Effects of sava syndemic-related factors on viral suppression among HIV positive women of color receiving HIV care

Background: Research suggests the interacting epidemics of substance abuse, violence, HIV/AIDS and related health and psychosocial factors create an excess burden in marginalized communities (the SAVA syndemic). This study examines the relationships between SAVA syndemic-related factors and viral suppression among HIV-positive women of color (WoC) who have received recent HIV care. Methods: Data are from the cross-site evaluation of the HRSA-funded SPNS initiative designed to engage and retain WoC in HIV care. A standardized multi-site baseline survey was employed and matched with chart abstraction data. Women were included if they had a viral load test within 90 days of the baseline survey (implying the receipt of some level of HIV care). GEEs were utilized to test the predictive value of the psychosocial/health variables on viral suppression (y/n) while accounting for the clustering of women by site. Models included the dichotomous predictor variables frequent mental distress (≥14 days of symptoms/month), substance abuse, alcohol use, history of STD(s), and intimate partner violence, controlling for demographic variables. Results: Data for 268 HIV+ WoC were analyzed; 49% (N=132) were virally suppressed. Frequent mental distress and a history of STDs decreased the odds of viral suppression (95% CI, .518,.960,α=.026, and .378,.851,α=.006, respectively). No interactive or additive effects of the SAVA-related variables were found. Conclusions: While two SAVA syndemic-related factors were found to negatively effect viral suppression, the absence of interactive or additive effects of the variables suggest that the syndemic approach may not be a viable framework for predicting HIV clinical outcomes among this population.