Past-Year Violence Victimization is Associated with Viral Load Failure Among HIV-Positive Adolescents and Young Adults

Katherine G Merrill,Caitlin E Kennedy,Michele R Decker,Jacquelyn C Campbell,Sam Miti,John Mcgready,Christiana Frimpong,Virginia M Burke,Julie A Denison,Jonathan K Mwansa

doi:10.1007/s10461-020-02958-3

Katherine G Merrill, Caitlin E Kennedy + Show 8 more

Open Access

https://doi.org/10.1007/s10461-020-02958-3

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Abstract

We examined the relationship between past-year violence victimization and viral load (VL) failure among consecutively-sampled male and female adolescents and young adults, aged 15–24, in four HIV clinics in Ndola, Zambia. Measures of past-year physical violence, psychological abuse, and forced sex were adapted from the ICAST-C and WHO Multi-Country Study. Using logistic regression, we derived associations between VL failure (≥ 1000 copies/mL) and: any victimization; cumulative victimization; and types and perpetrators of violence. Among 272 youth (59.2% female, 72.8% perinatally infected), 73.5% (n = 200) experienced past-year violence and 36.8% (n = 100) had VL failure. Higher odds of VL failure were observed for participants who reported high frequency of any violence versus no violence victimization (adjusted OR, aOR: 3.58; 95% CI 1.14–11.27), high frequency of psychological abuse versus no psychological abuse (aOR: 3.32; 95% CI 1.26–8.70), any versus no violence from a family member other than a parent/caregiver for physical violence (aOR: 2.18, 95% CI 1.05–4.54) and psychological abuse (aOR: 2.50; 95% CI 1.37–4.54), and any versus no physical violence from a friend/peer (aOR: 2.14, 95% CI 1.05–4.36). Past-year violence victimization was associated with VL failure when considering the frequency, type, and perpetrator of violence. Programs addressing violence among youth living with HIV may be critical to improving viral suppression and preventing onward transmission.

Highlights

Despite significant progress made in HIV prevention, care, and treatment in the past decade, HIV remains a leading cause of death among adolescents and young adults, ages 15–24 years, in sub-Saharan Africa [1]
The small proportion (7%, n = 19) reporting a high frequency of any past-year victimization had 3.58 times the odds of viral load (VL) failure compared to those reporting no past-year violence, after adjusting for covariates (Model 2)
We found that past-year violence victimization among adolescents and young adults living with HIV was associated with VL failure when considering the frequency, type, and perpetrator of violence

Summary

Introduction

Despite significant progress made in HIV prevention, care, and treatment in the past decade, HIV remains a leading cause of death among adolescents and young adults, ages 15–24 years, in sub-Saharan Africa [1]. Compared to adults, these youth in the region demonstrate lower levels of antiretroviral therapy (ART) adherence and viral suppression [2]. In Zambia, 43% of female and 34% of male adolescents ages 13–17 experience past-year physical, emotional, or sexual violence [6]. Among young women aged 20–24 years, over one-third experience past-year physical violence and onetenth experience past-year sexual violence [7]

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