Examining pathways between stigma, extreme weather exposure, resource insecurities and ART adherence among young men who have sex with men and female sex workers living with HIV in Kampala, Uganda

IF 3.2 3区医学 Q2 INFECTIOUS DISEASES

HIV Medicine Pub Date : 2026-09-06 Epub Date: 2026-07-03 DOI:10.1111/hiv.70275

Carmen H. Logie, Ying Wang, Moses Okumu, Jingchuan Fan, Frannie MacKenzie, Gerald Pande, Aidah Nakitende, Brenda Katisi, Peter Kyambadde, Lawrence Mbuagbaw, Amaya Perez-Brumer, Caetano Dorea, Lesley Gittings, Paul Bukuluki, Julien Brisson

{"title":"Examining pathways between stigma, extreme weather exposure, resource insecurities and ART adherence among young men who have sex with men and female sex workers living with HIV in Kampala, Uganda","authors":"Carmen H. Logie, Ying Wang, Moses Okumu, Jingchuan Fan, Frannie MacKenzie, Gerald Pande, Aidah Nakitende, Brenda Katisi, Peter Kyambadde, Lawrence Mbuagbaw, Amaya Perez-Brumer, Caetano Dorea, Lesley Gittings, Paul Bukuluki, Julien Brisson","doi":"10.1111/hiv.70275","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Objectives</h3>\n \n <p>Stigma is multidimensional and undermines HIV care. We examined socio-environmental pathways linking HIV-related stigma, everyday discrimination and structural stigma to antiretroviral therapy (ART) adherence among men who have sex with men (MSM) and female sex workers (FSW) living with HIV in Kampala, Uganda.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>We conducted a cross-sectional survey (06/2024–02/2025) among MSM and FSW aged 18–35 receiving HIV services from a key population clinic in Kampala. ART adherence was assessed using the Wilson 3-item adherence scale. We conducted stratified multivariable linear regression and multi-group structural equation modelling (SEM) to estimate direct and indirect associations from stigma to adherence through socio-environmental stressors (traumatic exposure severity to extreme weather [TESS], food insecurity, water insecurity), adjusted for socio-demographic variables.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>Participants included MSM (<i>n</i> = 225, mean age: 27.65, standard deviation [SD] = 3.54) and FSW (<i>n</i> = 240, mean age: 25.68, SD: 2.90). SEM showed acceptable fit. In adjusted SEM analyses (a) among MSM, higher TESS, HIV-related stigma and everyday discrimination were directly associated with lower ART adherence and (b) among FSW, higher TESS, HIV-related stigma, water and food insecurity were directly associated with lower ART adherence. There were significant indirect associations between HIV-related stigma and ART adherence via TESS for FSW and MSM, and between everyday discrimination and structural stigma with ART adherence via TESS for MSM.</p>\n </section>\n \n <section>\n \n <h3> Conclusions</h3>\n \n <p>Stigma and socio-environmental stressors, including traumatic exposure to extreme weather events, were associated with reduced ART adherence among MSM and FSW participants. Population-tailored HIV care interventions may benefit from integrating intersectional stigma reduction with economic and disaster preparedness supports.</p>\n </section>\n </div>","PeriodicalId":13176,"journal":{"name":"HIV Medicine","volume":"27 9","pages":"1503-1516"},"PeriodicalIF":3.2000,"publicationDate":"2026-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/hiv.70275","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"HIV Medicine","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1111/hiv.70275","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2026/7/3 0:00:00","PubModel":"Epub","JCR":"Q2","JCRName":"INFECTIOUS DISEASES","Score":null,"Total":0}

引用次数: 0

Abstract

Objectives

Stigma is multidimensional and undermines HIV care. We examined socio-environmental pathways linking HIV-related stigma, everyday discrimination and structural stigma to antiretroviral therapy (ART) adherence among men who have sex with men (MSM) and female sex workers (FSW) living with HIV in Kampala, Uganda.

Methods

We conducted a cross-sectional survey (06/2024–02/2025) among MSM and FSW aged 18–35 receiving HIV services from a key population clinic in Kampala. ART adherence was assessed using the Wilson 3-item adherence scale. We conducted stratified multivariable linear regression and multi-group structural equation modelling (SEM) to estimate direct and indirect associations from stigma to adherence through socio-environmental stressors (traumatic exposure severity to extreme weather [TESS], food insecurity, water insecurity), adjusted for socio-demographic variables.

Results

Participants included MSM (n = 225, mean age: 27.65, standard deviation [SD] = 3.54) and FSW (n = 240, mean age: 25.68, SD: 2.90). SEM showed acceptable fit. In adjusted SEM analyses (a) among MSM, higher TESS, HIV-related stigma and everyday discrimination were directly associated with lower ART adherence and (b) among FSW, higher TESS, HIV-related stigma, water and food insecurity were directly associated with lower ART adherence. There were significant indirect associations between HIV-related stigma and ART adherence via TESS for FSW and MSM, and between everyday discrimination and structural stigma with ART adherence via TESS for MSM.

Conclusions

Stigma and socio-environmental stressors, including traumatic exposure to extreme weather events, were associated with reduced ART adherence among MSM and FSW participants. Population-tailored HIV care interventions may benefit from integrating intersectional stigma reduction with economic and disaster preparedness supports.

查看原文本刊更多论文

在乌干达坎帕拉，对年轻男男性行为者和感染艾滋病毒的女性性工作者的耻辱、极端天气暴露、资源不安全感和抗逆转录病毒治疗依从性之间的关系进行研究。

目标：耻辱感是多方面的，会破坏艾滋病毒护理。我们研究了乌干达坎帕拉的男男性行为者（MSM）和感染艾滋病毒的女性性工作者（FSW）中与艾滋病毒相关的耻辱、日常歧视和结构性耻辱与抗逆转录病毒治疗（ART）依从性之间的社会环境途径。方法：对在坎帕拉某重点人群诊所接受HIV服务的18-35岁MSM和FSW进行了横断面调查（2024年6月- 2025年2月）。采用Wilson 3项依从性量表评估ART依从性。我们进行了分层多变量线性回归和多组结构方程建模（SEM），以估计通过社会环境压力因素（极端天气的创伤暴露程度[TESS]，粮食不安全，水不安全），调整了社会人口变量，从耻辱到依从性的直接和间接关联。结果：参与者包括MSM （n = 225，平均年龄：27.65，标准差[SD] = 3.54）和FSW （n = 240，平均年龄：25.68,SD: 2.90）。扫描电镜显示契合度可接受。在调整后的SEM分析中，(a)在男男性接触者中，较高的TESS、hiv相关的耻辱感和日常歧视与较低的抗逆转录病毒治疗依从性直接相关；(b)在FSW中，较高的TESS、hiv相关的耻辱感、水和食物不安全与较低的抗逆转录病毒治疗依从性直接相关。hiv相关的耻辱感与FSW和MSM的抗逆转录病毒治疗依从性之间存在显著的间接关联，日常歧视与结构性耻辱感与MSM的抗逆转录病毒治疗依从性之间存在显著的间接关联。结论：耻辱感和社会环境压力因素，包括极端天气事件的创伤性暴露，与MSM和FSW参与者抗逆转录病毒治疗依从性降低有关。针对人群的艾滋病毒护理干预措施可能受益于将交叉污名减少与经济和备灾支持相结合。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

HIV Medicine 医学-传染病学

CiteScore

5.10

自引率

10.00%

发文量

167

审稿时长

6-12 weeks

期刊介绍： HIV Medicine aims to provide an alternative outlet for publication of international research papers in the field of HIV Medicine, embracing clinical, pharmocological, epidemiological, ethical, preclinical and in vitro studies. In addition, the journal will commission reviews and other feature articles. It will focus on evidence-based medicine as the mainstay of successful management of HIV and AIDS. The journal is specifically aimed at researchers and clinicians with responsibility for treating HIV seropositive patients.