Amsterdam 2015
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| Abstract #3406 - Syndemics and the Treatment Cascade | ||||
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Session: 6.1: Syndemics and the Treatment Cascade (Parallel) on Wednesday @ 11.30-13.00 in C104 Chaired by Ron Stall, Udi Davidovich Authors: Presenting Author: Dr. Mackey Friedman - University of Pittsburgh, United States |
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| Additional Authors: | ||||
| Aim: Recent research has demonstrated strong associations between synergistic epidemics (syndemics), antiretroviral therapy (ART) adherence, and HIV viral load suppression among HIV positive men who have sex with men (MSM). Though social support has been shown in varied cultural contexts to serve as a protective factor for HIV viral load suppression, little research has been conducted that examines this relationship among MSM in the United States, or that examines whether social support serves to moderate the relationship between syndemics and viral load suppression in this population. The aim of this study was to longitudinally assess characteristics of social support, effects of social support on HIV viral load, and moderation by social support of the relationship between syndemics and HIV viral load. | ||||
| Method / Issue: We analyzed longitudinal data from HIV positive MSM using ART who were enrolled in the Multicenter AIDS Cohort Study (MACS) between 2003—2009 (n=712). First, we conducted reliability assessments of a previously untested social support measure. Then, we conducted a series of generalized mixed models with repeated measures to assess our research questions. Moderation was assessed using an interaction term. All models were adjusted for sociodemographics and ART adherence. | ||||
| Results / Comments: A three-level (low/medium/high) social support variable demonstrated high reliability (ICC=0.72 95% CI: 0.70, 0.75). Black and Hispanic MSM and bisexually-behaving men reported lower social support than their counterparts (p<.0001). Higher numbers of concurrent syndemics (depression, polysubstance use, and condomless anal sex) were associated with lower social support (p<.0001). Recent sero-conversion was associated with higher social support (p<.05). Medium and high social support levels were associated with greater viral load suppression and lower viral load means (p<.0001). Social support moderated the relationships between syndemics and HIV viral load means (p<.05), and between syndemics and HIV viral load suppression (p<.05). | ||||
| Discussion: Our findings suggest that HIV positive MSM benefit greatly from social support. We strongly recommend a renewed focus on the design, implementation, and evaluation of interventions that successfully boost social support in this population. Creating resilience-based interventions may have the strongest effects among HIV positive MSM with the highest levels of syndemics. We will discuss the implications of our findings with a focus on maximizing the potential of ART treatment and Treatment as Prevention (TasP) models. | ||||
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