Amy A Conroy1, Jennifer P Jain2, Lila Sheira3, Edward A Frongillo4, Torsten B Neilands1, Mardge H Cohen5, Tracey E Wilson6, Aruna Chandran7, Adaora A Adimora8, Seble Kassaye9, Anandi N Sheth10, Margaret A Fischl11, Adebola Adedimeji12, Janet M Turan13, Phyllis C Tien14, Sheri D Weiser1,3. 1. Department of Medicine, Center for AIDS Prevention Studies, University of California, San Francisco, CA. 2. Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA. 3. Division of HIV, Infectious Diseases, and Global Medicine, University of California, San Francisco, CA. 4. Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, SC. 5. Department of Medicine, Stroger Hospital, Chicago, IL. 6. Department of Community Health Sciences, State University of New York Downstate Health Sciences University, School of Public Health, Brooklyn, NY. 7. Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD. 8. School of Medicine and UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC. 9. Department of Family Medicine, Georgetown University Medical Center, Washington, DC. 10. School of Medicine, Emory University, Grady Health System, Atlanta, GA. 11. Department of Medicine, University of Miami, Miami, FL. 12. Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY. 13. Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, AL; and. 14. Department of Medicine, Department of Veteran Affairs Medical Center, UCSF and Medical Service, San Francisco, CA.
Abstract
BACKGROUND: Gender-based violence (GBV) is associated with poorer engagement in HIV care and treatment. However, there is a dearth of research on the psychological (eg, mental health) and structural (eg, food insecurity) factors that mediate and moderate this association. GBV could lead to poor mental health, which in turn affects adherence, whereas food insecurity could worsen the effect of GBV on engagement in care. This study uses data from the Women's Interagency HIV Study to address these gaps. METHODS: Women completed 6 assessments from 2013 to 2016 on GBV, mental health, food insecurity, adherence to antiretroviral therapy, and missed HIV care appointments in the past 6 months. Multilevel logistic regression models estimated associations between GBV and engagement in care and whether associations were mediated by depression, generalized anxiety disorder (GAD), and posttraumatic stress disorder (PTSD) and moderated by food insecurity. RESULTS: GBV was associated with higher odds of suboptimal adherence (adjusted odds ratio: 1.88; 95% confidence interval: 1.24 to 2.87) and missed appointments (adjusted odds ratio: 1.76; 95% confidence interval: 1.16 to 2.67). The association between GBV and adherence was mediated by depressive symptoms, GAD, and PTSD, accounting for 29.7%, 15.0%, and 16.5%, respectively, of the total association. The association between GBV and missed appointments was mediated by depression and GAD, but not PTSD, with corresponding figures of 25.2% and 19.7%. Associations did not differ by food insecurity. CONCLUSIONS: GBV is associated with suboptimal engagement in care, which may be explained by mental health. Interventions should address women's mental health needs, regardless of food insecurity, when improving engagement in HIV care.
BACKGROUND: Gender-based violence (GBV) is associated with poorer engagement in HIV care and treatment. However, there is a dearth of research on the psychological (eg, mental health) and structural (eg, food insecurity) factors that mediate and moderate this association. GBV could lead to poor mental health, which in turn affects adherence, whereas food insecurity could worsen the effect of GBV on engagement in care. This study uses data from the Women's Interagency HIV Study to address these gaps. METHODS: Women completed 6 assessments from 2013 to 2016 on GBV, mental health, food insecurity, adherence to antiretroviral therapy, and missed HIV care appointments in the past 6 months. Multilevel logistic regression models estimated associations between GBV and engagement in care and whether associations were mediated by depression, generalized anxiety disorder (GAD), and posttraumatic stress disorder (PTSD) and moderated by food insecurity. RESULTS: GBV was associated with higher odds of suboptimal adherence (adjusted odds ratio: 1.88; 95% confidence interval: 1.24 to 2.87) and missed appointments (adjusted odds ratio: 1.76; 95% confidence interval: 1.16 to 2.67). The association between GBV and adherence was mediated by depressive symptoms, GAD, and PTSD, accounting for 29.7%, 15.0%, and 16.5%, respectively, of the total association. The association between GBV and missed appointments was mediated by depression and GAD, but not PTSD, with corresponding figures of 25.2% and 19.7%. Associations did not differ by food insecurity. CONCLUSIONS: GBV is associated with suboptimal engagement in care, which may be explained by mental health. Interventions should address women's mental health needs, regardless of food insecurity, when improving engagement in HIV care.
Authors: Brian Zunner; Shari L Dworkin; Thomas C Neylan; Elizabeth A Bukusi; Patrick Oyaro; Craig R Cohen; Matilda Abwok; Susan M Meffert Journal: J Affect Disord Date: 2014-12-13 Impact factor: 4.839
Authors: Reed A C Siemieniuk; Hartmut B Krentz; Patricia Miller; Kate Woodman; Karen Ko; M John Gill Journal: J Acquir Immune Defic Syndr Date: 2013-09-01 Impact factor: 3.731
Authors: Anna M Leddy; Jennifer M Zakaras; Jacqueline Shieh; Amy A Conroy; Ighovwerha Ofotokun; Phyllis C Tien; Sheri D Weiser Journal: PLoS One Date: 2021-05-26 Impact factor: 3.752
Authors: Amy A Conroy; Mardge H Cohen; Edward A Frongillo; Alexander C Tsai; Tracey E Wilson; Eryka L Wentz; Adaora A Adimora; Daniel Merenstein; Ighovwerha Ofotokun; Lisa Metsch; Mirjam-Colette Kempf; Adebola Adedimeji; Janet M Turan; Phyllis C Tien; Sheri D Weiser Journal: PLoS One Date: 2019-03-06 Impact factor: 3.752
Authors: Nadia Diamond-Smith; Amy A Conroy; Alexander C Tsai; Manali Nekkanti; Sheri D Weiser Journal: J Glob Health Date: 2019-06 Impact factor: 4.413
Authors: Jennifer P Jain; Lila A Sheira; Edward A Frongillo; Torsten B Neilands; Mardge H Cohen; Tracey E Wilson; Aruna Chandran; Adaora A Adimora; Seble G Kassaye; Anandi N Sheth; Margaret A Fischl; Adebola A Adedimeji; Janet M Turan; Phyllis C Tien; Sheri D Weiser; Amy A Conroy Journal: AIDS Date: 2022-08-10 Impact factor: 4.632