***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Stigma has become a gendered phenomenon that affects increasing numbers of HIV-infected women worldwide . This study examined the role of age as a possible moderator of the relationship between stigma and antiretroviral therapy adherence , CD4 % and viral load among 120 HIV-infected women . A secondary analysis was conducted using data from the Keeping Healthy and Active with Risk Reduction and Medication Adherence ( KHARMA ) Project , an National Institutes of Health ( NIH ) funded r and omized controlled trial to improve Antiretroviral treatment ( ART ) adherence and reduce risky behaviors in HIV-infected women at five clinical sites in a South-eastern city from 2005 to 2008 .  Stigma was measured using the  Perceived Personal Stigma of Human Immunodeficiency Virus and Acquired Immune Deficiency Syndrome ( HIV/AIDS ) scale . Among participants < 50 years old ( n=90 ) , age was significantly associated with viral load ( rho=-.24 , p=.02 ) and stigma was negatively associated with CD4 % ( r = -.26 , p=.02 ) . For the 30 participants > 50 years old , age was not significantly associated with viral load , stigma or CD4 % , and there was no significant association between stigma and CD4 % ( r=.07 , p=.70 ) . These findings indicate the need for further study regarding this potential moderating effect and possible interventions to address the susceptibility of younger women to the harmful effects of stigma BACKGROUND Dramatic increases in the number of patients requiring linkage to treatment for human immunodeficiency virus ( HIV ) infection are anticipated in response to up date d Centers for Disease Control and Prevention HIV testing recommendations that advocate routine , opt-out HIV testing . METHODS A retrospective analysis nested within a prospect i ve HIV clinical cohort study evaluated patients who established initial outpatient treatment for HIV infection at the University of Alabama at Birmingham 1917 HIV/AIDS Clinic from 1 January 2000 through 31 December 2005 .  Survival methods were used to evaluate the impact of missed visits during the first year of care on subsequent mortality in the context of other baseline sociodemographic , psychosocial , and clinical factors . Mortality was ascertained by query of the Social Security Death Index as of 1 August 2007 . RESULTS Among 543 study participants initiating outpatient care for HIV infection , 60 % missed a visit within the first year . The mortality rate was 2.3 deaths per 100 person-years for patients who missed visits , compared with 1.0 deaths per 100 person-years for those who attended all scheduled appointments during the first year after establishing outpatient treatment ( P = .02 ) . In Cox proportional hazards analysis , higher hazards of death were independently associated with missed visits ( hazard ratio , 2.90 ; 95 % confidence interval , 1.28 - 6.56 ) , older age ( hazard ratio , 1.58 per 10 years of age ; 95 % confidence interval , 1.12 - 2.22 ) , and baseline CD4 + cell count < 200 cells/mm(3 ) ( hazard ratio , 2.70 ; 95 % confidence interval , 1.00 - 7.30 ) . CONCLUSIONS Patients who missed visits within the first year after initiating outpatient treatment for HIV infection had more than twice the rate of long-term mortality , compared with those patients who attended all scheduled appointments . We posit that early missed visits are not causally responsible for the higher observed mortality but , rather , identify those patients who are more likely to exhibit health behaviors that portend increased subsequent mortality Objective : To determine the association of race with clinical and laboratory outcomes after initiation of highly active antiretroviral therapy ( HAART ) in HIV-1-infected women in the United States . Study Design : Prospect i ve cohort study . Participants : A total of 961 HIV-1-infected women participating in the Women 's Interagency HIV Study initiating HAART between July 1 , 1995 and September 30 , 2003 . Results : Over a median of 5.1 years of follow-up , in univariate Cox regression analyses , white women were more likely than African American women to attain a virologic response ( relative hazard [ RH ] = 1.34 , P = 0.005 ) , less likely to experience viral rebound ( RH = 0.76 , P = 0.051 ) , and less likely to die ( RH = 0.63 , P = 0.040 ) . There were no significant differences , however , among racial groups in outcomes after adjustment for pre-HAART CD4 + , HIV-1 RNA , history of AIDS-defining illness , age , antiretroviral therapy use , baseline HIV-1 exposure category , and post-HAART behavioral and clinical variables associated with poorer response ( discontinuation of HAART , lower income , smoking , current drug use , and depression ) . Continuous HAART use and lack of depression differed by race and were the strongest predictors of favorable outcomes . Conclusion : No significant differences by race were found in virologic , immunologic , or clinical outcomes after adjustment for continued HAART use and depression . These findings suggest that strategies to enhance HAART continuation , including assessing pharmacogenetic influences that may result in greater toxicity and discontinuation rates , and treating depression can improve individual and population -based effects of treatment and potentially mitigate racial disparities in AIDS-related outcomes This intervention sought to improve overall quality of life and health behavior in women living with human immunodeficiency virus ( HIV ) . We contrasted the effect of a group cognitive behavioral stress management expressive supportive therapy ( CBSM+ ) intervention plus a healthier lifestyles ( HL ) component with an individual educational/informational format plus HL on  HIV-medication adherence .  Women , n = 237 , predominantly African-American and Latina , living with HIV were recruited from Miami , New York and New Jersey and r and omized to group or individual conditions ( ten weekly sessions ) plus group or individual HL , i.e. , four conditions . Women reported relatively high levels of adherence at baseline . Participants in any of the group conditions increased self-reported adherence and emotion-focused coping skills in comparison with individual participation . This study suggests that group interventions may be an important adjunct in increasing medication adherence for HIV positive women Abstract Objective . To test the impact of participation in a peer-based intervention for symptom management for women living with HIV infection on selected outcome measures including , symptom intensity , medication adherence , viral control , and quality of life . Design . R and omized clinical trial . Methods . Participants were recruited using a convenient , consecutive sampling method . Those participants r and omized to the experimental condition attended seven , peer-led sessions over seven weeks . Participants r and omized to the control condition received a copy of HIV Symptom Management Strategies : A Manual for People Living with HIV/AIDS . Participants completed four surveys assessing change over time in the aforementioned outcome variables . Results . Eighty-nine HIV-infected women followed over 14 weeks and there were no differences between the two groups on baseline demographic variables . Mixed-effects regression indicated no significant difference between groups across time in total symptom intensity score and medication adherence . There was a significant difference between groups across time for two of the nine quality of life scales – HIV Mastery ( χ 2=25.08 ; p<0.005 ) and Disclosure Worries ( χ 2=24.67 ; p<0.005 ) . Conclusions . In urban-dwelling women living with HIV/AIDS , results suggest that a peer-based symptom management intervention may not decrease symptom intensity or increase medication adherence . There is positive evidence that suggests that the intervention may increase some important aspects of quality of life . However , further research is warranted to eluci date the effect of peer-based interventions in achieving positive self-management outcomes Purpose : Strict adherence to HIV medications is critical to ensure long‐term disease control , and adherence interventions that are possible in a clinic setting with limited re sources are needed . Data sources : This r and omized controlled pilot study tested an adherence intervention guided by the Information‐Motivation‐Behavioral Skills ( IMB ) model . The intervention included HIV education , a peer video , motivational interviewing , and attention to behavioral skills including communication with providers and adherence‐enhancing devices . Dependent variables included 3‐4 week adherence recall , medication refill rate , changes in IMB subscale scores , appointment attendance , and HIV‐associated laboratory findings . Seventy‐three individuals starting or restarting antiretroviral therapy were enrolled and 56 were r and omized . Conclusions : Improvements were seen in most outcomes , with small to moderate effect sizes , but the study was not powered to show statistical significance . Threats to power included a 51 % attrition rate , result ing mostly from loss to clinical care or prolonged gaps in care . Implication s for practice : A telephone‐based intervention to improve HIV medication adherence shows promise . Further study is needed with greater attention to retention in care 
    Output:
    
Psychosocial factors such as intersectional stigmas and depression were among the salient factors associated with adherence‐to‐care behaviors in women living with HIV ( WLWH ) .
In addition , interpersonal factors such as social support and the patient – provider relationship were frequently associated with adherence‐to‐care behaviors .