Associations between psychosocial factors and antiretroviral therapy outcomes differ by gender and sexual orientation among people living with HIV in British Columbia, Canada

ABSTRACT

Little is known about how the co-occurrence of psychosocial factors affect sub-populations of people living with HIV (PLWH). We used cross-sectional data from 999 PLWH, aged ≥19, accessing antiretroviral therapy (ART) in British Columbia, Canada (2007–2010) to examine associations between psychosocial factors and ART-related outcomes separately for trans/cis inclusive women; heterosexual men; and gay, bisexual, and other men who have sex with men (gbMSM). Multivariable logistic regression examined associations between psychosocial factors (0–3): any violence in the past 6 months, depressive symptoms in the past week, and current street drug use (heroin, crack, meth or speedball) with sub-optimal adherence (outcome 1: average annual ART adherence <95% from interview until end of follow-up, death, or December 31st, 2018) and ever viral rebound (outcome 2) adjusting for potential confounders. Of 999 PLWH (264 women, 382 heterosexual men, and 353 gbMSM), women and heterosexual men had significantly higher median counts than gbMSM. Overall, higher counts were associated with sub-optimal adherence (adjusted odds ratio [aOR] = 1.26/1-unit increase, 95%CI = 1.07–1.49). All effect estimates were of a greater magnitude among gbMSM, but not significant for women or heterosexual men, highlighting the need for population (e.g., gender and sexual orientation)-centered care and research.

KEYWORDS:

• Psychosocial factors
• HIV/AIDS
• violence
• gender
• sexual orientation

Acknowledgements

The authors would like to sincerely thank all of the LISA participants who took the time to share their experiences with the study. We would also like to acknowledge the LISA Community Advisory Committee: Terry Howard, Rosa Jamal, Isabella Kirchner, Sandy Lambert, Kecia Larkin, Steve Levine, Melissa Medjuck, Stacie Migwans, Sam Mohan, Lori Montgomery, Glynn Townson, Michelle Webb, and Sarah White. Lastly, we want to thank and acknowledge the study coinvestigators: Dr Rolando Barrios, Dr David Burdge, Dr Marianne Harris, Dr David Henderson, Dr Thomas Kerr, Dr Julio S.G. Montaner, Dr Thomas Patterson, Dr Eric Roth, Dr MarkW. Tyndall, Dr BrianWilloughby and Dr Evan Wood. K.C. is supported by a Canadian Institutes for Health Research Vanier Doctoral Award. A.G.’s salary support is provided by the What Works to Prevent Violence Against Women and Girls Global Programme and the South African Medical Research Council. A.K. received salary support through a Tier 2 Canada Research Chair in Global Perspectives on HIV and Sexual and Reproductive Health. J.S.G.M. is supported with grants paid to his institution by the British Columbia Ministry of Health and by the National Institutes of Health (r01da036307).

Disclosure statement

J.S.G.M. has received limited unrestricted funding, paid to his institution,from Abbvie, Bristol-Myers Squibb, Gilead Sciences, Janssen, Merck, and ViiV Healthcare.