156575 Factors affecting HIV therapy adherence amongst marginalized urban men who have sex with men (MSM)

Monday, November 5, 2007

Jason Gagnon, MPH, MA , Graduate Medical Sciences and Clinical Investigation, Boston University School of Medicine, Boston, MA
Seth Welles, ScD, PhD , Department of Epidemiology and Biostatistics, Drexel University School of Public Health, Philadelphia, PA
Anthony Japour, MD , University of Miami Miller School of Medicine, Miami, FL
     
Background: This study evaluated whether demographic and behavioral factors, current illicit drug use and history of addiction, HIV disease indicators and treatment history are associated with low HAART adherence in populations seeking free healthcare.

Methods: Ninety-seven HIV+ MSM enrolled in an AIDS Drug Assistance Program in Miami participated in focus groups to identify barriers to HAART adherence and condom use. Surveys administered during focus groups collected data on demographics, illicit drug use/history of addiction, and history of HAART treatment adherence.

Findings: Patients recruited were mature (median age: 40 yrs.) with lower level of education (77% ≤ high school), high unemployment (79%); approximately half were Black/African-American and half were Hispanic. Greater than 50% of subjects reported non-adherence to HAART ever, and over one-third reported non-adherence in the prior weekend. Factors associated with low adherence included marijuana use (odds ratio: 4.67, p = 0.01), and years since HIV diagnosis (OR: 1.08 (8% increase per year), p< 0.04). Additionally, results suggested cocaine use (OR: 2.81, p = 0.15) and history of drug treatment program participation (OR: 2.35, p = 0.13) were associated with low adherence.

Conclusion: Among these HIV+ men receiving free HIV medications through a government supported AIDS Drug Assistance program, years since HIV diagnosis, current drug use and addiction history (not demographic profiles or ART treatment parameters) were associated with HAART non-adherence. Our findings suggest that treatment of current illicit drug use may have optimal impact on treatment adherence in groups of lower income HIV+ men with long-term infection.

Learning Objectives:
1. Describe the link between demographic and behavioral factors, as well as disease indicators and history of disease, to HIV therapy non-compliance. 2.Understand and articulate the newly discovered unique indicators of HIV therapy non-compliance in a special population of indigent, urban men who have sex with men. 3.Develop new treatment plan and strategy for identifying and treating indigent, urban, mostly men of color who have sex with men. Other public health professionals will have a better undertanding this population and the need for special support programming.

Keywords: Sexual Risk Behavior, Community-Based Public Health

Presenting author's disclosure statement:

Any relevant financial relationships? No
Any institutionally-contracted trials related to this submission?

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

See more of: Issues Related to Medical Management and Medication Adherence of HIV/AIDS among Underserved Populations
See more of: HIV/AIDS