority men.

Methods: This study used community-based participatory research methods and was conducted in the context of an established community-academic partnership in Los Angeles, CA. Participants were recruited using convenience sampling. Participants were eligible if they self-identified as Latinx; were at least 18 years of age; were HIV-positive; were biologically male; ever had sex with another man; and were not on ART, on ART but missed a dose in the last month, or had less than two HIV care visits in the last year. A total of 82 participants completed a survey in Spanish using an audio computer-assisted self-interview (ACASI). The Multiple Discrimination Scale (MDS) was used to examine perceived discrimination, the Brief COPE and the Coping Self Efficacy Scale (CSES) were used to assess effective and ineffective coping with perceived discrimination experiences. To test for mediation, a series of linear regressions were used. These regressions consisted of: (1) the mediator with the independent variable (coping with discrimination), (2) the dependent variable with the independent variable (self-reported ART adherence with discrimination), and (3) the dependent variable with the independent variable and the mediator (self-reported ART adherence with discrimination and coping). To assess whether a significant portion of the effect of each discrimination variable on self-reported ART adherence was accounted for by coping, a bootstrapping approach was used; this results in a 95% confidence interval, with the absence of zero indicating significance at p < 0.05.

Results: Discrimination based on ethnicity, undocumented residency status, and sexual orientation were each significantly associated with lower self-reported ART adherence (i.e., percentage of doses taken in the last month) in bivariate linear regressions. Having higher confidence in one’s ability to cope with discrimination (e.g., to seek emotional support from family and friends) was associated with higher self-reported ART adherence. The associations between ethnic and sexual orientation-based discrimination on nonadherence were mediated by ineffective coping responses (e.g., denial, substance use, venting, self-blame, behavioral disengagement).

Conclusions and Implications: The deleterious effects of discrimination on the health have been well documented. Our study expands on the mediating role of coping, to suggest it could present a potential lever to minimize the effect of discrimination on ART adherence. Going forward programs, policies, and research should continue to explore how to bolster existing coping strategies and people’s ability to implement them in a culturally responsive approach to help address pervasive inequities, especially among Latinx sexual minority men living with HIV.