PEC0536
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Title
Examining associations between syndemic factors and HIV-outcomes by gender and sexual orientation among women, straight men, and gay, bisexual, and other men who have sex with men living with HIV
Presenter
Kalysha Closson
Authors
K. Closson * (1,2), V. Nicholson (1,3), M. Lee (3), K. Card (4), C. Cassidy-Matthews (1,2), T. McLinden (1), M. Marziali (5), J. Trigg (1), L. Wang (1), S. Parashar (1), J.S.G. Montaner (1), A. Gibbs (6,7), T. Hart (8), A. Kaida (3), R.S. Hogg (1,3)
Institutions
(1) British Columbia Centre for Excellence in HIV/AIDS, Epidemiology and Population Health, Vancouver, Canada, (2) University of British Columbia, School of Population and Public Health, Vancouver, Canada, (3) Simon Fraser University, Faculty of Health Sciences, Burnaby, Canada, (4) University of Victoria, School of Public Health and Social Policy, Victoria, Canada, (5) Columbia University, Mailman School of Public Health, New York, United States, (6) South African Medical Research Council, Gender and Health, Cape Town, South Africa, (7) University of KwaZulu Natal, Centre for Rural Health, School of Nursing and Public Health, Durban, South Africa, (8) Ryerson University, Psychology, Toronto, Canada

BACKGROUND: Little is known about how multiple, co-occurring syndemic experiences affect different populations of people living with HIV (PLHIV). We examined associations between syndemic factors and HIV-outcomes between: women; heterosexual men; and gay, bisexual, and other men who have sex with men (gbMSM) living with HIV (cis and trans inclusive).
METHODS: Using cross-sectional data of 1,000 PLHIV '¥19 years of age accessing antiretroviral therapy (ART) from 2007-2010 in British Columbia, Canada, we assessed associations between a syndemic scores and HIV-related outcomes (from time of interview until December 31st, 2018 or last-contact with the provincial drug treatment program) by gender and sexual orientation. The syndemic score included: any violence (never, ever, in the last 6 months), any sexual violence (ever vs. never), depressive symptoms in the past week (10-item Centre for Epidemiological Studies Depression scale ['¥10 indicating probable depression]), post-traumatic stress disorder (ever vs. never), current street drug use (heroin, crack, crystal meth or speedball), and history of excessive drinking ('¥2 CAGE score) (range 0-7). Crude and adjusted logistic regression examined associations between syndemic scores and 1) ever viral rebound and 2) average annual ART adherence '¥95% from interview to last-contact, adjusting for age, education, employment, ethnicity and stable housing.
RESULTS: Of 999 participants with complete survey data, 264 (26.4%) were women, 382 (38.2%) were heterosexual men, and 353 (35.3%) were gbMSM. Heterosexual men and women had significantly higher median syndemic scores than gbMSM (3 vs. 2, p<0.001). Overall, higher syndemic scores were associated with reduced odds of '¥95% average annual ART adherence from interview until last contact (adjusted odds ratio [aOR]=0.86, 95%CI=0.78-0.95). Among gbMSM, higher syndemic scores were associated with increased odds of viral rebound (aOR=1.30, 95%CI=1.04-1.62) and reduced odds of '¥95% average annual antiretroviral adherence (aOR=0.67, 95%CI=0.55-0.82) from interview until last contact. Associations were not significant for women or heterosexual men.
CONCLUSIONS: We found significant differences in experiences of syndemic factors by gender and sexual orientation. However, higher syndemic scores were only associated with poorer HIV-outcomes among gbMSM, highlighting the need for population-specific adherence supports and additional research examining the unique syndemic experiences of heterosexual men and women living with HIV.