Life Instability and Its Effects on Psychosocial Syndemic Problems and HIV-Care Outcomes in People Living With HIV in Care in South Florida.

BACKGROUND

Structural life instability may negatively affect HIV-care outcomes in people living with HIV (PLWH), particularly in South Florida, a US HIV epidemic "hotspot" with high rates of poverty, immigration, and inconsistent health care access.

SETTING

PLWH (N = 241) receiving care at a community clinic in Miami were assessed at 2 points.

METHODS

Sequential mediation regression analyses were used to explore the relationships between additive indices of structural life instability (indicators: unemployment, low educational attainment, incarceration history, history of immigration as an adult, housing instability, and lack of a significant other) and psychosocial syndemic burden (indicators: depression, anxiety, trauma history, interpersonal violence, and substance use), self-reported antiretroviral therapy (ART) adherence, and documented HIV RNA viral load (VL) collected through medical records.

RESULTS

Participants reported an average of 2.23 indicators of life instability at baseline and 3.05 psychosocial syndemic problems at follow-up. Each additional indicator of life instability at baseline predicted a 0.23 increase in syndemic count at follow-up and each additional psychosocial problem at follow-up was associated with a 1.37 percentage point decrease in self-reported ART adherence covarying for baseline life instability. Self-reported adherence was, in turn, significantly inversely associated with participants' continuous log RNA VL when holding variables constant. Finally, there was a significant indirect effect of baseline structural life instability on log RNA VL at follow-up sequentially through psychosocial syndemic burden and ART adherence.

CONCLUSIONS

Results suggest a temporal relationship between baseline life instability and psychosocial problems that negatively affects HIV-related care outcomes among PLWH in South Florida.