Challenges to Viral Suppression among Young Adults in a US Outpatient Clinic

Introduction: New HIV infections persist, regardless of medical advancements. With young adults being those that are most often newly infected, research needs to be conducted to assess adherence barriers, specific to young adults with HIV.

Methods: As standard of care, patients presenting for care completed behavioral and psychological distress assessments annually. Sexually transmitted infection (STI) tests are conducted annually and by need. Data were abstracted from medical charts in 2013 among patients aged 18 and 30 years. Bivariate analyses were conducted to identify factors related to viral suppression and STI attainment.

Results: A total of 335 individuals presented for care during the 12 month period. The majority of the sample was African American and had a mean age of 25.1.  Nearly all had current prescriptions antiretroviral therapy (ART); among those receiving ARTs, 72.8% were virally suppressed. Women and individuals who expressed psychological distress symptoms more often had unsuppressed viral loads. Nearly 60% reported condom use at last sex. One-third of this sample had at least 1 STI diagnosis within the last year, with 193 total STI events. Of the 102 individuals that had an STI, 47% had > two. Having two or more STIs was significantly associated with race, gender, and having two or more partners.

Conclusions: These findings identify challenges that young adults experience as they manage their HIV care. Increased prevention efforts need to incorporate preventing additional STIs, manage psychological distress, and address race and gender in the clinic setting.