Linkages between gender-based violence and engagement in HIV care in a prospective cohort of U.S. women living with HIV
Evidence is mounting that gender-based violence (GBV) is a major barrier to engagement in HIV care and treatment, and viral suppression. Research has documented the powerful role of GBV on ART uptake and adherence, including a meta-analysis showing that intimate partner violence had a larger effect on adherence than other factors such as stigma, financial constraints, and pill burden. Yet four key gaps in knowledge remain. Few longitudinal studies have been conducted to assess: (1) directionality/temporality; (2) chronic versus acute exposure to violence, (3) mechanisms through which this may occur (e.g., via poorer mental health), and (4) syndemic factors involved (e.g., food insecurity, stigma, incarceration). This information is critical to optimize and implement effective and cost-effective GBV interventions with the greatest payoffs. To fill these gaps, we propose to existing leverage data and infrastructure from the Women’s Interagency HIV Study (WIHS), a nationally representative prospective study of ethnically-diverse U.S. women comprising around 1500 HIV-positive women engaged in active follow-up (continuing as the MACS/WIHS Combined Cohort Study). The specific aims are to: (1) to test for longitudinal associations between sexual, physical, and psychological violence on HIV care engagement, and identify the mental health pathways involved (e.g., depression, PTSD); (2) to assess the whether the effect of violence on HIV care engagement outcomes is greater in the presence of syndemic factors. Our primary outcomes will be viral suppression and adherence to care appointments. Our secondary outcomes will be self-reported ART adherence and antiretroviral drug levels in hair. Findings will inform future plans to develop and evaluate of a trauma-focused intervention for HIV-positive women in the U.S.