THE IMPACT OF NEW AWARENESS OF A SEXUALLY TRANSMITTED INFECTION ON INTERNALIZED HIV STIGMA AND DEPRESSIVE SYMPTOMS AMONG WOMEN LIVING WITH HIV IN THE UNITED STATES

Women living with HIV (WLWH) experience internalized HIV stigma (hereafter stigma) and increased depressive symptoms compared to women without HIV and men with HIV in the United States (US). Both psychological experiences impact WLWH’s mental health, but their drivers remain underexplored. I postulated a new non-HIV sexually transmitted infection (STI) may increase stigma and depressive symptoms via retraumatization. Separately, causal effect estimates of a stigma reduction intervention on depressive symptoms remain unknown and warrant further investigation.Data from the Women’s Interagency HIV Study (WIHS) included new STI awareness (chlamydia, gonorrhea, syphilis, herpes simplex 2, genital warts, or trichomoniasis), stigma scores, and depressive symptom scores. I modeled mean differences in stigma and depressive symptom scores, separately, at visits with an STI versus visits without using generalized linear models with generalized estimating equations, weighted for confounding and censoring. Results were stratified by race/ethnicity categories, and 95% confidence intervals (CIs) were bootstrapped. The g-formula simulated the effects of a stigma reduction intervention on depressive symptoms. The effect of the hypothetical intervention was calculated, at varying point reductions, for the total analysis population and a subset population with probable depression (CES-D ≥ 16). Mean differences in stigma scores between visits with and without an STI varied by race/ethnicity and ranged from -0.43 (95% CI: -1.18, 0.32) to 0.42 (-0.10, 0.93). All Hispanic ethnicity groups (White, Hispanic; Black, Hispanic; and Other, Hispanic) experienced increased scores at visits with STIs. Mean differences in CES-D scores between visits with and without an STI also varied by race/ethnicity. Black, non-Hispanic participants had a 1.46 (0.57, 2.34) point increase in CES-D scores at visits with a reported STI versus visits without. In the total population, decreases in stigma decreased depressive symptoms by varying degrees. A 0.50 decrease led to a mean difference in -1.45 (-2.33, 0.57) in CES-D scores in the total population. For WLWH, an STI affected stigma and CES-D scores differently by race/ethnicity group. Analyses suggested that increased mental health support following a new STI may reduce depressive symptom burden in some WLWH. Interventions focusing on stigma reduction are one potential way to improve WLWH’s mental health.