Mechanisms linking gender-based violence to worse HIV treatment and care outcomes among women in the United States
Year: 2022
Type: article
Abstract: OBJECTIVE: To test whether substance use mediates the associations between gender-based violence (GBV) and suboptimal adherence to antiretroviral therapy (ART), and GBV and poor engagement in care, among women living with HIV (WLHIV) in the United States (US). DESIGN: We analyzed longitudinal data collected among 1717 WLHIV in the Women's Interagency HIV Study (WIHS). METHODS: From 2013 to 2017, WLHIV completed semi-annual assessments on GBV, substance use, and HIV treatment and care. Adjusted multilevel logistic regression models were built to estimate the impact of GBV on; suboptimal (<95%) adherence and at least one missed HIV care appointment without rescheduling in the past 6 months. Mediation analyses were performed to test whether heavy drinking and illicit drug use mediated the associations between GBV and the two HIV outcomes. RESULTS: The mean age was 47 (standard deviation = 9), 5% reported experiencing GBV, 17% reported suboptimal adherence and 15% reported at least one missed appointment in the past 6 months. Women who experienced GBV had a significantly higher odds of suboptimal adherence [adjusted odds ratio (aOR) = 1.99; 95% confidence interval (CI) = 1.40-2.83] and missed appointments (aOR = 1.92, 95% CI = 1.32-2.33). Heavy drinking and illicit drug use mediated 36 and 73% of the association between GBV and suboptimal adherence and 29 and 65% of the association between GBV and missed appointments, respectively. CONCLUSIONS: Substance use is an underlying mechanism through which GBV affects outcomes along the HIV care continuum among WLHIV in the US. To optimize HIV treatment and care among women, interventions should address the combined epidemics of substance use, violence, and HIV.
Source: AIDS
Institutions: University of California, San Francisco, University of South Carolina, SUNY Downstate Health Sciences University, Johns Hopkins University, University of North Carolina at Chapel Hill, Georgetown University Medical Center, Emory University, Grady Health System, University of Miami, Albert Einstein College of Medicine, University of Alabama at Birmingham, San Francisco VA Medical Center
Language: English
Subfield: Infectious Diseases
Field: Medicine
Domain: Health Sciences
Open Access status: green
Awards: G1400602301, G1655989834, G183157880, G192128497, G2127051194, G2237694255, G248584506, G2507967334, G2755707676, G2759654445, G30074556, G319781266, G3242306066, G343705321, G4378641832, G483408255, G5431849782, G559434143, G5747858550, G65070246, University of Miami Developmental HIV/AIDS Mental Health Research Center (D-ARC), G693265041, University of North Carolina Womens Interagency HIV Study UNC WIHS, Johns Hopkins Institute for Clinical and Translational Research, G9000035832, G9000088144, G9000100957, G9000357642, University of Pittsburgh MACS/WIHS CCS, MACS/WIHS -CCS, Women, Intersectionality, Substance Use and HIV ( WISH), Emory Specialized Center of Research Excellence (SCORE) on Sex Differences, UNC MACS/WIHS Combined Cohort Study Clinical Research Site, Surviving the HIV Epidemic (S/HE) in metropolitan Washington DC - Advancing knowledge through cohort studies, Center for AIDS Research at Emory University, Data Analysis and Coordination Center for the MACS-WIHS Combined Cohort Study, The University of North Carolina Center for AIDS Research, MACS/WIHS Combined Cohort Study: Brooklyn Clinical Research Site (Bklyn CRS), Clinical Research Sites for the MACS/WIHS Combined Cohort Study (MACS/WIHS-CCS) - Baltimore/Wash DC Center, UAB-MISS MACS/WIHS Combined Cohort Study, Extreme heat, pollution, wildfire smoke, and aging among people living with or at risk for HIV, The University of Miami AIDS Research Center on Mental Health and HIV/AIDS - Center for HIV & Research in Mental Health (CHARM), UCLA Clinical and Translational Science Institute, Clinical Research Sites for the MACS/WIHS Combined Cohort Study (MACS/WIHS-CCS), UAB Center for AIDS Research (CFAR), G97119092
OpenAlex ID: W4291021341