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Mental Health Mediates the Association Between Gender-Based Violence and HIV Treatment Engagement in US Women

Year: 2023

Type: article

Abstract: Background: Gender-based violence (GBV) is associated with poorer engagement in HIV care and treatment. However, there is a dearth of research on the psychological (eg, mental health) and structural (eg, food insecurity) factors that mediate and moderate this association. GBV could lead to poor mental health, which in turn affects adherence, whereas food insecurity could worsen the effect of GBV on engagement in care. This study uses data from the Women's Interagency HIV Study to address these gaps. Methods: Women completed 6 assessments from 2013 to 2016 on GBV, mental health, food insecurity, adherence to antiretroviral therapy, and missed HIV care appointments in the past 6 months. Multilevel logistic regression models estimated associations between GBV and engagement in care and whether associations were mediated by depression, generalized anxiety disorder (GAD), and posttraumatic stress disorder (PTSD) and moderated by food insecurity. Results: GBV was associated with higher odds of suboptimal adherence (adjusted odds ratio: 1.88; 95% confidence interval: 1.24 to 2.87) and missed appointments (adjusted odds ratio: 1.76; 95% confidence interval: 1.16 to 2.67). The association between GBV and adherence was mediated by depressive symptoms, GAD, and PTSD, accounting for 29.7%, 15.0%, and 16.5%, respectively, of the total association. The association between GBV and missed appointments was mediated by depression and GAD, but not PTSD, with corresponding figures of 25.2% and 19.7%. Associations did not differ by food insecurity. Conclusions: GBV is associated with suboptimal engagement in care, which may be explained by mental health. Interventions should address women's mental health needs, regardless of food insecurity, when improving engagement in HIV care.

Source: Carolina Digital Repository (University of North Carolina at Chapel Hill)

DOI: 10.17615/wcnk-ev76

Authors: Weiser, S.D., Tien, P.C., Conroy, A.A., Wilson, T.E., Frongillo, E.A., Turan, J.M., Kassaye, S.G., Sheira, L., Adimora, A.A., Fischl, M.A., Neilands, T.B., Adedimeji, A., Jain, J.P., Sheth, A.N., Chandran, A., Cohen, M.H.

Institution: University of North Carolina at Chapel Hill

Language: English

Topic: HIV/AIDS Research and Interventions

Subfield: Infectious Diseases

Field: Medicine

Domain: Health Sciences

SDGs: Good health and well-being, Gender equality, Reduced inequalities, Peace, justice, and strong institutions

Open Access status: green

Funders: Northwestern University, Georgia Clinical and Translational Science Alliance, National Institutes of Health, University of California, San Francisco, Center for AIDS Research, University of Alabama at Birmingham, National Institute on Alcohol Abuse and Alcoholism, National Heart, Lung, and Blood Institute, National Institute of Mental Health, National Institute on Drug Abuse, National Cancer Institute, National Institute on Deafness and Other Communication Disorders, National Institute of Nursing Research, National Institute of Allergy and Infectious Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institute of Neurological Disorders and Stroke, National Institute of Dental and Craniofacial Research, National Institute on Minority Health and Health Disparities, Center for AIDS Research, University of North Carolina at Chapel Hill, Clinical and Translational Science Institute, University of California, Los Angeles

Awards: G1034546755, G12089860, G1296759572, G1329112180, G1400602301, G1655989834, G1787625665, G183157880, G1849940085, G1913134163, G192128497, G2008237588, G2127051194, G2334180555, G248584506, G2507967334, G255204022, G2755707676, G2759654445, G2908277772, G30074556, G311558797, G3181090803, G319781266, G3242306066, G3630727822, G3671922257, G3869857964, G4016133911, G4044828089, G4391827178, G4535678174, G456742281, G5078796989, G5147848267, G521591464, G559434143, G5660189159, G5691055145, G5747858550, G5863844756, G5900455136, G6185377402, G6396423216, G65070246, G6745172908, G693265041, G6990385686, G7152846654, G775892330, G7807729167, Johns Hopkins Institute for Clinical and Translational Research, G9000010044, G9000016284, G9000025681, G9000030772, G9000035832, G9000037749, G9000039899, G9000050451, G9000066220, G9000080293, G9000082816, G9000088144, G9000093720, G9000100957, G9000102070, G9000108991, G9000126231, G9000132212, UNC MACS/WIHS Combined Cohort Study Clinical Research Site, Surviving the HIV Epidemic (S/HE) in metropolitan Washington DC - Advancing knowledge through cohort studies, Clinical Research Sites for the MACS/WIHS Combined Cohort Study (MACS/WIHS-CCS) - Baltimore/Wash DC Center, Extreme heat, pollution, wildfire smoke, and aging among people living with or at risk for HIV, Clinical Research Sites for the MACS/WIHS Combined Cohort Study (MACS/WIHS-CCS), UAB Center for AIDS Research (CFAR), G97119092

OpenAlex ID: W4400022049

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