Mechanisms Linking Gender-Based Violence to Worse HIV Treatment and Care Outcomes among Women in the United States

• Type of Material: Article
• Authors: Jennifer P. Jain, University of California, San Francisco; Lila A. Sheira, University of California, San Francisco; Edward A. Frongillo, University of South Carolina, Columbia; Torsten B. Neilands, University of California, San Francisco; Mardge H. Cohen, Stroger Hospital; Tracey E. Wilson, State University of New York Downstate Health Sciences University; Aruna Chandran, Johns Hopkins University; Adaora A. Adimora, University of North Carolina, Chapel Hill; Seble G. Kassaye, Georgetown University; Anandi Sheth, Emory University; Margaret A. Fischl, University of Miami; Adebola A. Adedimeji, Albert Einstein College of Medicine; Janet M. Turan, University of Alabama, Birmingham; Phyllis C. Tien, University of California, San Francisco; Sheri D. Weiser, University of California, San Francisco; Amy A. Conroy, University of California, San Francisco
• Language: English
• Date: 2022-08-10
• Publisher: Wolters Kluwer Health, Inc.
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2022 Wolters Kluwer Health, Inc. All rights reserved.
• Final Published Version (URL): https://doi.org/10.1097/QAD.0000000000003329
• Title of Journal or Parent Work: AIDS
• Volume: 36
• Issue: 13
• Start Page: 1861
• End Page: 1869
• Grant/Funding Information: This study was funded by a Women’s Interagency HIV Study (WIHS) sub-study grant from the National Institute of Mental Health, R01MH095683, mentoring grants K24AI134326 (Sheri Weiser) and K24 AI 108516 (Phyllis Tien). Dr. Jain is supported by a postdoctoral fellowship award program from the National Institute on Drug Abuse (T32DA007250). Additional salary support for Dr. Conroy was provided by P30AI027763. Data in this manuscript were collected by the Women’s Interagency HIV Study (WIHS), now the MACS/WIHS Combined Cohort Study (MWCCS). The contents of this publication are solely the responsibility of the authors and do not represent the official views of the National Institutes of Health (NIH). MWCCS (Principal Investigators): Atlanta CRS (Ighovwerha Ofotokun, Anandi Sheth, and Gina Wingood), U01-HL146241; Baltimore CRS (Todd Brown and Joseph Margolick), U01-HL146201; Bronx CRS (Kathryn Anastos and Anjali Sharma), U01-HL146204; Brooklyn CRS (Deborah Gustafson and Tracey Wilson), U01-HL146202; Data Analysis and Coordination Center (Gypsyamber D’Souza, Stephen Gange and Elizabeth Golub), U01-HL146193; Chicago-Cook County CRS (Mardge Cohen and Audrey French), U01-HL146245; Chicago-Northwestern CRS (Steven Wolinsky), U01-HL146240; Northern California CRS (Bradley Aouizerat, Jennifer Price, and Phyllis Tien), U01-HL146242; Los Angeles CRS (Roger Detels and Matthew Mimiaga), U01-HL146333; Metropolitan Washington CRS (Seble Kassaye and Daniel Merenstein), U01-HL146205; Miami CRS (Maria Alcaide, Margaret Fischl, and Deborah Jones), U01-HL146203; Pittsburgh CRS (Jeremy Martinson and Charles Rinaldo), U01-HL146208; UAB-MS CRS (Mirjam-Colette Kempf, Jodie Dionne-Odom, and Deborah Konkle-Parker), U01-HL146192; UNC CRS (Adaora Adimora), U01-HL146194. The MWCCS is funded primarily by the National Heart, Lung, and Blood Institute (NHLBI), with additional co-funding from the Eunice Kennedy Shriver National Institute Of Child Health & Human Development (NICHD), National Institute On Aging (NIA), National Institute Of Dental & Craniofacial Research (NIDCR), National Institute Of Allergy And Infectious Diseases (NIAID), National Institute Of Neurological Disorders And Stroke (NINDS), National Institute Of Mental Health (NIMH), National Institute On Drug Abuse (NIDA), National Institute Of Nursing Research (NINR), National Cancer Institute (NCI), National Institute on Alcohol Abuse and Alcoholism (NIAAA), National Institute on Deafness and Other Communication Disorders (NIDCD), National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institute on Minority Health and Health Disparities (NIMHD), and in coordination and alignment with the research priorities of the National Institutes of Health, Office of AIDS Research (OAR). MWCCS data collection is also supported by UL1-TR000004 (UCSF CTSA), UL1-TR003098 (JHU ICTR), UL1-TR001881 (UCLA CTSI), P30-AI-050409 (Atlanta CFAR), P30-AI-073961 (Miami CFAR), P30-AI-050410 (UNC CFAR), P30-AI-027767 (UAB CFAR), and P30-MH-116867 (Miami CHARM).
• Keywords: HIV; Women; heavy drinking and HIV treatment and care; Gender-based violence; drug use
• Research Categories: Health Sciences, Public Health; Health Sciences, Epidemiology

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 1,717 WLHIV in the Women’s Interagency HIV Study (WIHS). Methods: From 2013–2016, 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 six 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 (SD=9), 5% reported experiencing GBV, 17% reported suboptimal adherence and 15% reported at least one missed appointment in the past six months. Women who experienced GBV had a significantly higher odds of suboptimal adherence (adjusted odds ratio aOR=1.99; 95% 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.