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.