Background
In a US Midwestern state, the Black community living with HIV is subject to disparities. Investigations into laws and public policies that govern society as structural barriers to ending the epidemic are vastly under-researched. As such, this study examined the racial gap in ART adherence outcomes among Midwestern PWH contextualized within structural drivers of disparities, hypothesizing that reported experiences with social determinants of health negatively affect ART adherence PWH in a state with punitive HIV criminalization policies.
Methods
This study utilized local Medical Monitoring Project surveillance data to investigate medication adherence outcomes among a midwestern population of PWH, n=716. The outcome of interest was a binary outcome indicating antiretroviral dose adherence of 90% or more. Multiple nested logistic regression models were estimated. The models included unadjusted racial differences, the impact of discrimination and stigma, health status variables, and structural and individual experiences of social determinants of health.
Results
In the full model, identifying as Black (OR=.63, 95% CI= .44 – .91) and experiencing discrimination in healthcare settings (OR=.52, 95% CI= .36 – .77) were significantly associated with lower odds of ART adherence. When analyzing the social determinants, food insecurity was significantly associated with lower ART adherence (OR=.60, 95% CI= .41 – .88). Overwhelmingly, the results show that individuals who identified as Black had significantly lower odds of optimal ART adherence in all models. These outcomes, when considered with the results from the key variables, align with previous research demonstrating that racism and discriminatory experiences have harmful effects on ART adherence. While the findings related to HIV-related discrimination were robust, those associated with HIV-related stigma were explained away when controlling for age. Models indicated that older age was a protective factor in medication adherence outcomes.
Conclusions
Research identifies racism as the facilitator of social determinants of health, including social and economic disparities, transportation issues, stigma, and discrimination. This study makes an important contribution to the literature by investigating how structural determinants impact adherence in the Midwest, particularly for Black PWH, contextualized in a state that, despite robust HIV resources, exists under HIV criminalization laws that place at increased risk for adverse outcomes.
Table or Figure
