Psychosocial burdens negatively impact HIV antiretroviral adherence in gay, bisexual, and other men who have sex with men aged 50 and older

Abstract

We sought to characterize HIV antiretroviral therapy (ART) adherence and psychosocial correlates of adherence in a sample of gay, bisexual, and other non-gay or –bisexual identified MSM ages 50 and over. As part of a cross-sectional study we recruited a community-based sample of 199 men and assessed adherence to current ART medications along four domains: 1) missing doses in the past 4 days, 2) taking doses on the specified schedule in the past 4 days, 3) following instructions about how to take the medications (e.g. to take medications with food), and 4) missing doses in the last weekend. A total adherence score was also computed. Bivariable analyses indicated negative associations between depression, sexual compulsivity, and HIV-related stigma with each of the individual adherence variables and the composite adherence score, while an older age was found to be protective. In multivariable analyses, controlling for age and educational attainment, a higher likelihood of missing doses and failing to follow instructions were related to higher levels of HIV-related stigma, while dosing off-schedule was associated with higher levels of sexual compulsivity. These results indicate that psychosocial burdens undermine the adherence behaviors of older HIV-positive sexual minority men. Programming and services to address this compromising health behavior must embrace a holistic approach to health as informed by syndemics theory, while attending to the developmental and age-specific needs of older men.

The Association of HIV-Related Stigma to HIV Medication Adherence: A Systematic Review and Synthesis of the Literature

“…Six investigations found that stigma was significantly associated with poor self-reported adherence at the multivariate level, after adjusting for factors such as demographics, perceived health, structural barriers, and alcohol and drug use [42,44,45,47,49,56]. Two prospective investigations lent support to this association as well.…”

“…PLWH who have experienced discrimination, stereotyping, or prejudice from others (i.e., enacted stigma), or who anticipate these experiences (i.e., anticipated stigma), may fear disclosing their HIV status. The complexity of medication regimens can interfere with PLWH's ability to conceal HIV status because it can require pill taking at inopportune times and in public settings [47]. Anticipated or enacted stigma may produce concerns about potentially revealing one's HIV status when accessing or consuming medications.…”

“…The most frequently used measure was an original or modified version of Berger's HIV Stigma Scale [46][47][48][49][50][51], which includes four subscales of personalized stigma, disclosure concerns, negative self-image, and concern with public attitudes. In other investigations, stigma was assessed through a variety of instruments including the HIV Internalized Stigma Measure [52,53], HIV/AIDS Stigma Instrument-PLWA [54], Self-Stigma Scale [55], HIV/AIDS-related Stigma and Discrimination [56], Stigma Scale for Chronic Illness [57], and items selected from the Patient Medication Adherence Questionnaire [52].…”

Current Knowledge and Future Directions on Aging and HIV Research

“…Recently, Halkitis and colleagues found depression to be associated with poorer antiretroviral therapy adherence in a sample of 180 HIV-positive MSM in New York City. 15 The mental health studies in this issue, along with other recent research, reinforce the impact depression and other mental health issues can have on older HIV-positive adults. Treatment adherence and efficacy of secondary prevention strategies can be impacted by depressive symptoms.…”

Untangling the Gordian knot of HIV, stress, and cognitive impairment

“…Stress, emotional reactivity, and avoidant coping behaviors contribute to HIV progression through increases in nonadherence (Martinez et al., 2012). Additionally, aging-associated complexities may exacerbate the effects of stress on nonadherence in PLWH aged 50 and older (Halkitis et al., 2014, Warren-Jeanpiere et al., 2014, Wu et al., 2014). Notably, cognitive functioning is a predictor of medication management and nonadherence (Wagner, 2002, Hinkin et al., 2004), and the strength of the predictive capacity increases with age (Frain et al., 2014).…”