Syndemic factors associated with adherence to antiretroviral therapy among HIV-positive adult heterosexual men

James M Mcmahon,Michael Chen,Angela Aidala,Janie Simmons,Natalie Leblanc,Chen Zhang,Amy Braksmajer

doi:10.1186/s12981-019-0248-9

Abstract

BackgroundSuboptimal adherence to HIV antiretroviral therapy (ART) and concomitant lack of viral control can have severe consequences for health and onward transmission among persons living with HIV. Little is known about the barriers and facilitators of optimal ART adherence among heterosexual HIV-positive men.MethodsStructural equation modeling (SEM) was performed to test a theory-derived model of ART adherence using data from a cross-sectional sample of 317 HIV-positive self-identified heterosexual men residing in New York City. We assessed a conceptual model in which mental health (depression, anxiety) and substance use dependence mediated the effects of socio-structural factors (HIV-related stigma, social support) on ART adherence, and subsequently, undetectable viral load.ResultsStructural equation modeling analyses indicated that men who reported higher levels of HIV-related stigma tended to experience higher levels of general anxiety, which in turn was associated with reduced probability of optimal ART adherence. Moreover, men who reported higher levels of social support tended to exhibit less dependence on illicit substance use, which in turn was associated with increased probability of optimal ART adherence. African-American men reported lower ART adherence compared to other racial/ethnic groups.ConclusionsOur findings support the hypothesis that substance use dependence and mental health problems, particularly anxiety, may be primary drivers of suboptimal ART adherence among heterosexual men, and that socio-structural factors such as HIV-related stigma and social support are potential modifiable antecedents of these drivers.

Highlights

Optimal adherence to HIV antiretroviral therapy (ART) is essential for sustained HIV-1 RNA viral suppression
Suboptimal ART adherence can lead to lack of viral control and adverse clinical outcomes among people living with HIV/AIDS (PLWHA), including the emergence of drug-resistant virus [1,2,3,4], virologic failure [5,6,7], accelerated disease progression, [8,9,10], and increased risk of
The current study evaluated a model on the effects of selected psychosocial factors on ART adherence, mediated by the syndemic constructs of severity of drug dependence and anxiety, among men who have sex with women (MSW) living with HIV in New York City

Summary

Introduction

Optimal adherence to HIV antiretroviral therapy (ART) is essential for sustained HIV-1 RNA viral suppression. Heterosexual men make up about 8% of people living with HIV (PLWH) nationally, and there were an estimated 2829 new HIV diagnoses among MSW in 2017 [22]. Analysis of 2014 data from the National HIV Surveillance System revealed that 46% of HIV-positive MSW failed to achieve viral suppression, and even among those engaged in HIV care 26% did not achieve viral suppression [23, 24] This is noteworthy, given that HIV-positive MSW are mostly men of color (61% African American and 22% Latino) and increasingly older [22], factors that are associated with worse disease progression [25, 26]. Little is known about the barriers and facilitators of optimal ART adherence among heterosexual HIV-positive men

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Results

Discussion

Conclusion