Longitudinal analysis of the role of mindfulness on HIV stigma, depression, substance use and HIV outcomes among female sex workers living with HIV in the Dominican Republic.

Summary

Greater mindfulness is linked to lower depression and improved HIV outcomes among female sex workers (FSW) living with HIV. In a study of 240 FSW from the Dominican Republic, increased mindfulness correlated with a 57% reduction in depression and higher adherence to antiretroviral therapy (ART). Additionally, mindfulness was associated with decreased HIV stigma and reduced substance use. These findings suggest that mindfulness training could be an effective intervention to enhance mental health and support the Sustainable Development Goal 3 for good health and well-being.

Abstract

Female sex workers (FSW) living with HIV experience greater depression and worse HIV outcomes than people living with HIV (PLHIV) overall. Mindfulness is related to lower depression and higher ART adherence in PLHIV. Few studies have assessed these relationships among FSW, especially longitudinally. This study assessed the temporal relationship between mindfulness, mental health and HIV outcomes among FSW from the Dominican Republic (DR). We analyzed data collected between 2018 and 2021 among 240 FSW using mixed modeling to assess contemporaneous relationships and time-lagged relationships between mindfulness and mental health (i.e., depression,HIV stigma, drug and alcohol use ), and HIV outcomes (i.e., ART adherence, viral suppression) , accounting for clustering of repeated measures. Greater mindfulness showed contemporaneous and time-lagged associations with lower depression (contemporaneous: b = -0.57, SE = 0.03, p < 0.001; time-lagged: b = -0.16, SE = 0.05, p < 0.001), lower HIV stigma (contemporaneous: b = -0.11, SE = 0.02, p < 0.001; time-lagged: b = -0.08, SE = 0.03, p = 0.003) and higher ART adherence (contemporaneous: b = 0.03, SE = 0.01, p = 0.003; time-lagged: b = 0.04, SE = 0.01, p = 0.004), and contemporaneous associations with reduced at-risk alcohol use and higher viral suppression (aOR = 0.99, 95% CI = 0.99-1.00, p = 0.003; aOR = 1.01, 95% CI: 1.00-1.01, p = 0.036, separately). Mindfulness instruction is a promising intervention for reducing depression and HIV stigma, and promoting better HIV outcomes among FSW living with HIV, meriting future intervention research in this area.

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