The role of social support and syndemic factors in HIV medical adherence among African-American injection drug users

HIV;injection drug use;medical adherence;African-Americans;health disparities;Social & Behavioral Sciences

Robinson, Allysha CamilleGallo, Joseph ;

Johns Hopkins University

关键词: HIV;    injection drug use;    medical adherence;    African-Americans;    health disparities;    Social & Behavioral Sciences;   

Others  :  https://jscholarship.library.jhu.edu/bitstream/handle/1774.2/60536/ROBINSON-DISSERTATION-2015.pdf?sequence=1&isAllowed=y

瑞士|英语

来源: JOHNS HOPKINS DSpace Repository

【 摘 要 】

Problem Statement: Substance use, familial conflict, mental illness, and gender disparities may comprise a syndemic exacerbating African-Americans’ HIV disparities. Informal caregiving may be protective among persons who inject drugs (PWID). Therefore, the present dissertation assessed the associations between: 1) sex and HIV medical adherence; 2) a latent syndemic and HIV medical adherence; and 3) sex and social support as moderators between the latent syndemic and HIV medical adherence Methods: Data were from the BEACON study, of health outcomes among PWID who were persons living with HIV (PLHIV). Participants completed surveys and biomarker assays (N=351). Results: African-American females were less likely than males to achieve undetectable viral load (UVL; 67.1% vs. 65.9%; non-significant) and optimal acute care utilization (OAU; 53.9% vs. 48.5%; non-significant). Males with moderate physical functioning had 1.3 times the likelihood of UVL, as males with low functioning (Adjusted Incidence Rate Ratio [AIR] = 1.38; 95% Confidence Interval [95% CI] = 1.07, 1.77; N=199). In latent class analyses, 9% of participants had high syndemic substance use/mental illness (Class 4); 23% had moderate levels of all factors (Class 3); 25% had high mental illness (Class 2); and 43% had moderate substance use/mental illness (Class 1). In adjusted analyses, individuals whose supporter was their main partner had 35% higher likelihood of UVL, than individuals whose supporter was neither family nor a main supporter (Adjusted Incidence Rate Ratio [AIR] = 1.35; 95% Confidence Interval [95% CI] = 1.05, 1.74). Individuals with frequent health-related support had nearly 30% lower likelihood of OAU, as those with low health-related support (AIR = 0.73; 95% CI = 0.55, 0.97). Finally, individuals with informal main supporters, and higher physical functioning, had lower likelihood of OAU. Conclusions: Results suggest that female PWID PLHIV have high levels of substance use, mental illness, and familial conflict and lower HIV medical adherence compared to males. Furthermore, social support was not clearly associated with increased viral suppression, particularly among females. Healthcare professionals should tailor interventions around constellations of risk factors and gender differences, to improve this population’s health outcomes. Additionally, dyadic-level interventions could improve the effects of social support on health outcomes.