Association between HIV care and the syndemic burden of intravenous drug use, mental health, and HIV stigma

UNCG Author/Contributor (non-UNCG co-authors, if there are any, appear on document)
Rachel E. Williams Faller (Creator)
The University of North Carolina at Greensboro (UNCG )
Web Site:
Jennifer Erausquin

Abstract: Initial linkage to and ongoing engagement in HIV medical care among people who inject drugs who are living with HIV (PWID/LWH) are challenging but vital components of ending the HIV epidemic in the United States. However, PWID/LWH are less likely to be engaged in care than those that do not inject drugs, resulting in higher risk of poor health outcomes and HIV transmission. PWID/LWH may have multiple barriers to HIV care, including mental health conditions such as depression and anxiety. Further complicating HIV care among PWID/LWH is the discrimination and stigma they experience. These complex, synergistic relationships between multiple diseases and adverse social conditions, which result in poor health outcomes, can be better understood using syndemic theory. The purpose of this dissertation is to examine the association between HIV care and the syndemic burden of intravenous drug use, mental health, and HIV stigma. Using data from three Southern states participating in the Centers for Disease Control and Prevention’s Medical Monitoring Project, the construct validity of measurement models for syndemic burden and HIV care and coverage were tested using confirmatory factor analysis. Each resulting measurement model was included in a structural equation model to assess the association between syndemic burden and HIV care and coverage. Results showed a statistically significant negative correlation between HIV care and coverage and the syndemic burden of intravenous drug use, mental health, and HIV stigma among PLWH. HIV stigma, depression symptoms, and anxiety symptoms were the greatest indicators of syndemic burden, while care retention, ART adherence, and viral suppression were the greatest indicators of HIV care and coverage. In addition to stigma and mental health, this study found female/transgender, less than high school education, younger age, and non-Hispanic Black race/ethnicity were all associated with higher levels of syndemic burden. A notable outcome from this study was that ever-injecting drugs was not a statistically significant factor for syndemic burden. Since almost 80% of participants reporting ever-injecting drugs did not report injecting in the past year, this result may reflect resiliency and social support associated with being in recovery. Results of this study suggest HIV stigma and mental health could be targets for intervention to improve HIV care outcomes. Future research should identify and assess potential mechanisms driving relationships between syndemic indicators and explore aspects associated with recovery that may reduce syndemic burden or improve HIV care among PWID/LWH.

Additional Information

Language: English
Date: 2022
HIV, Mental health, Stigma, Substance use, Syndemic
HIV-positive persons $x Medical care
Intravenous drug abusers $x Medical care
Stigma (Social psychology)

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