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

Solomon, Hiwote (2017)

Permanent URL: https://etd.library.emory.edu/concern/etds/tt44pn35x?locale=en%5D
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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

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