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

• Published in: AIDS and behavior 2019-11, Vol.23 (11), p.2956-2965
• Main Authors: Glynn, Tiffany R., Safren, Steven A., Carrico, Adam W., Mendez, Noelle A., Duthely, Lunthita M., Dale, Sannisha K., Jones, Deborah L., Feaster, Daniel J., Rodriguez, Allan E.
• Format: Article
• Language: English
• Subjects: Acquired immune deficiency syndrome; Adhesion; Adult; Aggression; AIDS; Antiretroviral drugs; Antiretroviral therapy; Anxiety; Anxiety - epidemiology; Anxiety - psychology; Binge drinking; Comorbidity; Cross-Sectional Studies; Depression - epidemiology; Depression - psychology; Drug abuse; Epidemics; Ethnicity; Female; Florida - epidemiology; Health Psychology; HIV; HIV Infections - drug therapy; HIV Infections - epidemiology; HIV Infections - psychology; HIV Infections - virology; Housing; Housing - statistics & numerical data; Human immunodeficiency virus; Humans; Infectious Diseases; Intoxication; Male; Medication Adherence - psychology; Medication Adherence - statistics & numerical data; Medicine; Medicine & Public Health; Mental depression; Mental disorders; Mental Health; Middle Aged; Original Paper; Prevalence; Public Health; Sex; Sexual Behavior; Sexually transmitted diseases; Social Stigma; Socioeconomic factors; STD; Substance-Related Disorders - epidemiology; Substance-Related Disorders - psychology; Syndemic; Violence; Viral Load
• ISSN: 1090-7165; 1573-3254
• DOI: 10.1007/s10461-019-02619-0

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.