Housing Instability, Depression, and HIV Viral Load among Young Black Men Who Have Sex with Men in Atlanta, GA Open Access

Abstract

Background: Housing instability is common among sexual minority youth. Prior research suggests psychological distress may mediate the association between housing instability and poor HIV-related outcomes, but this hypothesis remains underexplored.

Objectives: 1) Assess the cross-sectional relationship between housing instability and achieving an undetectable HIV-1 viral load (VL) in a sample of young black men who have sex with men (YBMSM) in Atlanta, GA. 2) Assess whether depression mediated this relationship.

Methods: We surveyed 81 HIV-infected YBMSM [mean age=22 years (SD=1.5)] recruited from a single HIV clinic in Atlanta, GA. Housing instability was defined as a dichotomous variable (no moves in the past months vs. at least one residential move in the past 6 months). Depression was defined as a score of ³16 on the Center for Epidemiologic Studies-Depression Revised version (CESD-R) scale. Undetectable VL was defined as ≤ 40 copies/mL.

Results: Among the sample, 65% of YBMSM achieved undetectable VL; 55.6% reported housing instability; and 46.9% reported depression. Housing instability was significantly associated with both depression (Adjusted Odds Ratio (AOR)=2.74, 95% CI: 1.1-6.806) and HIV VL detectability (AOR=2.8, 95% CI: 1.05-6.47). When depression was included in the model as a mediator, the association between housing instability and HIV VL detectability was no longer significant (AOR=2.149, 95% CI 0.76-6.01).

Conclusion: This pilot study suggests that psychological distress may partially mediate the inverse association between housing instability and undetectable VL among HIV-infected YBMSM. In addition to structural interventions that ensure housing stability, increasing utilization of mental health services among HIV-infected-unstably housed people may improve HIV outcomes in this high-risk population.

Table of Contents

TABLE OF CONTENTS

CHAPTER I: Introduction.......................................................................................................... 1

CHAPTER II: Literature Review................................................................................................ 7

Housing and HIV......................................................................................................................... 7

Factors affecting HIV VL.......................................................................................................... 10

Mental Health among PLWH.................................................................................................... 12

Gaps in the Literature............................................................................................................... 14

CHAPTER III: Manuscript....................................................................................................... 16

Abstract..................................................................................................................................... 19

Introduction............................................................................................................................... 20

Methods...................................................................................................................................... 24

Results........................................................................................................................................ 27

Discussion................................................................................................................................... 29

Tables............................................................................................................................................ 33

Table 1. Sociodemographic, housing, and clinical indicators by HIV Viral Load (VL) Detectability 33

Table 2. Bivariate analysis......................................................................................................... 34

Table 3. Multivariable analysis.................................................................................................. 34

CHAPTER IV: Public Health Implications.............................................................................. 35

References..................................................................................................................................... 37

About this Master's Thesis

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School	Rollins School of Public Health
Department	Hubert Department of Global Health
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Health Sciences, Mental Health Health Sciences, Epidemiology
Keyword	Men who have sex with men depression housing instability housing mental health MSM HIV/AIDS
Committee Chair / Thesis Advisor	Hussen, Sophia A, Emory University
Committee Members	Linton, Sabriya L, Emory University
Partnering Agencies	Hospital or other health care provider

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