Psychosocial barriers to linkage to and retention in HIV care among MSM in Atlanta Open Access

Derni, Ryan Camille (2014)

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Limited research has examined how multiple psychosocial factors shape linkage to and retention in HIV care for men who have sex with men (MSM). To address this gap, survey data on depression, internal HIV stigma, perceived negative health, HIV status disclosure, social support, and resilience were collected for 201 HIV-positive MSM in Atlanta, GA. MSM without depression had greater odds of being linked to care compared to those with depression (OR=2.58; 95% CI: 1.1, 6.02). More social support was associated with retention in HIV care (OR=1.71; 95% CI: 1.16, 2.51). MSM aged 18-29 (p=0.003) and 30-39 (p=0.01) with higher levels of resilience had poorer retention. Resilience interacted with depression in their association with retention (p=0.006). Tailored interventions are needed to address the different psychosocial barriers affecting linkage to and retention in HIV care among MSM.

Table of Contents

Chapter I: Introduction - 9
Objectives & aims of study - 10
The HIV/AIDS epidemic among msm in the U.S. - 10
HIV Care engagement among msm - 12
ART Adherence & viral suppression - 14
Psychosocial barriers to HIV care engagement - 15
Chapter II: Manuscript - 17
Introduction - 21
Methods - 23
Study Design - 23
Measures - 24
Statistical analysis - 27
Results - 29
Discussion - 30
Tables & Figures - 34
Table I. Characteristics of HIV-positive MSM in Atlanta - 34
Table II. Psychosocial mean scores by linkage - 36
Table III. Psychosocial mean scores by retention - 37
Table IV. Multivariate logistic model of psychosocial barriers associated with linkage and retention - 38
Figure I. Resilience mean scores by retention stratified by depression - 39
Figure II. Resilience mean scores by retention stratified by age-level - 40
Figure III. Percentage of MSM depressed by age-level - 41
Chapter IV: Conclusion & Recommendations - 42
Screen for depression at HIV testing sites - 42
Manage depressive symptoms through resilience promotion among MSM retained in care - 43
Research resilience among MSM depressed and not retained in HIV care - 44
Research how depression shapes retention in HIV care by age - 44
Examine the role of resiliency in MSM under age 40 - 45
Help MSM seek support from social network members - 45
Standardize psychosocial and care engagement measures - 46
Conclusion - 46
References - 48
Appendix - 53
Appendix A: Andresen short-form (CESD-10) of the Center for Epidemiologic Studies Depression (CES-D) Scale - 53
Appendix B: SubScale of the Berger HIV Stigma Scalse - 54
Appendix C: Perceived Negative Health Scale - 55
Appendix D: HIV-Specific Social Support Scale - 56
Appendix E: Subscale of the Wagnild and Young 14-item Resilience Scale (RS) - 57

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