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AIDS and Behavior
Published in: AIDS and Behavior 11/2019

01-11-2019 | Human Immunodeficiency Virus | Original Paper

High Levels of Syndemics and Their Association with Adherence, Viral Non-suppression, and Biobehavioral Transmission Risk in Miami, a U.S. City with an HIV/AIDS Epidemic

Authors: Tiffany R. Glynn, Steven A. Safren, Adam W. Carrico, Noelle A. Mendez, Lunthita M. Duthely, Sannisha K. Dale, Deborah L. Jones, Daniel J. Feaster, Allan E. Rodriguez

Published in: AIDS and Behavior | Issue 11/2019

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Abstract

Miami is a Southeastern United States (U.S.) city with high health, mental health, and economic disparities, high ethnic/racial diversity, low resources, and the highest HIV incidence and prevalence in the country. Syndemic theory proposes that multiple, psychosocial comorbidities synergistically fuel the HIV/AIDS epidemic. People living with HIV/AIDS in Miami may be particularly affected by this due to the unique socioeconomic context. From April 2017 to October 2018, 800 persons living with HIV/AIDS in a public HIV clinic in Miami completed an interviewer-administered behavioral and chart-review cross-sectional assessment to examine the prevalence and association of number of syndemics (unstable housing, low education, depression, anxiety, binge drinking, drug use, violence, HIV-related stigma) with poor ART adherence, unsuppressed HIV viral load (≥ 200 copies/mL), and biobehavioral transmission risk (condomless sex in the context of unsuppressed viral load). Overall, the sample had high prevalence of syndemics (M = 3.8), with almost everyone (99%) endorsing at least one. Each syndemic endorsed was associated with greater odds of: less than 80% ART adherence (aOR 1.64, 95% CI 1.38, 1.98); having unsuppressed viral load (aOR 1.16, 95% CI 1.01, 1.33); and engaging in condomless sex in the context of unsuppressed viral load (1.78, 95% CI 1.30, 2.46). The complex syndemic of HIV threatens to undermine the benefits of HIV care and are important to consider in comprehensive efforts to address the disproportionate burden of HIV/AIDS in the Southern U.S. Achieving the 90-90-90 UNAIDS and the recent U.S. “ending the epidemic” targets will require efforts addressing the structural, social, and other syndemic determinants of HIV treatment and prevention.
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Metadata
Title
High Levels of Syndemics and Their Association with Adherence, Viral Non-suppression, and Biobehavioral Transmission Risk in Miami, a U.S. City with an HIV/AIDS Epidemic
Authors
Tiffany R. Glynn
Steven A. Safren
Adam W. Carrico
Noelle A. Mendez
Lunthita M. Duthely
Sannisha K. Dale
Deborah L. Jones
Daniel J. Feaster
Allan E. Rodriguez
Publication date
01-11-2019
Publisher
Springer US
Published in
AIDS and Behavior / Issue 11/2019
Print ISSN: 1090-7165
Electronic ISSN: 1573-3254
DOI
https://doi.org/10.1007/s10461-019-02619-0

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