Trauma exposure, PTSD, and suboptimal HIV medication adherence among marginalized individuals connected to public HIV care in Miami

• Published in: Journal of behavioral medicine 2021-04, Vol.44 (2), p.147-158
• Main Authors: Glynn, Tiffany R., Mendez, Noelle A., Jones, Deborah L., Dale, Sannisha K., Carrico, Adam W., Feaster, Daniel J., Rodriguez, Allan E., Safren, Steven A.
• Format: Article
• Language: English
• Subjects: Adherence; Antiretroviral drugs; Antiretroviral therapy; Comorbidity; Cross-Sectional Studies; Demographic aspects; Drug therapy; Drug use; Drugs; Epidemics; Ethnic groups; Ethnicity; Family Medicine; General Practice; Health disparities; Health Psychology; Hispanic Americans; HIV; HIV Infections - complications; HIV Infections - drug therapy; HIV patients; Housing; Human immunodeficiency virus; Humans; Medication Adherence; Medicine; Medicine & Public Health; Mental depression; Minority Groups; Patient compliance; Post traumatic stress disorder; Psychological aspects; Psychological trauma; Self care; Socioeconomic factors; Socioeconomic status; Stress Disorders, Post-Traumatic; Substance abuse; Substance use; Symptoms; Trauma
• ISSN: 0160-7715; 1573-3521; 1573-3521
• DOI: 10.1007/s10865-020-00191-w

Individuals living with HIV report disproportionately high levels of trauma exposure and PTSD symptoms, both which have been associated with suboptimal ART adherence. Often conflated, the question arises as to which construct is driving subsequent HIV self-care behavior. Given the HIV disparities among Black and Hispanic/Latinx individuals, and that Miami is a geographic region with a high racial/ethnic minority make up and a unique socioeconomic environment, it is important to explore factors related to HIV outcomes in Miami to mitigate its uncontrolled epidemic. This study aimed to examine the association of trauma exposure, PTSD symptoms, and relevant additional key factors with adherence to ART among a sample of majority Black and Hispanic/Latinx individuals who are economically marginalized receiving public HIV care in Miami, FL ( N  = 1237) via a cross-sectional survey. Sequential linear regression was used to examine the study aim in four blocks: (1) trauma, (2) PTSD symptoms, and key covariates of ART adherence including (3) depression and substance use (potential psychological covariates), and (4) indicators of socioeconomic status (potential structural covariates). In the first block, trauma exposure was associated with worse adherence. However, in the second block, the association with trauma dropped and PTSD was significantly associated with worse adherence. Of note, for those experiencing high levels of trauma exposure, adherence was negatively impacted regardless of PTSD. When other key factors associated with adherence were entered in the third and fourth blocks, neither trauma exposure nor PTSD were uniquely significant. In this final model, depression, substance use, and unstable housing were uniquely associated with worse adherence. Trauma-informed models of HIV care that holistically address co-occurring factors are warranted to cater to communities with HIV health disparities and keep them from falling off the HIV care continuum.