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This study examined these associations with longitudinal data spanning the first nine months following\n HIV<\/jats:styled-content>\n diagnosis and explored whether avoidant coping mediates these associations.\n <\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n Longitudinal data were collected from 398 South African\n PLWH<\/jats:styled-content>\n recruited from testing centres in 2014 to 2015. Self\u2010report data, including internalized stigma and avoidant coping (denying and distracting oneself from stressors), were collected one week and three months following\n HIV<\/jats:styled-content>\n diagnosis.\n ART<\/jats:styled-content>\n initiation at six months and\n HIV<\/jats:styled-content>\n \u20101\n RNA<\/jats:styled-content>\n at nine months were extracted from the South Africa National Health Laboratory Service database. Two path analyses were estimated, one testing associations between internalized stigma, avoidant coping and\n ART<\/jats:styled-content>\n initiation, and the other testing associations between internalized stigma, avoidant coping and\n HIV<\/jats:styled-content>\n \u20101\n RNA<\/jats:styled-content>\n suppression.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Participants were 36\u00a0years old, on average, and 63% identified as female, 18% as Zulu and 65% as Xhosa. The two path models fit the data well (\n ART<\/jats:styled-content>\n initiation outcome:\n X<\/jats:italic>\n 2<\/jats:sup>\n (7)\u00a0=\u00a08.14,\n p\u00a0<\/jats:italic>\n =\n \u00a0<\/jats:italic>\n 0.32; root mean square error of approximation (\n RMSEA<\/jats:styled-content>\n )\u00a0=\u00a00.02; comparative fit index (CFI)\u00a0=\u00a00.92;\n HIV<\/jats:styled-content>\n \u20101\n RNA<\/jats:styled-content>\n suppression outcome:\n X<\/jats:italic>\n 2<\/jats:sup>\n (7) \u00a0=\u00a06.58,\n p\u00a0<\/jats:italic>\n =\n \u00a0<\/jats:italic>\n 0.47;\n RMSEA<\/jats:styled-content>\n \u00a0=\u00a00.00;\n CFI<\/jats:styled-content>\n \u00a0=\u00a01.00). In both models, internalized stigma one week after diagnosis was associated with avoidant coping at three months, controlling for avoidant coping at one week. In turn, avoidant coping at three months was associated with lower likelihood of\n ART<\/jats:styled-content>\n initiation at six months in the first model and lower likelihood of\n HIV<\/jats:styled-content>\n \u20101\n RNA<\/jats:styled-content>\n suppression at nine months in the second model. Significant indirect effects were observed between internalized stigma with\n ART<\/jats:styled-content>\n non\u2010initiation and unsuppressed\n HIV<\/jats:styled-content>\n \u20101\n RNA<\/jats:styled-content>\n via the mediator of avoidant coping.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n \n Internalized stigma experienced soon after\n HIV<\/jats:styled-content>\n diagnosis predicted lower likelihood of\n ART<\/jats:styled-content>\n initiation and\n HIV<\/jats:styled-content>\n \u20101\n RNA<\/jats:styled-content>\n suppression over the first year following\n HIV<\/jats:styled-content>\n diagnosis. Avoidant coping played a role in these associations, suggesting that\n PLWH<\/jats:styled-content>\n who internalize stigma engage in greater avoidant coping, which in turn worsens medication\u2010 and health\u2010related outcomes. Interventions are needed to address internalized stigma and avoidant coping soon after\n HIV<\/jats:styled-content>\n diagnosis to enhance treatment efforts during the first year after\n HIV<\/jats:styled-content>\n diagnosis.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1002\/jia2.25198","type":"journal-article","created":{"date-parts":[[2018,10,26]],"date-time":"2018-10-26T08:05:28Z","timestamp":1540541128000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":73,"title":["Internalized\n HIV<\/scp>\n stigma,\n ART<\/scp>\n initiation and\n HIV<\/scp>\n \u20101\n RNA<\/scp>\n suppression in South Africa: exploring avoidant coping as a longitudinal mediator"],"prefix":"10.1002","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4147-3301","authenticated-orcid":false,"given":"Valerie A","family":"Earnshaw","sequence":"first","affiliation":[{"name":"Department of Human Development and Family Sciences University of Delaware Newark DE USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura M","family":"Bogart","sequence":"additional","affiliation":[{"name":"RAND Corporation Santa Monica CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean\u2010Philippe","family":"Laurenceau","sequence":"additional","affiliation":[{"name":"Department of Psychological & Brain Sciences University of Delaware Newark DE USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6971-3039","authenticated-orcid":false,"given":"Brian T","family":"Chan","sequence":"additional","affiliation":[{"name":"Department of Medicine Brigham and Women's Hospital Boston MA USA"},{"name":"Harvard Medical School Boston MA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7606-8744","authenticated-orcid":false,"given":"Brendan G","family":"Maughan\u2010Brown","sequence":"additional","affiliation":[{"name":"Southern Africa Labour and Development Research Unit University of Cape Town Rondebosch Cape Town South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Janan J","family":"Dietrich","sequence":"additional","affiliation":[{"name":"Perinatal HIV Research Unit Faculty of Health Sciences University of the Witwatersrand Johannesburg South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ingrid","family":"Courtney","sequence":"additional","affiliation":[{"name":"Desmond Tutu HIV Centre, IDM and Department of Medicine University of Cape Town Cape Town South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gugulethu","family":"Tshabalala","sequence":"additional","affiliation":[{"name":"Perinatal HIV Research Unit Faculty of Health Sciences University of the Witwatersrand Johannesburg South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catherine","family":"Orrell","sequence":"additional","affiliation":[{"name":"Desmond Tutu HIV Centre, IDM and Department of Medicine University of Cape Town Cape Town South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Glenda E","family":"Gray","sequence":"additional","affiliation":[{"name":"Perinatal HIV Research Unit Faculty of Health Sciences University of the Witwatersrand Johannesburg South Africa"},{"name":"South African Medical Research Council Cape Town South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David R","family":"Bangsberg","sequence":"additional","affiliation":[{"name":"Oregon Health & Science University\u2010Portland State University School of Public Health Portland OR USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ingrid T","family":"Katz","sequence":"additional","affiliation":[{"name":"Department of Medicine Brigham and Women's Hospital Boston MA USA"},{"name":"Harvard Medical School Boston MA USA"},{"name":"Center for Global Health Massachusetts General Hospital Boston MA USA"},{"name":"Harvard Global Health Institute Cambridge MA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2018,10,26]]},"reference":[{"key":"e_1_2_10_2_1","unstructured":"The Joint United Nations Programme on HIV\/AIDS (UNAIDS).Fast\u2010track: Ending the AIDS epidemic by 2030. 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