Structural Syndemics and Antiretroviral Medication Adherence Among Black Sexual Minority Men Living With HIV

• Published in: Journal of acquired immune deficiency syndromes (1999) Vol. 88; no. S1; p. S12
• Main Authors: Holloway, Ian W, Beltran, Raiza, Shah, Saanchi V, Cordero, Luisita, Garth, Gerald, Smith, Terry, Wilson, Bianca D M, Ochoa, Ayako M
• Format: Journal Article
• Language: English
• Published: United States 15.12.2021
• Subjects: Child; Cross-Sectional Studies; Ethnicity; HIV Infections - drug therapy; HIV Infections - epidemiology; Homosexuality, Male; Humans; Male; Medication Adherence; Minority Groups; Sexual and Gender Minorities; Syndemic
• ISSN: 1944-7884
• DOI: 10.1097/QAI.0000000000002806

Although HIV antiretroviral treatment (ART) access and uptake have increased among racial/ethnic minority individuals, lower rates of ART adherence and viral suppression persist, especially among Black men who have sex with men (BMSM) compared with their White counterparts. Black men who have sex with men living with HIV (BMSM+) residing in Los Angeles County (N = 124) were recruited in-person (eg, clinic) and online (eg, social networking apps). Participants completed a cross-sectional survey measuring demographic characteristics, structural syndemics (poverty, criminal justice involvement, and housing instability), and psychosocial syndemics (mental health and substance use). A text message survey assessed missed doses of ART over the past week. Zero-inflated Poisson regression models were used to evaluate variables associated with the number of missed doses of ART. On average, participants missed 1.30 doses of ART (SD = 2.09) and reported structural syndemics: poverty (56.1%), criminal justice involvement (36.6%), housing instability (26.3%), and psychosocial syndemics: childhood sexual abuse (51.8%), intimate partner violence (16.9%), depression (39%), and problem alcohol use (15.5%). After controlling for employment, age, education, and psychosocial syndemics, participants with a one-point increase in structural syndemic indicators were found to be 1.63 times more likely to have missed a dose of ART. Structural syndemic were associated with ART nonadherence among BMSM+ after adjusting for demographic and psychosocial factors. HIV treatment interventions that incorporate financial incentives, legal support, and housing may help improve ART adherence among BMSM+. Findings suggest that key priorities to ending the HIV epidemic must include structural interventions that alleviate poverty, eliminate disproportionate policing and criminalization, and end homelessness.