Amsterdam 2015
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| Abstract #3444 - Late Breaker | ||||
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Session: 47.2: Late Breaker (Parallel) on Friday @ 09.00-10.30 in C001 Chaired by Ophelia Haanyama, Chen Zhang Authors: Presenting Author: Dr Carla Alexander - University of Maryland Baltimore, United States |
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| Additional Authors: | ||||
| Aim: HIV management must address the complexity of syndemics among the most-affected populations. Despite the availability of effective antiretroviral therapy (ART), behaviorly infected young men (BiY) remain at high risk for poor outcomes as they face myriad impediments in achieving disease control. One barrier is difficulty in becoming engaged in treatment that may be related to adverse childhood experience. This clinical research program aims to determine the needs of BiY men from a syndemic model, and to develop an appropriate integrated care model. | ||||
| Method / Issue: Using a quasi-experimental design, we have completed baseline self-report surveys on 97 of 204 intended BiY from two outpatient clinics in one urban U.S. city with high HIV prevalence and deprivation to describe this population in the context of effective ART. Demographics, psychosocial support, life events, and substance use and mental health information has been collected. This is compared with usual disease markers for HIV disease. | ||||
| Results / Comments: In the era of HIV disease control, the pre-intervention sample includes 23% who are 18-25 years of age 40% who are 26-30 and 37% who are 31-35. The majority ࿭%) self-identify as African-American, 9% Hispanic, and 5% mixed. Seventy-five percent have completed high school or an equivalent, and one quarter have either graduated college or completed vocational or technical training. Forty-one % are employed and 16% are disabled. Despite the young age, 26% have been incarcerated. Recent marijuana use is reported by 55% and about one quarter report a high level of alcohol consumption and recent cocaine use. One third have received a mental health diagnosis. Seventy percent of this population has a suppressed viral measurement (<200 copies/cc3) despite the fact that 60% of participants missed a third or more of their scheduled outpatient visits in the past 6 months. Seventy-four percent of those taking medications report having skipped doses in the past month. On average, BiY reported on the Life Events Scale that they or someone they knew had experienced 4 of the 17 serious adverse events. For 68% this was personal experience 25% had experienced 3 or more. Forty-four per cent report depressive symptomatology above the cutoff for likely clinical depression by the CES-D Short Form, and respondents report high levels of a measure of perceived stress. Bivariate analyses found a significant association between number of life events encountered and depression (F1,95 = 14.2 ?<.001). Personal experience of adverse life events was associated with poor psychosocial outcomes. For example, those reporting two or more events were twice as likely as those reporting none to be either depressed ࿠% vs. 32% ?2,2,N=97 = 8.881, ?=.012) or report an alcohol problem ࿕% vs. 26% ?2,2,N=97 = 5.562, ?=.062). | ||||
| Discussion: BiY currently enrolled in outpatient treatment, have experienced adverse childhood events and report depressive symptomatology. Despite missing outpatient visits, viral suppression is currently achieved. Clinical services must incorporate holistic assessment to be aware of historical and concurrent need to ensure that medical management is delivered within a care and support model. | ||||
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