Understanding the Racial Disparities in Antiretroviral Therapy Adherence Among Black and White HIV-Positive Men Who Have Sex with Men in Atlanta, Georgia Open Access

McKeever, Erin (Spring 2019)

Permanent URL: https://etd.library.emory.edu/concern/etds/v118rf44p?locale=en


Background: There are many documented racial disparities along the human immunodeficiency virus (HIV) care continuum. Studies have indicated HIV-positive minorities are less likely to initiate and adhere to antiretroviral therapy (ART) than HIV-positive whites, and therefore less likely to have HIV viral suppression. Better understanding these disparities in ART adherence, can inform work that needs to be done to address this issue, specifically among the black men who have sex with men (MSM) population, the population with the highest burden of HIV.

Methods: Data were collected from a prospective cohort study of black and white HIV-positive MSM in Atlanta, Georgia from 2017-2019. This analysis used cross-sectional baseline survey data. Self-reported non-adherence was measured by missing a dose of HIV medication on one or more days in the last 30 days. A multivariate logistic regression model was fit to the data to calculate the adjusted odds ratios (aOR) and 95% confidence interval (CI) for factors associated ART adherence among black and white HIV-positive MSM, while controlling for relevant confounders.

Results: The adjusted association between race and ART adherence showed that the black MSM were 68% less likely than white MSM to be adherent to ART (aOR = 0.32, 95% CI: 0.18-0.57, p = 0.0001), when controlling for confounding by education level, poverty, health insurance, inability to pay for medical care, mental health (depression and anxiety), multiple substances use, and self-reported viral.

Conclusions: Our data show that black/white racial disparities exist in ART adherence, one component of HIV care. These data highlight the need for increased education and innovation on adherence and retention efforts in black HIV-positive MSM. These data also indicate that this focus should include the social and structural factors, mental health, substance use, and health care inequalities that are making this disparity even more pronounced. Because HIV treatment is of utmost importance for the health outcomes of people living with HIV and preventing the spread of HIV, focusing control efforts on ART adherence, and the racial disparities within it, is especially important. 

Table of Contents



Study Design. 5

Setting. 5

Study Population. 6

Study size. 7

Variables. 7

Data Sources/Measurement. 8

Statistical Methods. 9


Demographics and Baseline Characteristics. 10

Bivariate Analysis. 11

Multivariate Analysis. 12


Main Findings. 14

Limitations. 15

Public Health Implications. 16

Conclusion. 17



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