UCSF

For people living with HIV, lack of adherence to medication regimen is a significant problem with serious deleterious outcomes. Reasons for non-adherence are co-concurring psychosocial health conditions—also known as syndemic conditions—such as symptoms of depression, post-traumatic stress disorder (PTSD), past physical or sexual abuse, intimate partner violence (IPV), stimulant use, and binge drinking. Majority of all new HIV infections in the United States are among men who have sex with men (MSM).

This dissertation reports on a secondary analysis of cross-sectional data from older MSM living with HIV receiving treatment at two outpatient HIV clinics in San Francisco. The sample included 281 MSM who were HIV positive and who were 50 years of age or older. The study period was December 2012–July 2016.

The participants’ mean age was 57.89 years with a slight majority being Caucasian (54.8%). The majority (82.9%) of the participants had completed some college education; a minority of participants was working or retired (48.5%). The majority (68.7%) of the participants had incomes of $40,000 less. Over 70% of participants had one or more syndemic conditions. A large majority (84%) reported very good or excellent medication adherence.

In a bivariate linear regression model symptoms of depression (p < .0001), symptoms of PTSD (p < .0001), past physical or sexual abuse (p = .009), stimulant use (p < .0001), and binge drinking (p = .015) were significantly associated with lower medication adherence. In a multivariate linear regression model symptoms of depression (p = .008), symptoms of PTSD (p = .002), and binge drinking (p < .0001) remained significant associated with lower medication adherence. Experiencing two or more syndemic conditions was significantly associated with lower medication adherence than was experiencing no or one syndemic condition (p < .0001).

The present study’s findings are important contributions to the body of literature on medication adherence because they suggest that in older MSM, syndemic conditions such as symptoms of depression, symptoms of PTSD, past physical and sexual abuse, IPV, stimulant use, and binge drinking may affect the outcome of medication adherence.