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Social factors create differences in HIV control

Picture of Tina Gutiérrez
Tina Gutiérrez

Although cases of well-controlled HIV infection are increasing in the United States, there are still many social factors that make treatment outcomes different for each person, noted a study recently published in the medical journal AIDS.

“Many studies of HIV disparities use a reductionist approach (for example, focusing only on racial differences or trying to see the association with income),” said study leader Dr. Adovich Rivera.

“This is not consistent with the real world, where people with HIV have multiple identity characteristics and face social forces that do not act in isolation,” he considered, as quoted by the Physicians Weekly news portal.

Disparities Influencing Outcomes

For the study, the research team used an approach that took “intersectionality” into account to provide a more detailed understanding of the differences that cause people to achieve viral suppression (adequate control of HIV infection) that is also durable.

A retrospective analysis was conducted using data from people with HIV treated at a sexual diversity health center between 2012 and 2019. Researchers identified people with HIV who achieved durable viral suppression and then assessed disparities using three intersectional approaches: aggregating interactions, latent class analysis (LCA) and qualitative comparative analysis (QCA).

The study included 5,967 people with HIV, 90% of whom had long-lasting viral suppression. Those who achieved durable viral suppression were older than those who did not (age at baseline, 43.43 years vs. 39.15 years) and were more likely to identify as cisgender men. People’s sexual orientations did not vary significantly between groups.

The team showed that drug use and socioeconomic status, including factors such as homelessness, were associated with long-lasting viral suppression, but sexual orientation or gender identity was not. When interactions were added, the results showed that ethnicity modified the association between health insurance and durable viral suppression.

In the latent class analysis (LCA), the study team identified four social categories that were influenced by sexual orientation or gender identity. “For example, the class made up of mostly trans women had lower rates of durable viral suppression compared to the class made up of mostly white, non-poor cisgender gay men (82% vs. 95%),” the study notes.

“Qualitative comparative analysis (QCA) showed that combinations, rather than individual factors alone, were important in achieving durable viral suppression. These combinations vary in vulnerable populations (e.g., black lesbian Trans women) and differ from historically privileged groups (e.g., white cisgender gay men).”

Negative factors do not determine failure

According to Dr. Rivera, his research findings “demonstrate that the presence of negative conditions does not necessarily doom a person with HIV to failure to achieve viral suppression.”

And he adds that, in fact, “even people with two or more adverse conditions (for example, being homeless or having a drug use problem) also achieved durable viral suppression.”

The key factor is the context in which people receive medical care. “These people were receiving culturally adapted care, and they were being linked to comprehensive services that were helping them address the different issues they face,” Rivera says.

“The findings on factors such as health insurance, as well as race and ethnicity, show how individual interventions do not necessarily have equal effects across all demographic groups. We’re not saying health insurance isn’t important; our results suggest that health insurance may not be sufficient to ensure that durable viral suppression is achieved in certain groups.”

The findings indicate that “efforts aimed at addressing individual problems would likely fail to eliminate disparities in durable viral suppression,” says Dr. Rivera.

The importance of addressing multiple factors 

“Our study confirms findings from previous work showing how substance use and housing are key issues that need to be managed together, along with HIV infection,” he says. “We found that across all intersectional groups, such as people with drug use problems or homelessness, they were still likely to achieve durable viral suppression in the presence of other favorable conditions.”

As a result, the researcher argues that while addressing social risks is important among people with HIV, strategies to address these risks should be offered as a package. “Efforts that focus only on individual problems would probably not help eliminate disparities in durable viral suppression,” he concludes.

For all this, at AHF Latin America and the Caribbean we work to bring HIV services to as many people as possible. If you want to get a free screening test, locate our offices in your country and make an appointment now.