Abstract
Purpose of Review
In the USA, gay, bisexual, and other men who have sex with men (MSM) are disproportionately affected by HIV. High levels of adherence to antiretroviral therapy (ART) can dramatically improve outcomes for persons living with HIV and reduce the risk of HIV transmission to others. Yet, there are numerous individual, social, and structural barriers to optimal ART adherence. Many of these factors disproportionately impact Black MSM and may contribute to their poorer rates of ART adherence. This review synthesizes the key challenges and intervention opportunities to improve ART adherence among MSM in the USA.
Recent Findings
Key challenges to ART adherence include stigma, violence, depression, and substance use. Black MSM are significantly disadvantaged by several of these factors. There are several promising interventions to improve ART adherence among MSM, and there remains an opportunity to culturally tailor these to the needs of Black MSM populations to enhance adherence.
Summary
Despite high rates of HIV among MSM, there continues to be a paucity of research on the various contributors to poor ART adherence among this population. Similarly, few interventions have been tested that lead to increased and sustained ART adherence among Black MSM.
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Introduction
In the USA, although the overall rates of HIV have remained relatively stable over the past decade, the incidence of new infections has increased among men who have sex with men (MSM), with those who are young and Black bearing the highest burden. Almost 70% of new infections among adolescents and adults in 2018 were attributable to male-to-male sexual contact [1]. Black and Latinx MSM face the greatest burden of HIV; 1 in 2 Black MSM and 1 in 5 Latinx MSM are projected to acquire HIV in their lifetime, compared with 1 in 11 White MSM [2]. These disparate rates highlight the fact that there are several distinct HIV epidemics.
Adherence to antiretroviral therapy (ART), a core tenet of the US National HIV/AIDS Strategy [3], and a critical step in the HIV care continuum [4, 5], can improve health outcomes for people living with HIV (PLH) and reduce HIV transmission [6]. Since 2012, all US adults living with HIV have been recommended to initiate ART [7, 8]. For patients who maintain adequate levels of ART adherence, HIV can be a manageable chronic condition and reduce risk for opportunistic infections [9, 10]. Consequently, adherence is essential in suppressing viral load, maintaining high CD4 cell counts, prolonging survival, and reducing risk of transmitting HIV to others [6, 11, 12]. Viral suppression is the basis for the global public health initiative, Treatment as Prevention (TaP) [13]. As such, optimal ART adherence is essential not only in improving individual health outcomes but also in the eradication of new infections. Additionally, ART adherence is associated with reductions in hospitalizations [14] and mortality [15,16,17], slowed HIV disease progression [18, 19], and improved quality of life [20]. Yet, estimates suggest that approximately 63% of patients living with HIV have optimal ART adherence [12], far lower than the goal of 90% set forth by UNAIDS [21]. In the USA, only 60% of all MSM diagnosed with HIV are estimated to achieve viral suppression [22], with significantly lower rates documented among young MSM [23]. Black and Latinx MSM have poorer viral suppression rates relative to their White MSM counterparts, even after adjusting for insurance type, duration of ART use, and CD4+ cell count [24]. Moreover, although ART prescription and viral suppression rates increased among all racial and ethnic groups of MSM between 2009 and 2013, racial and ethnic disparities remain, particularly between Black and White MSM [25]. Black PLH are less likely to be engaged in HIV care, receive ART, and adhere to ART long enough to be virally suppressed compared with individuals of other races or ethnicities [26,27,28]. Racial and ethnic minority youth are at particularly high risk of poor ART adherence and thus having a detectable viral load [27, 29].
The purpose of this review article is to identify key challenges to ART adherence faced by MSM in the USA and posit some of the mechanisms by which they may compromise ART adherence. In doing so, we highlight how factors such as stigma, substance use, depression, anxiety, and violence are structural factors that have been linked to suboptimal ART adherence and disproportionately impact Black and Latinx MSM. We conclude with highlighting several promising interventions to improve adherence rates.
Challenges to Achieving Optimal ART Adherence Among MSM Living with HIV
Stigma
There is strong evidence that various domains of stigma contribute to poor ART adherence [30, 31]. Stigma domains include enacted stigma, or prior experiences with discrimination, prejudice, and stereotyping associated with one’s HIV status; anticipated stigma, or the expectation of discrimination or prejudice from others due to one’s serostatus; and internalized stigma, or the self-endorsing negative feelings and beliefs about living with HIV [32,33,34]. Stigma is particularly important to consider for MSM and MSM of color, for whom HIV stigma may intersect with stigmas associated with their sexual and racial identities [35]. The stigmatization and marginalization of racial and ethnic minorities in the USA can include overt discrimination and mistreatment as well as brief, commonplace microaggressions [36].
The literature on the mechanisms linking stigma to ART adherence and other poor HIV health outcomes remain limited, yet there are several proposed causal mechanisms including vulnerability to mental health challenges [37, 38] and reduction in self-efficacy for medication taking [39], although such mechanisms remain understudied, particularly among Black and Latinx MSM. A 2016 systematic review by Sweeney and Vanable found mounting evidence that numerous HIV stigma indicators interfere with ART adherence among PLH by reducing self-efficacy for adherence and self-care and raising concerns about inadvertent disclosure of HIV status [30]. Yet, studies that have examined multiple domains of stigma have revealed variation in the ways in which stigma influences ART adherence.
Enacted stigma includes experiences of discrimination and prejudice associated with living with HIV or having other stigmatized identities, including sexual, gender, and racial identity. Perceived discrimination is associated with suboptimal ART adherence [40]. This is evidenced by research by Galvan and colleagues (2017), which found that among Latino PLH, perceived discrimination associated with being Latino and living with HIV were associated with lower ART adherence, mediated by medical mistrust [41]. Similarly, Eaton and colleagues (2015) found that perceived stigma or mistreatment due to sexual identity or race from health care providers was associated with longer elapsed time since last appointment with an HIV provider among Black MSM, which may interfere with ART adherence. [42, 43] Experiences of discrimination may negatively impact patient-provider relationships and make it difficult for racial and ethnic minority patients to trust providers, subsequently affecting ART adherence. Although not specific to MSM, data from the Women’s Interagency HIV Study (WIHS) found that perceived discrimination in healthcare settings may contribute to internalized HIV stigma, with downstream adverse effects on ART adherence [44]. Future longitudinal studies among MSM PLH are needed to better understand how health care institutions and practices influence patient experiences and perceptions of discrimination and stigma and contribute to suboptimal HIV outcomes.
Research suggests that the relationship between discrimination and ART adherence may be mediated my medical system mistrust [41]. Institutionally sanctioned discrimination and medical mistreatment have contributed to medical mistrust among Black Americans [42, 45, 46]. Furthermore, beliefs implicating the government in the origins of HIV and withholding of a cure may be rooted in historical mistreatment of Black Americans including medical experimentation on Black slaves, involuntary sterilization, and the Tuskegee Syphilis Study [47]. Medical mistrust may be related to historical and contemporary stigma and discrimination against Black Americans [47,48,49], particularly in healthcare settings [35, 42]. Medical mistrust is associated with lower rates of ART adherence and higher viral load among Black MSM [46, 50, 51], and associations between medical mistrust and nonadherence to ART are stronger among older Black MSM, as compared with their younger, White counterparts [52].
Research on the relationship between anticipated HIV stigma, or the expectation that one will experience prejudice and discrimination as a result of others learning of their HIV status, and ART adherence has had mixed conclusions [53,54,55,56]. Recent cross-sectional research with a sample of primarily Black PLH found anticipated stigma to be positively associated with increased medication concerns and treatment nonadherence [57]. However, in our prior research, greater concerns about public attitudes toward HIV (anticipated stigma) were positively associated with medication adherence, such that individuals who were more concerned about how the public perceived PLH had greater ART adherence than those who were less concerned about public perceptions [58]. Greater research is needed to understand anticipated stigma experienced by PLH and its effects on ART adherence.
Extant, albeit limited, research suggests that internalized stigma has a stronger association with suboptimal ART adherence [53, 59] than anticipated or enacted stigma [53, 60•]. Researchers have found that PLH who internalize HIV-related stigma may have lower medication self-efficacy or confidence in their ability to adhere to ART, particularly during difficult times, which can decrease adherence [61]. PLH with internalized HIV stigma may also face concerns about being seen taking HIV medications, subsequently reducing adherence [61]. Drawing on recent research from other PLH populations, data suggest that internalized stigma may negatively influence medication adherence via decrease adherence self-efficacy or avoidant coping [61, 62]. However, more research is needed on how internalized stigma affects ART adherence among MSM, particularly racial and ethnic minority MSM, who often face compounded stigma and discrimination related to the intersection of race, sexual identity, and HIV status [63, 64].
Violence and Trauma
Trauma and violence disproportionately affect MSM living with HIV [65] and influence HIV care outcomes via a variety of psychological (e.g. post-traumatic stress disorder, depression, anxiety) and behavioral (e.g. substance use) sequalae [66, 67]. In our previous research with young Black MSM, we found high levels of exposure to community violence; 40% of participants had a close friend or relative die due to community violence, 52% had been a victim of violence, and 42% had witnessed a gun-related incident in their community. Furthermore, high levels of community violence were associated with significantly lower odds of ART adherence [68]. Similar results have been found among PLH who have experienced extreme violence or death-related trauma; in a recent study by Brown and colleagues (2019), men who reported exposure to any trauma were 58% less likely to be adherent to ART; those who experienced extreme violence or death-related trauma were 63% less likely to be adherent to ART [69].
Research has examined HIV-related health outcomes among PLH who have experienced intimate partner violence (IPV), although research among IPV among MSM PLH is lacking. Most commonly IPV literature among PLH focuses on women in opposite-sex relationships [70,71,72]. Yet, rates of IPV among MSM are comparable with or higher than those seen among heterosexual women [73], with estimated prevalence range from 12 [74] to 45% [75]. Yet little recent research has examined the effects of IPV on ART adherence among MSM. Finally, childhood sexual abuse (CSA) is another form of violence that disproportionately affects MSM [76, 77] and PLH [78,79,80,81,82]. Research has shown a strong and positive relationship between CSA and HIV risk behaviors and infections [83] and poorer HIV continuum of care outcomes [84] among MSM. Although extant research is mixed, recent literature suggests that trauma and violence might negatively impact ART adherence through a variety of mechanisms. For example, trauma may induce substance misuse, which is negatively correlated with ART adherence [85]. Persons who engage in heavy substance use might forget to take their medications, may have more missed medical appointments, and/or forget to fill prescriptions. Additionally, trauma may also induce depression, feelings of low self-efficacy and self-worth, mood dysregulation all of which in some studies are associated with lower rates of self-care, and compliance with positive health-seeking behaviors and medical adherence [86, 87].
Substance Use
Alcohol and substance misuse are among the most common barriers to ART adherence among adults and adolescents living with HIV [68, 88,89,90,91]. Substance use is a well-documented risk factor for HIV infection among MSM and may exist prior to one’s HIV infection [92, 93]. MSM may use substances to cope with experiences of shame, stigma, and inhibition when exploring sexual desires and identities, increasing risk for HIV [94]. Additionally, PLH may also use substances as a coping mechanism for dealing with an HIV diagnosis [95]. A qualitative study with Black and Latinx PLH (60% of whom were MSM) found that heavy substance use, as compared with social or casual use, impeded ART initiation by undermining medication management abilities and contributing to depressive symptoms [96].
In a longitudinal examination of ART adherence among young Black MSM, our prior research found that higher levels of alcohol and marijuana use were among the strongest predictors of suboptimal ART adherence [91]. Alcohol use can impede ART adherence through multiple mechanisms, including impaired memory, cognitive distortions, hangover effects, and other factors leading to treatment lapses [97, 98]. Furthermore, as many as half of people on ART who drink alcohol intentionally delay or forgo taking their ART when drinking [99,100,101], partially due to toxicity concerns about mixing alcohol and certain HIV antiretrovirals. Although mixing ART with alcohol is not completely benign, it does not present toxicity concerns, and there are no major health concerns resulting from mixing ART medications and antiretrovirals [100]. In other research with young Black MSM, researchers demonstrated a relationship between anxiety and alcohol and marijuana use, which contributed to poor ART adherence [102]. Similar research found that among a sample of Black youth living with HIV, poor ART adherence was positively associated with higher psychological distress and weekly marijuana use [103•].
A large body of research has examined the use of methamphetamine among MSM [104,105,106]. Research by Feldman and colleagues (2015) found that among a sample of MSM living with HIV in New York, crystal meth use was associated with unsuppressed viral load [106]. Similarly, researchers have found that among MSM living with HIV with recent methamphetamine use, only 25% reported taking at least 90% of their ART medications [105]. However, they also found that substance use disorder treatment was also associated with significantly greater odds of ART adherence [105]. This has been supported by other research, which has found substance use treatment to help facilitate ART initiation and adherence. For example, medications for opioid use disorder, such as methadone maintenance treatment, can positively benefit ART adherence. A systematic review and meta-analysis on opioid substitution programs on HIV treatment outcomes found that opioid treatment programs were associated with a 69% increase into ART initiation, a two-fold increase in ART adherence, and a 45% increased odds of viral suppression [107]. More recent research, however, has shown that among opioid-dependent individuals maintained in a methadone treatment program, one in five was not able to achieve viral suppression [108]. A systematic review of HIV treatment adherence among people who inject drugs found that substance use treatment, specifically methadone maintenance therapy, facilitates ART adherence [109]. Individuals who use drugs and are newly diagnosed with HIV have faster entry into HIV care when they participate in substance use treatment compared with those who do not participate in substance use treatment [110].
Depressive Symptoms
Depression is one of the most commonly reported mental health challenges experienced by MSM living with HIV [111]. Prevalence of major depressive disorder among PLH has been reported to be as high as 37%, three times the rate found in general populations [112, 113]. Depression is associated with feelings of worthlessness, hopelessness, low self-efficacy, and loss of interest, which can act as barriers to self-care behaviors needed for disease management and ART adherence [114, 115]. MSM living with HIV may also use avoidant coping strategies to minimize the stress associated with their HIV status, including evading activities related to managing their HIV such as engagement in care and ART adherence [116].
Numerous studies have examined the relationship between depression and sexual risk behaviors among MSM [111, 117, 118], yet fewer have explored the effects of depression on ART nonadherence [119,120,121]. A systemic review of the literature found that the odds of achieving optimal ART adherence were lower among persons reporting depression when compared with those reporting no depression [122]. However, a recent study among MSM in San Francisco found no evidence that depressive symptoms lead to an increase in ART nonadherence among men living with HIV, although they did find an association between depressive symptoms and concurrence of ART nonadherence and condomless sex [121].
Syndemics
Although we briefly reviewed the literature on the independent contributions of stigma, violence, substance use, and depressive symptoms on ART adherence, there is evidence to suggest that for some MSM, many of these psychosocial conditions are co-occurring and mutually reinforcing, operating as part of a syndemic [31, 123,124,125]. Syndemics refers to the co-occurrence and interaction of multiple psychosocial and health conditions at the individual- and population-level that synergistically contribute to an excess burden of disease, including HIV [126]. Partly due to racism, structural inequality, residential segregation, a higher proportion of poverty, and policing, Blacks and Latinx populations face greater syndemic conditions [127]. Research has demonstrated how various co-occurring psychosocial conditions, including depression, childhood sexual abuse, intimate partner violence, and polysubstance use, increase risk for HIV and poor HIV outcomes [125, 128, 129]. The exact mechanisms by which syndemics influence ART adherence have yet to be untangled. For example, greater syndemic conditions may contribute to higher levels of stress, decreasing ability to plan and engage in daily health care behaviors [130]. Alternatively, syndemic conditions may impede self-efficacy around medication adherence and other self-care behaviors [130]. Additional research is needed to understand the pathways by which syndemics influence ART adherence, particularly for Black MSM.
Research by Friedman and colleagues (2016) found that among a racially diverse sample of MSM living with HIV, ART nonadherence was positively associated with increased syndemic conditions including depressive symptoms, polysubstance use, and sexual risk behaviors [127]. These findings were supported by more recent research by Harkness and colleagues (2018); in a longitudinal analysis of MSM living with HIV, they found that syndemic conditions were additively and longitudinally associated with greater nonadherence to ART [130]. Research with youth living with HIV has found that multiple conditions, including depression, anxiety, substance use, and HIV stigma, have an additive effect on ART adherence, with increasing numbers of conditions decreasing the likelihood of adherence and reducing the odds of viral suppression [102]. Similarly, among adults, greater number of syndemic conditions, including childhood abuse, current violence exposure, alcohol or substance dependence, post-traumatic stress disorder, anxiety, and other mood disorders, were associated with increased odds of reporting suboptimal ART adherence [131].
Promising Interventions to Improve ART Adherence Among MSM
Given suboptimal rates of ART adherence among MSM, and especially those who are Black and Latinx, researchers and healthcare providers have been working to identify and intervene on the key barriers to adherence. However, despite the clear need, few ART adherence interventions have explicitly focused on MSM [10, 132, 133]. In a 2017 systematic review of US-based ART adherence interventions published between 2007 and 2015, only two focused on MSM [132]. A 2018 review of more recently published studies identified an additional six mHealth ART adherence interventions for MSM living with HIV [133]. A 2015 systematic review of interventions to enhance ART adherence among diverse samples of PLH found a paucity of high quality that were effective at improving ART adherence and clinical outcomes [134]. Despite the paucity of research, collectively, these findings have implications for future adherence research and intervention development to address poor adherence among PLH.
In general, adherence randomized trials have only demonstrated a modest effect in improving adherence, which may be due to the multiple individual and structural challenges facing many PLH [88], and the multiple syndemic conditions faced by MSM as described above. There is a need for multilevel interventions that address the structural and social barriers to ART adherence. For example, stigma and resilience theories suggest that neighborhoods with lower levels of HIV stigma and homonegativity may be more supportive of ART adherence, facilitating supportive social networks and positive behavioral and attitudinal norms [135,136,137]. Interventions are needed that address mistrust of the health care system, racism and homonegativity, and other social inequities facing Black MSM. Rather than focusing on modifying patient behaviors, efforts are needed to improve systems and communities in which Black MSM live and develop services tailored to meet the needs of Black MSM.
For youth, specifically, there are relatively few tested interventions to improve ART adherence, most with only modest effects [138,139,140,141,142,143,144,145]. A systematic review by Shaw and Amico (2016) of effective ART adherence intervention strategies for youth found evidence of promising results among several pilot studies, but highlighted the needed for more adherence-related trials with youth with larger sample size, longer follow-up periods, and tailoring to specific populations (e.g. sexual and gender minorities or racial minorities) [146]. Interventions that focus on primary drivers of poor adherence such as reminders [140, 142] or motivation to take medication [139], engagement with the healthcare system [147•], or providing social support for medication adherence [141, 145] may be appropriate for some PLH, yet individuals experiencing multiple psychosocial and syndemic barriers to adherence would likely benefit from more intensive multilevel interventions [148].
Interventions utilizing social networks may also hold promise. A recent study among a diverse sample of MSM living with HIV utilized existing social network support to enhance ART adherence. Results indicate that reminders from a social network member to take ART medications ameliorated the negative association between depression and ART adherence. Similar peer-to-peer support interventions among existing social networks may be a cost-effective way of improving ART adherence, particularly among PLH with depression [149].
Social network interventions, when combined with mHealth or electronic tools, may be particularly beneficial, as there is compelling evidence for technology-based interventions that improve ART adherence. mHealth interventions to support ART adherence including text messages, apps, and social media interventions have demonstrated acceptability, feasibility, and preliminary efficacy [133, 150]. For example, Thrive with Me is a technology-delivered peer-support ART adherence intervention for MSM that includes electronic peer communication, tailored adherence information, text message reminders, and text-based mood, adherence, and substance use-self-monitoring. Pilot results demonstrated high feasibility, acceptability, and significant improvement in self-reported ART adherence [151]. A larger, RCT is currently underway [152]. LeGrand and colleagues (2016) recently demonstrated high feasibility and acceptability of a gaming app to improve adherence among young PLH [150]. Similarly Horvath and colleagues (2016) found support for a mobile phone app to optimize ART adherence among MSM living with HIV who use stimulants [153]. These studies demonstrate the promise of such novel interventions, yet more research is needed to test the effectiveness of apps in improving ART adherence.
Given the strong relationship between substance use, depression, and suboptimal ART adherence, interventions are needed that treat substance use disorders and mental health to help individuals better manage their healthcare [89]. However, a recent meta-analysis of psychological interventions to improve ART adherence found that although individual-level psychological interventions, including cognitive behavioral therapy or other discussions of cognitions, motivations, and expectations, are effective strategies to improve ART adherence in the short-term, there is a lack of evidence demonstrating long-term improvements in ART adherence and clinical outcomes [154]. Yet, despite a growing literature base, more intervention trials are needed with longer follow-up periods, dose monitoring adherence measurement strategies, and greater attention to the specific components of technology that impact ART adherence and the individuals most likely to benefit from such approaches [155]. While all the abovementioned interventions are promising, there is an opportunity to include more racialized populations into these clinical trials so that findings and evidence are based on and relevant to diverse populations. In addition, the expertise of Black and Latinx communities must be better harnessed and incorporated by developing more authentic and reciprocal relationships with university and communities in order to better understand and address the barriers to ART adherence among these populations.
Conclusions
The barriers to optimal ART adherence among MSM are multifaceted and likely require similarly multifaceted interventions that adequately account for complex and indirect barriers to adherence (e.g. stigma and community violence). The vast majority of ART adherence interventions focus on the individual-level behavioral and psychosocial interventions [156]. While such interventions have been implemented with varying levels of success, a review of the literature also highlights the importance of intervening in more distal factors including stigma and violence. As MacDonell and colleagues (2010) have previously noted, successful ART adherence interventions must target the broad range of factors that influence ART adherence decisions, including cultural, developmental, psychosocial, and societal factors [157]. Thus, while screening for and intervening on behavioral barriers to ART adherence (e.g. depressive symptoms, substance use), more research is needed to understand and intervene on social and structural barriers to adherence.
References
Papers of particular interest, published recently, have been highlighted as: • Of importance
Centers for Disease Control and Prevention. HIV Surveillance Report, 2018. Vol 30.; 2019. https://doi.org/10.1017/CBO9781107415324.004
Hess K, Hu X, Lansky A, Mermin J, Hall HI. Lifetime risk of a diagnosis of HIV infection in the United States. Ann Epidemiol. 2017;27(4):238–43.
White House Office of National AIDS Policy. National HIV/AIDS Strategy for the United States: Updated to 2020. Washington, DC: The White House; 2015. https://www.aids.gov/federal-resources/national-hiv-aids-strategy/nhas-update.pdf.
Hogg RS. Understanding the HIV care continuum. Lancet HIV. 2018;5(6):e269–70. https://doi.org/10.1016/S2352-3018(18)30102-4.
Kay ES, Batey DS, Mugavero MJ. The HIV treatment cascade and care continuum: updates, goals, and recommendations for the future. AIDS Res Ther. 2016;13(1). https://doi.org/10.1186/s12981-016-0120-0.
Cohen MS, Chen YQ, McCauley M, Gamble T, Hosseinipour MC, Kumarasamy N, et al. Prevention of HIV-1 infection with early antiretroviral therapy. N Engl J Med. 2011;365(6):493–505.
Thompson MA, Aberg JA, Cahn P, Montaner JS, Rizzardini G, Telenti A, et al. Antiretroviral treatment of adult HIV infection: 2010 recommendations of the International AIDS Society-USA panel. JAMA - J Am Med Assoc. 2010;304:321–33. https://doi.org/10.1001/jama.2010.1004.
US Department of Health and Human Services. Guidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescents. October. 2012. https://doi.org/10.3390/v7102887
Deeks SG, Lewin SR, Havlir DV. The end of AIDS: HIV infection as a chronic disease. Lancet. 2013;382:1525–33. https://doi.org/10.1016/S0140-6736(13)61809-7.
Chaiyachati KH, Ogbuoji O, Price M, Suthar AB, Negussie EK, Bärnighausen T. Interventions to improve adherence to antiretroviral therapy: a rapid systematic review. AIDS. 2014;28:S187–204. https://doi.org/10.1097/QAD.0000000000000252.
Thompson MA, Mugavero MJ, Amico KR, Cargill VA, Chang LW, Gross R, et al. Guidelines for improving entry into and retention in care and antiretroviral adherence for persons with HIV: evidence-based recommendations from an International Association of Physicians in AIDS Care panel. Ann Intern Med. 2012;156(11):817–33.
Bezabhe WM, Chalmers L, Bereznicki LR, Peterson GM. Adherence to antiretroviral therapy and virologic failure. Med (United States). 2016. https://doi.org/10.1097/MD.0000000000003361.
WHO. Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection: recommendations for a public health approach; 2013. ISBN 978 92 4 150572 7.
Paterson DL, Swindells S, Mohr J, Brester M, Vergis EN, Squier C, et al. Adherence to protease inhibitor therapy and outcomes in patients with HIV infection. Ann Intern Med. 2000;133(1):21–30.
Lima VD, Harrigan R, Bangsberg DR, et al. The combined effect of modern highly active antiretroviral therapy regimens and adherence on mortality over time. J Acquir Immune Defic Syndr. 2009;50(5):529–36. https://doi.org/10.1097/QAI.0b013e31819675e9.
Hogg RS, Heath K, Bangsberg D, Yip B, Press N, O'Shaughnessy MV, et al. Intermittent use of triple-combination therapy is predictive of mortality at baseline and after 1 year of follow-up. Aids. 2002;16(7):1051–8.
Wood E, Hogg RS, Yip B, Harrigan PR, O’Shaughnessy MV, Montaner JSG. Effect of medication adherence on survival of HIV-infected adults who start highly active antiretroviral therapy when the CD4 cell count is 0.200 to 0.350× 109 cells/L. Ann Intern Med. 2003;139(10):810–6.
Benator DA, Elmi A, Rodriguez MD, Gale HB, Kan VL, Hoffman HJ, et al. True durability: HIV virologic suppression in an urban clinic and implications for timing of intensive adherence efforts and viral load monitoring. AIDS Behav. 2015;19(4):594–600.
Eaton EF, Saag MS, Mugavero M. Engagement in human immunodeficiency virus care: linkage, retention, and antiretroviral therapy adherence. Infect Dis Clin N Am. 2014;28(3):355–69.
Burman WJ, Grund B, Roediger MP, et al. The impact of episodic CD4 cell count-guided antiretroviral therapy on quality of life. J Acquir Immune Defic Syndr. 2008;47(2):185–93. https://doi.org/10.1097/QAI.0b013e31815acaa4.
Levi J, Raymond A, Pozniak A, Vernazza P, Kohler P, Hill A. Can the UNAIDS 90-90-90 target be achieved? A systematic analysis of national HIV treatment cascades. BMJ Glob Health. 2016;1:e000010. https://doi.org/10.1136/bmjgh-2015-000010.
Linley L, Johnson AS, Song R, et al. Estimated HIV incidence and prevalence in the United States, 2010–2016. HIV Surveill Suppl Rep. 2019.
Zanoni BC, Mayer KH. The adolescent and young adult HIV cascade of care in the United States: exaggerated health disparities. AIDS Patient Care STDs. 2014;28(3):128–35.
Buchacz K, Armon C, Tedaldi E, Palella FJ Jr, Novak RM, Ward D, et al. Disparities in HIV viral load suppression by race/ethnicity among men who have sex with men in the HIV outpatient study. AIDS Res Hum Retrovir. 2018;34:357–64. https://doi.org/10.1089/aid.2017.0162.
Beer L, Bradley H, Mattson CL, Johnson CH, Hoots B, Shouse RL. Trends in racial and ethnic disparities in antiretroviral therapy prescription and viral suppression in the United States, 2009–2013. J Acquir Immune Defic Syndr. 2016. https://doi.org/10.1097/QAI.0000000000001125.
Crepaz N, Dong X, Wang X, Hernandez AL, Irene HH. Racial and ethnic disparities in sustained viral suppression and transmission risk potential among persons receiving HIV care - United States, 2014. Morb Mortal Wkly Rep. 2018. https://doi.org/10.15585/mmwr.mm6704a2.
Simoni JM, Huh D, Wilson IB, et al. Racial/ethnic disparities in ART adherence in the United States: findings from the MACH14 study. J Acquir Immune Defic Syndr. 2012;60(5):466–72. https://doi.org/10.1097/QAI.0b013e31825db0bd.
Dailey AF, Johnson AS, Wu B. HIV care outcomes among blacks with diagnosed HIV — United States, 2014. Morb Mortal Wkly Rep. 2017. https://doi.org/10.15585/mmwr.mm6604a2.
MacDonell K, Naar-King S, Huszti H, Belzer M. Barriers to medication adherence in behaviorally and perinatally infected youth living with HIV. AIDS Behav. 2013;17(1):86–93.
Sweeney SM, Vanable PA. The association of HIV-related stigma to HIV medication adherence: a systematic review and synthesis of the literature. AIDS Behav. 2016;20(1):29–50. https://doi.org/10.1007/s10461-015-1164-1.
Quinn KG, Reed SJ, Dickson-Gomez J, Kelly JA. An exploration of syndemic factors that influence engagement in HIV care among Black men. Qual Health Res. 2018;28(7). https://doi.org/10.1177/1049732318759529.
Earnshaw VA, Chaudoir SR. From conceptualizing to measuring HIV stigma: a review of HIV stigma mechanism measures. AIDS Behav. 2009;13(6):1160–77.
Nyblade LC. Measuring HIV stigma: existing knowledge and gaps. Psychol Health Med. 2006;11(3):335–45.
Link BG. Understanding labeling effects in the area of mental disorders: an assessment of the effects of expectations of rejection. Am Sociol Rev. 1987;52:96. https://doi.org/10.2307/2095395.
Quinn K, Bowleg L, Dickson-Gomez J. “The fear of being Black plus the fear of being gay”: the effects of intersectional stigma on PrEP use among young Black gay, bisexual, and other men who have sex with men. Soc Sci Med. 2019;Jul(232):86–93. https://doi.org/10.1016/j.socscimed.2019.04.042.
Sue DW. Microaggressions in everyday life: race, gender, and sexual orientation: Wiley; Hoboken, NJ; 2010.
Rao D, Feldman BJ, Fredericksen RJ, Crane PK, Simoni JM, Kitahata MM, et al. A structural equation model of HIV-related stigma, depressive symptoms, and medication adherence. AIDS Behav. 2012;16(3):711–6.
Sayles JN, Wong MD, Kinsler JJ, Martins D, Cunningham WE. The association of stigma with self-reported access to medical care and antiretroviral therapy adherence in persons living with HIV/AIDS. J Gen Intern Med. 2009;24(10):1101–8.
Li L, Lee SJ, Wen Y, Lin C, Wan D, Jiraphongsa C. Antiretroviral therapy adherence among patients living with HIV/AIDS in Thailand. Nurs Health Sci. 2010;12:212–20. https://doi.org/10.1111/j.1442-2018.2010.00521.x.
Bird ST, Bogart LM, Delahanty DL. Health-related correlates of perceived discrimination in HIV care. AIDS Patient Care STDs. 2004;18:19–26. https://doi.org/10.1089/108729104322740884.
Galvan FH, Bogart LM, Klein DJ, Wagner GJ, Chen YT. Medical mistrust as a key mediator in the association between perceived discrimination and adherence to antiretroviral therapy among HIV-positive Latino men. J Behav Med. 2017;40:784–93. https://doi.org/10.1007/s10865-017-9843-1.
Quinn KG, Dickson-Gomez J, Zarwell M, Pearson B, Lewis M. “A gay man and a doctor are just like, a recipe for destruction”: how racism and homonegativity in healthcare settings influence PrEP uptake among young Black MSM. AIDS Behav. 2019;23(7):1951–63. https://doi.org/10.1007/s10461-018-2375-z.
Eaton LA, Driffin DD, Kegler C, Smith H, Conway-Washington C, White D, et al. The role of stigma and medical mistrust in the routine health care engagement of black men who have sex with men. Am J Public Health. 2015;105(2):e75–82.
Turan B, Rogers AJ, Rice WS, Atkins GC, Cohen MH, Wilson TE, et al. Association between perceived discrimination in healthcare settings and HIV medication adherence: mediating psychosocial mechanisms. AIDS Behav. 2017;21:3431–9. https://doi.org/10.1007/s10461-017-1957-5.
Washington HA. Medical apartheid: the dark history of medical experimentation on Black Americans from colonial times to the present: Doubleday Books; Hamburg, Germany; 2006.
Quinn, KG, Kelly, JA, DiFranceisco, WJ, Tamira, SS, Petroll, AE, Sanders, C, St. Lawrence, JS, Amirkhanian, YA. The health and sociocultural correlates or AIDS genocidal beliefs and medical mistrust among African American MSM. AIDS and Behavior. 2018. 22(6):1814–1825.
Bogart LM, Thorburn S. Are HIV/AIDS conspiracy beliefs a barrier to HIV prevention among African Americans? JAIDS J Acquir Immune Defic Syndr. 2005;38(2):213–8.
Armstrong K, McMurphy S, Dean LT, Micco E, Putt M, Halbert CH, et al. Differences in the patterns of health care system distrust between blacks and whites. J Gen Intern Med. 2008;23:827–33. https://doi.org/10.1007/s11606-008-0561-9.
Earnshaw VA, Bogart LM, Dovidio JF, Williams DR. Stigma and racial/ethnic HIV disparities: moving toward resilience. Am Psychol. 2013;68(4):225–36.
Bogart LM, Wagner GJ, Galvan FH, Klein DJ. Longitudinal relationships between antiretroviral treatment adherence and discrimination due to HIV-serostatus, race, and sexual orientation among African–American men with HIV. Ann Behav Med. 2010;40(2):184–90.
Dale SK, Bogart LM, Wagner GJ, Galvan FH, Klein DJ. Medical mistrust is related to lower longitudinal medication adherence among African-American males with HIV. J Health Psychol. 2016;21(7):1311–21.
Mutchler MG, Bogart LM, Klein DJ, Wagner GJ, Klinger IA, Tyagi K, et al. Age matters: differences in correlates of self-reported HIV antiretroviral treatment adherence between older and younger black men who have sex with men living with HIV. AIDS Care - Psychol Socio-Medical Asp AIDS/HIV. 2019;31:965–72. https://doi.org/10.1080/09540121.2019.1612020.
Earnshaw VA, Smith LR, Chaudoir SR, Amico KR, Copenhaver MM. HIV stigma mechanisms and well-being among PLWH: a test of the HIV stigma framework. AIDS Behav. 2013;17(5):1785–95.
Nachega JB, Stein DM, Lehman DA, Hlatshwayo D, Mothopeng R, Chaisson RE, et al. Adherence to antiretroviral therapy in HIV-infected adults in Soweto, South Africa. AIDS Res Hum Retroviruses. 2004;20:1053–6. https://doi.org/10.1089/aid.2004.20.1053.
Watt MH, Maman S, Golin CE, Earp JA, Eng E, Bangdiwala SI, et al. Factors associated with self-reported adherence to antiretroviral therapy in a Tanzanian setting. AIDS Care - Psychol Socio-Medical Asp AIDS/HIV. 2010;22:381–9. https://doi.org/10.1080/09540120903193708.
Okoror TA, Falade CO, Olorunlana A, Walker EM, Okareh OT. Exploring the cultural context of HIV stigma on antiretroviral therapy adherence among people living with HIV/AIDS in Southwest Nigeria. AIDS Patient Care STDs. 2013;27:55–64. https://doi.org/10.1089/apc.2012.0150.
Camacho G, Kalichman S, Katner H. Anticipated HIV-related stigma and HIV treatment adherence: the indirect effect of medication concerns. AIDS Behav. 2019;24:185–91. https://doi.org/10.1007/s10461-019-02644-z.
Quinn K, Voisin DRDRDR, Bouris A, et al. Multiple dimensions of stigma and health related factors among young black men who have sex with men. AIDS Behav. 2017;21(1):207–16. https://doi.org/10.1007/s10461-016-1439-1.
Blake Helms C, Turan JM, Atkins G, Kempf MC, Clay OJ, Raper JL, et al. Interpersonal mechanisms contributing to the association between HIV-related internalized stigma and medication adherence. AIDS Behav. 2017;21(1):238–47. https://doi.org/10.1007/s10461-016-1320-2.
• Turan B, Hatcher AM, Weiser SD, Johnson MO, Rice WS, Turan JM. Framing mechanisms linking HIV-related stigma, adherence to treatment, and health outcomes. Am J Public Health. 2017;107(6):863–9 The authors develop a conceptual framework to highlight how various dimensions of stigma, including structural- and individual-levels of stigma, affect the health of individuals living with HIV.
Seghatol-Eslami VC, Dark HE, Raper JL, Mugavero MJ, Turan JM, Turan B. Brief report: interpersonal and intrapersonal factors as parallel independent mediators in the association between internalized HIV stigma and ART adherence. J Acquir Immune Defic Syndr. 2017;74:e18–22. https://doi.org/10.1097/QAI.0000000000001177.
Earnshaw VA, Bogart LM, Laurenceau JP, Chan BT, Maughan-Brown BG, Dietrich JJ, et al. Internalized HIV stigma, ART initiation and HIV-1 RNA suppression in South Africa: exploring avoidant coping as a longitudinal mediator. J Int AIDS Soc. 2018;21:e25198. https://doi.org/10.1002/jia2.25198.
Stangl AL, Earnshaw VA, Logie CH, van Brakel W, C. Simbayi L, Barré I, et al. The health stigma and discrimination framework: a global, crosscutting framework to inform research, intervention development, and policy on health-related stigmas. BMC Med. 2019;17:31. https://doi.org/10.1186/s12916-019-1271-3.
Quinn K, Dickson-Gomez J, Broaddus M, Kelly JA. “It’s almost like a crab-in-a-barrel situation”: stigma, social support, and engagement in care among black men living with HIV. AIDS Educ Prev. 2018;30(2). https://doi.org/10.1521/aeap.2018.30.2.120.
Kamen C, Flores S, Taniguchi S, Khaylis A, Lee S, Koopman C, et al. Sexual minority status and trauma symptom severity in men living with HIV/AIDS. J Behav Med. 2012;35:38–46. https://doi.org/10.1007/s10865-011-9329-5.
Klot JF, Auerbach JD, Berry MR. Sexual violence and HIV transmission: summary proceedings of a scientific research planning meeting. Am J Reprod Immunol. 2013. https://doi.org/10.1111/aji.12033.
Schnurr PP, Green BL. Understanding relationships among trauma, posttraumatic stress disorders, and health outcomes. Adv Mind Body Med. 2004. https://doi.org/10.1037/10723-010.
Quinn K, Voisin DR, Bouris A, Schneider J. Psychological distress, drug use, sexual risks and medication adherence among young HIV-positive Black men who have sex with men: exposure to community violence matters. AIDS Care - Psychol Socio-Medical Asp AIDS/HIV. 2016;28(7). https://doi.org/10.1080/09540121.2016.1153596.
Brown MJ, Harrison SE, Li X. Gender disparities in traumatic life experiences and antiretroviral therapy adherence among people living with HIV in South Carolina. AIDS Behav. 2019;23:2904–15. https://doi.org/10.1007/s10461-019-02440-9.
Hotton AL, Keene L, Corbin DE, Schneider J, Voisin DR. The relationship between Black and gay community involvement and HIV-related risk behaviors among black men who have sex with men. J Gay Lesbian Soc Serv. 2018;30:64–81. https://doi.org/10.1080/10538720.2017.1408518.
Anderson JC, Campbell JC, Glass NE, Decker MR, Perrin N, Farley J. Impact of intimate partner violence on clinic attendance, viral suppression and CD4 cell count of women living with HIV in an urban clinic setting. AIDS Care - Psychol Socio-Medical Asp AIDS/HIV. 2018;30:399–408. https://doi.org/10.1080/09540121.2018.1428725.
Onono M, Odwar T, Abuogi L, Owuor K, Helova A, Bukusi E, et al. Effects of depression, stigma and intimate partner violence on postpartum women’s adherence and engagement in HIV care in Kenya. AIDS Behav. 2019;24:1807–15. https://doi.org/10.1007/s10461-019-02750-y.
Finneran C, Stephenson R. Intimate partner violence among men who have sex with men: a systematic review. Trauma Violence Abuse. 2013. https://doi.org/10.1177/1524838012470034.
Stephenson R, Khosropour C, Sullivan P. Reporting of Intimate Partner Violence among Men Who Have Sex with Men in an Online Survey. West J Emerg Med. 2010;11(3):242–246.
Craft SM, Serovich JM. Family-of-origin factors and partner violence in the intimate relationships of gay men who are HIV positive. J Interpers Violence. 2005;20:777–91. https://doi.org/10.1177/0886260505277101.
Paul JP, Catania J, Pollack L, Stall R. Understanding childhood sexual abuse as a predictor of sexual risk-taking among men who have sex with men: The Urban Men’s Health Study. Child Abuse Negl. 2001;25:557–84. https://doi.org/10.1016/S0145-2134(01)00226-5.
Welles SL, Baker AC, Miner MH, Brennan DJ, Jacoby S, Rosser BRS. History of childhood sexual abuse and unsafe anal intercourse in a 6-city study of HIV-positive men who have sex with men. Am J Public Health. 2009;99:1079–86. https://doi.org/10.2105/AJPH.2007.133280.
Soto T, Komaie G, Neilands TB, Johnson MO. Exposure to crime and trauma among HIV-infected men who have sex with men: associations with HIV stigma and treatment engagement. J Assoc Nurses AIDS Care. 2013;24:299–307. https://doi.org/10.1016/j.jana.2012.11.008.
Yiaslas TA, Kamen C, Arteaga A, Lee S, Briscoe-Smith A, Koopman C, et al. The relationship between sexual trauma, peritraumatic dissociation, posttraumatic stress disorder, and HIV-related health in HIV-positive men. J Trauma Dissociation. 2014;15:420–35. https://doi.org/10.1080/15299732.2013.873376.
Wilson SM, Sikkema KJ, Ranby KW. Gender moderates the influence of psychosocial factors and drug use on HAART adherence in the context of HIV and childhood sexual abuse. AIDS Care - Psychol Socio-Medical Asp AIDS/HIV. 2014;26:959–67. https://doi.org/10.1080/09540121.2013.873765.
Borwein A, Salters KA, Palmer AK, Miller CL, Duncan KC, Chan K, et al. High rates of lifetime and recent violence observed among harder-to-reach women living with HIV. AIDS Care - Psychol Socio-Medical Asp AIDS/HIV. 2014;26:587–94. https://doi.org/10.1080/09540121.2013.844763.
Dale S, Cohen M, Weber K, Cruise R, Kelso G, Brody L. Abuse and resilience in relation to HAART medication adherence and HIV viral load among women with HIV in the United States. AIDS Patient Care STDs. 2014;28:136–43. https://doi.org/10.1089/apc.2013.0329.
Mimiaga MJ, Noonan E, Donnell D, Safren SA, Koenen KC, Gortmaker S, et al. Childhood sexual abuse is highly associated with HIV risk-taking behavior and infection among MSM in the EXPLORE study. J Acquir Immune Defic Syndr. 2009;51:340–8. https://doi.org/10.1097/QAI.0b013e3181a24b38.
Boroughs MS, Valentine SE, Ironson GH, Shipherd JC, Safren SA, Taylor SW, et al. Complexity of childhood sexual abuse: predictors of current post-traumatic stress disorder, mood disorders, substance use, and sexual risk behavior among adult men who have sex with men. Arch Sex Behav. 2015;44:1891–902. https://doi.org/10.1007/s10508-015-0546-9.
Socias ME, Milloy MJ. Substance use and adherence to antiretroviral therapy: what is known and what is unknown. Curr Infect Dis Rep. 2018;20:36. https://doi.org/10.1007/s11908-018-0636-7.
Lee WK, Milloy MJS, Nosova E, Walsh J, Kerr T. Predictors of antiretroviral adherence self-efficacy among people living with HIV/AIDS in a Canadian setting. J Acquir Immune Defic Syndr. 2019;80:103–9. https://doi.org/10.1097/QAI.0000000000001878.
Cook PF, Schmiege SJ, Starr W, Carrington JM, Bradley-Springer L. Prospective state and trait predictors of daily medication adherence behavior in HIV. Nurs Res. 2017;66:275–85. https://doi.org/10.1097/NNR.0000000000000216.
Shubber Z, Mills EJ, Nachega JB, Vreeman R, Freitas M, Bock P, et al. Patient-reported barriers to adherence to antiretroviral therapy: a systematic review and meta-analysis. PLoS Med. 2016;13:e1002183. https://doi.org/10.1371/journal.pmed.1002183.
Bulsara SM, Wainberg ML, Newton-John TRO. Predictors of adult retention in HIV care: a systematic review. AIDS Behav. 2018;22:752–64. https://doi.org/10.1007/s10461-016-1644-y.
Hinkin CH, Hardy DJ, Mason KI, et al. Medication adherence in HIV-infected adults: effect of patient age, cognitive status, and substance abuse. AIDS. 2004;18(Suppl 1):S19–25.
Voisin DR, Quinn K, Kim DH, Schneider J. A longitudinal analysis of antiretroviral adherence among young Black men who have sex with men. J Adolesc Health. 2017;60(4). https://doi.org/10.1016/j.jadohealth.2016.10.428.
Kelly JA, St. Lawrence JS, Amirkhanian YA, DiFranceisco WJ, Anderson-Lamb M, Garcia LI, et al. Levels and predictors of HIV risk behavior among black men who have sex with men. AIDS Educ Prev. 2013;25(1):49–61. https://doi.org/10.1521/aeap.2013.25.1.49.
Mimiaga MJ, Reisner SL, Fontaine YM, Bland SE, Driscoll MA, Isenberg D, et al. Walking the line: stimulant use during sex and HIV risk behavior among Black urban MSM. Drug Alcohol Depend. 2010;110:30–7. https://doi.org/10.1016/j.drugalcdep.2010.01.017.
Mutchler MG, McDavitt B, Gordon KK. Becoming bold: alcohol use and sexual exploration among black and latino young men who have sex with men (YMSM). J Sex Res. 2014;51:696–710. https://doi.org/10.1080/00224499.2013.772086.
Sprague C, Simon SE. Understanding HIV care delays in the US South and the role of the social-level in HIV care engagement/retention: a qualitative study. Int J Equity Health. 2014;13(1):1.
Gwadz M, de Guzman R, Freeman R, et al. Exploring how substance use impedes engagement along the HIV care continuum: a qualitative study. Front Public Health. 2016;8(4):62.
Fritz K, Morojele N, Kalichman S. Alcohol: the forgotten drug in HIV/AIDS. Lancet. 2010;376:398–400. https://doi.org/10.1016/S0140-6736(10)60884-7.
Hendershot CS, Stoner SA, Pantalone DW, Simoni JM. Alcohol use and antiretroviral adherence: review and meta-analysis. J Acquir Immune Defic Syndr. 2009;52:180–202. https://doi.org/10.1097/QAI.0b013e3181b18b6e.
Fatch R, Emenyonu NI, Muyindike W, Kekibiina A, Woolf-King S, Hahn JA. Alcohol interactive toxicity beliefs and ART non-adherence among HIV-infected current drinkers in Mbarara, Uganda. AIDS Behav. 2017;21:1812–24. https://doi.org/10.1007/s10461-016-1429-3.
Kalichman SC, Horne R, Katner H, Hernandez D. Perceived sensitivity to medicines, alcohol interactive toxicity beliefs, and medication adherence among people living with HIV who drink alcohol. J Behav Med. 2019;42:392–400. https://doi.org/10.1007/s10865-018-9987-7.
Pellowski JA, Kalichman SC, Kalichman MO, Cherry C. Alcohol-antiretroviral therapy interactive toxicity beliefs and daily medication adherence and alcohol use among people living with HIV. AIDS Care - Psychol Socio-Medical Asp AIDS/HIV. 2016;28:963–70. https://doi.org/10.1080/09540121.2016.1154134.
Kuhns LM, Hotton AL, Garofalo R, Muldoon AL, Jaffe K, Bouris A, et al. An index of multiple psychosocial, syndemic conditions is associated with antiretroviral medication adherence among HIV-positive youth. AIDS Patient Care STDs. 2016;30(4):185–92.
• Gross IM, Hosek S, Richards MH, Fernandez MI. Predictors and profiles of antiretroviral therapy adherence among African American adolescents and young adult males living with HIV. AIDS Patient Care STDs. 2016;30(7):324–38 This study examines predictors of ART adherence among lack adolescents and young adult males living with HIV. Findings demonstrate that better adherence is associated with lower psychological distress and minimal alcohol use.
Horvath KJ, Lammert S, MacLehose RF, Danh T, Baker JV, Carrico AW. A pilot study of a Mobile app to support HIV antiretroviral therapy adherence among men who have sex with men who use stimulants. AIDS Behav. 2019;23:3184–98. https://doi.org/10.1007/s10461-019-02597-3.
Jin H, Ogunbajo A, Mimiaga MJ, Duncan DT, Boyer E, Chai P, et al. Over the influence: the HIV care continuum among methamphetamine-using men who have sex with men. Drug Alcohol Depend. 2018;192:125–8. https://doi.org/10.1016/j.drugalcdep.2018.07.038.
Feldman MB, Thomas JA, Alexy ER, Irvine MK. Crystal methamphetamine use and HIV medical outcomes among HIV-infected men who have sex with men accessing support services in New York. Drug Alcohol Depend. 2015;147:266–71. https://doi.org/10.1016/j.drugalcdep.2014.09.780.
Low AJ, Mburu G, Welton NJ, May MT, Davies CF, French C, et al. Impact of opioid substitution therapy on antiretroviral therapy outcomes: a systematic review and meta-analysis. Clin Infect Dis. 2016;63:1094–104. https://doi.org/10.1093/cid/ciw416.
Shrestha R, Copenhaver MM. Viral suppression among HIV-infected methadone-maintained patients: the role of ongoing injection drug use and adherence to antiretroviral therapy (ART). Addict Behav. 2018;85:88–93. https://doi.org/10.1016/j.addbeh.2018.05.031.
Bazzi AR, Drainoni ML, Biancarelli DL, Hartman JJ, Mimiaga MJ, Mayer KH, et al. Systematic review of HIV treatment adherence research among people who inject drugs in the United States and Canada: evidence to inform pre-exposure prophylaxis (PrEP) adherence interventions 11 Medical and Health Sciences 1117 Public Health and Health Se. BMC Public Health. 2019;19:31. https://doi.org/10.1186/s12889-018-6314-8.
Gardner LI, Marks G, Strathdee SA, Loughlin AM, del Rio C, Kerndt P, et al. Faster entry into HIV care among HIV-infected drug users who had been in drug-use treatment programs. Drug Alcohol Depend. 2016;165:15–21. https://doi.org/10.1016/j.drugalcdep.2016.05.018.
Ciesla JA, Roberts JE. Meta-analysis of the relationship between HIV infection and risk for depressive disorders. Am J Psychiatry. 2001;158:725–30. https://doi.org/10.1176/appi.ajp.158.5.725.
Bing EG, Burnam MA, Longshore D, Fleishman JA, Sherbourne CD, London AS, et al. Psychiatric disorders and drug use among human immunodeficiency virus–infected adults in the United States. Arch Gen Psychiatry. 2001;58(8):721–8. https://doi.org/10.1001/archpsyc.58.8.721.
Valente SM. Depression and HIV disease. J Assoc Nurses AIDS Care. 2003;14:41–51. https://doi.org/10.1177/1055329002250993.
Rabkin JG. HIV and depression: 2008 review and update. Curr HIV/AIDS Rep. 2008;5:163–71. https://doi.org/10.1007/s11904-008-0025-1.
Kavanagh DJ, Bower GH. Mood and self-efficacy: impact of joy and sadness on perceived capabilities. Cognit Ther Res. 1985;9:507–25. https://doi.org/10.1007/BF01173005.
White JM, Gordon JR, Mimiaga MJ. The role of substance use and mental health problems in medication adherence among HIV-infected MSM. LGBT Heal. 2014;1:319–22. https://doi.org/10.1089/lgbt.2014.0020.
Tucker A, Liht J, De Swardt G, et al. Homophobic stigma, depression, self-efficacy and unprotected anal intercourse for peri-urban township men who have sex with men in Cape Town, South Africa: a cross-sectional association model. AIDS Care - Psychol Socio-Medical Asp AIDS/HIV. 2014;26:882–9. https://doi.org/10.1080/09540121.2013.859652.
Williams JK, Wilton L, Magnus M, Wang L, Wang J, Dyer TP, et al. Relation of childhood sexual abuse, intimate partner violence, and depression to risk factors for HIV among black men who have sex with men in 6 US cities. Am J Public Health. 2015;105:2473–81. https://doi.org/10.2105/AJPH.2015.302878.
Halkitis PN, Perez-Figueroa RE, Carreiro T, Kingdon MJ, Kupprat SA, Eddy J. Psychosocial burdens negatively impact HIV antiretroviral adherence in gay, bisexual, and other men who have sex with men aged 50 and older. AIDS Care - Psychol Socio-Medical Asp AIDS/HIV. 2014;26:1426–34. https://doi.org/10.1080/09540121.2014.921276.
Mitzel LD, Vanable PA, Brown JL, Bostwick RA, Sweeney SM, Carey MP. Depressive symptoms mediate the effect of HIV-related stigmatization on medication adherence among HIV-infected men who have sex with men. AIDS Behav. 2015;19:1454–9. https://doi.org/10.1007/s10461-015-1038-6.
Chen YH, Raymond HF. Associations between depressive syndromes and HIV risk behaviors among San Francisco men who have sex with men. AIDS Care - Psychol Socio-Medical Asp AIDS/HIV. 2017;29:1538–42. https://doi.org/10.1080/09540121.2017.1307925.
Uthman OA, Magidson JF, Safren SA, Nachega JB. Depression and adherence to antiretroviral therapy in low-, middle- and high-income countries: a systematic review and meta-analysis. Curr HIV/AIDS Rep. 2014;11:291–307. https://doi.org/10.1007/s11904-014-0220-1.
Singer M. Introduction to syndemics: a critical systems approach to public and community health.; Jossey-Bass, San Francisco, CA; 2009.
Dyer TP, Shoptaw S, Guadamuz TE, Plankey M, Kao U, Ostrow D, et al. Application of syndemic theory to black men who have sex with men in the multicenter AIDS cohort study. J Urban Health. 2012;89(4):697–708.
Quinn K. Applying an intersectional framework to understand syndemic conditions among young Black gay, bisexual, and other men who have sex with men. Soc Sci Med. 2019:112779. https://doi.org/10.1016/j.socscimed.2019.112779.
Singer M. A dose of drugs, a touch of violence, a case of AIDS: conceptualizing the SAVA syndemic. Free Inq Creat Sociol. 1996;24(2):99.
Friedman MR, Stall R, Silvestre AJ, et al. Effects of syndemics on HIV viral load and medication adherence in the multicentre AIDS cohort study. AIDS. 2015;29(9):1087–96. https://doi.org/10.1097/QAD.0000000000000657.
Stall R, Mills TC, Williamston J. Association of co-occurring psychosocial health problems and increased vulnerability to HIV/AIDS among urban men who have sex with men. Am J Public Health. 2003;93:939–42.
O’Leary A, Jemmott JB, Stevens R, Rutledge SE, Icard LD. Optimism and education buffer the effects of syndemic conditions on HIV status among African American men who have sex with men. AIDS Behav. 2014;18(11):2080–8.
Harkness A, Bainter SA, O’Cleirigh C, Mendez NA, Mayer KH, Safren SA. Longitudinal effects of syndemics on ART non-adherence among sexual minority men. AIDS Behav. 2018;22:2564–74. https://doi.org/10.1007/s10461-018-2180-8.
Blashill AJ, Bedoya CA, Mayer KH, O’Cleirigh C, Pinkston MM, Remmert JE, et al. Psychosocial syndemics are additively associated with worse ART adherence in HIV-infected individuals. AIDS Behav. 2015;19(6):981–6.
Risher KA, Kapoor S, Daramola AM, Paz-Bailey G, Skarbinski J, Doyle K, et al. Challenges in the evaluation of interventions to improve engagement along the HIV care continuum in the United States: a systematic review. AIDS Behav. 2017;21:2101–23. https://doi.org/10.1007/s10461-017-1687-8.
Muessig KE, LeGrand S, Horvath KJ, Bauermeister JA, Hightow-Weidman LB. Recent mobile health interventions to support medication adherence among HIV-positive MSM. Curr Opin HIV AIDS. 2017;12(5):432–41. https://doi.org/10.1097/COH.0000000000000401.
Mbuagbaw L, Sivaramalingam B, Navarro T, Hobson N, Keepanasseril A, Wilczynski NJ, et al. Interventions for enhancing adherence to antiretroviral therapy (ART): a systematic review of high quality studies. AIDS Patient Care STDs. 2015;29:248–66. https://doi.org/10.1089/apc.2014.0308.
Bogart LM, Wagner GJ, Green HD, et al. Medical mistrust among social network members may contribute to antiretroviral treatment nonadherence in African Americans living with HIV. Soc Sci Med. 2016;164:133–140.
Oldenburg CE, Perez-Brumer AG, Hatzenbuehler ML, et al. State-level structural sexual stigma and HIV prevention in a national online sample of HIV-uninfected MSM in the United States. AIDS. 2015;29(7):837–45. https://doi.org/10.1097/QAD.0000000000000622.
Van Tieu H, Koblin BA, Latkin C, et al. Neighborhood and network characteristics and the HIV care continuum among gay, bisexual, and other men who have sex with men. J Urban Health. 2018. https://doi.org/10.1007/s11524-018-0266-2.
Reisner SL, Mimiaga MJ, Skeer M, Perkovich B, Johnson CV, Safren SA. A review of HIV antiretroviral adherence and intervention studies among HIV-infected youth. Top HIV Med. 2009;17(1):14–25.
Naar-King S, Outlaw AY, Sarr M, et al. Motivational Enhancement System for Adherence (MESA): pilot randomized trial of a brief computer-delivered prevention intervention for youth initiating antiretroviral treatment. J Pediatr Psychol. 2013;38(6):638–48. https://doi.org/10.1093/jpepsy/jss132.
Garofalo R, Kuhns LM, Hotton A, Johnson A, Muldoon A, Rice D. A randomized controlled trial of personalized text message reminders to promote medication adherence among HIV-positive adolescents and young adults. AIDS Behav. 2016;20:1049–59. https://doi.org/10.1007/s10461-015-1192-x.
Belzer ME, Naar-King S, Olson J, et al. The use of cell phone support for non-adherent HIV-infected youth and young adults: an initial randomized and controlled intervention trial. AIDS Behav. 2014;18:686–96. https://doi.org/10.1007/s10461-013-0661-3.
Dowshen N, Kuhns LM, Johnson A, Holoyda BJ, Garofalo R. Improving adherence to antiretroviral therapy for youth living with HIV/AIDS: a pilot study using personalized, interactive, daily text message reminders. J Med Internet Res. 2012;14:e51. https://doi.org/10.2196/jmir.2015.
Kerrigan D, Grieb SM, Ellen J, Sibinga E. Exploring the dynamics of art adherence in the context of a mindfulness instruction intervention among youth living with HIV in Baltimore, Maryland. AIDS Care - Psychol Socio-Medical Asp AIDS/HIV. 2018;30:1400–5. https://doi.org/10.1080/09540121.2018.1492699.
Mimiaga MJ, Kuhns LM, Biello KB, Olson J, Hoehnle S, Santostefano CM, et al. Positive STEPS - a randomized controlled efficacy trial of an adaptive intervention for strengthening adherence to antiretroviral HIV treatment among youth: study protocol. BMC Public Health. 2018;18:867. https://doi.org/10.1186/s12889-018-5815-9.
Sayegh CS, MacDonell KK, Clark LF, et al. The impact of cell phone support on psychosocial outcomes for youth living with HIV nonadherent to antiretroviral therapy. AIDS Behav. 2018;22:3357–62. https://doi.org/10.1007/s10461-018-2192-4.
Shaw S, Amico KR. Antiretroviral therapy adherence enhancing interventions for adolescents and young adults 13-24 years of age: a review of the evidence base. J Acquir Immune Defic Syndr. 2016;72:387–99. https://doi.org/10.1097/QAI.0000000000000977.
• Hosek SG, Harper GW, Lemos D, et al. Project ACCEPT: evaluation of a group-based intervention to improve engagement in Care for Youth Newly Diagnosed with HIV. AIDS Behav. 2018. https://doi.org/10.1007/s10461-018-2034-4This study presents the findings of a promising pilot intervention to improve engagement in care for youth living with HIV. Findings demonstrate the intervention was positively associated with ART adherence and declining viral load over time.
Thurston IB, Bogart LM, Wachman M, Closson EF, Skeer MR, Mimiaga MJ. Adaptation of an HIV medication adherence intervention for adolescents and young adults. Cogn Behav Pract. 2014;21(2):191–205.
Holloway IW, Tan D, Dunlap SL, Palmer L, Beougher S, Cederbaum JA. Network support, technology use, depression, and ART adherence among HIV-positive MSM of color. AIDS Care - Psychol Socio-Medical Asp AIDS/HIV. 2017;29:1153–61. https://doi.org/10.1080/09540121.2017.1325435.
LeGrand S, Muessig KE, McNulty T, Soni K, Knudtson K, Lemann A, et al. Epic allies: development of a gaming app to improve antiretroviral therapy adherence among young HIV-positive men who have sex with men. JMIR Serious Games. 2016;4. https://doi.org/10.2196/games.5687.
Horvath KJ, Michael Oakes J, Simon Rosser BR, Danilenko G, Vezina H, Rivet Amico K, et al. Feasibility, acceptability and preliminary efficacy of an online peer-to-peer social support ART adherence intervention. AIDS Behav. 2013;17:2031–44. https://doi.org/10.1007/s10461-013-0469-1.
Horvath KJ, Amico KR, Erickson D, Ecklund AM, Martinka A, DeWitt J, et al. Thrive with me: protocol for a randomized controlled trial to test a peer support intervention to improve antiretroviral therapy adherence among men who have sex with men. JMIR Res Protoc. 2018;7:e10182. https://doi.org/10.2196/10182.
Horvath KJ, Alemu D, Danh T, Baker JV, Carrico AW. Creating effective mobile phone apps to optimize antiretroviral therapy adherence: perspectives from stimulant-using HIV-positive men who have sex with men. JMIR mHealth uHealth. 2016;4:e48. https://doi.org/10.2196/mhealth.5287.
Locher C, Messerli M, Gaab J, Gerger H. Long-term effects of psychological interventions to improve adherence to antiretroviral treatment in HIV-infected persons: a systematic review and meta-analysis. AIDS Patient Care STDs. 2019;33:131–44. https://doi.org/10.1089/apc.2018.0164.
Amico KR. Evidence for technology interventions to promote ART adherence in adult populations: a review of the literature 2012–2015. Curr HIV/AIDS Rep. 2015;12(4):441–50. https://doi.org/10.1007/s11904-015-0286-4.
Haberer JE, Sabin L, Amico KR, Orrell C, Galárraga O, Tsai AC, et al. Improving antiretroviral therapy adherence in resource-limited settings at scale: a discussion of interventions and recommendations. J Int AIDS Soc. 2017;20(1):21371. https://doi.org/10.7448/IAS.20.1.21371.
Macdonell KE, Naar-King S, Murphy DA, Parsons JT, Harper GW. Predictors of medication adherence in high risk youth of color living with HIV. J Pediatr Psychol. 2010;35(6):593–601. https://doi.org/10.1093/jpepsy/jsp080.
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Quinn, K.G., Voisin, D.R. ART Adherence Among Men Who Have Sex with Men Living with HIV: Key Challenges and Opportunities. Curr HIV/AIDS Rep 17, 290–300 (2020). https://doi.org/10.1007/s11904-020-00510-5
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DOI: https://doi.org/10.1007/s11904-020-00510-5