Beyond Viral Suppression—The Impact of Cumulative Violence on Health-Related Quality of Life Among a Cohort of Virally Suppressed Patients

Abstract

Objective:To elucidate how and in what ways cumulative violence affects health-related quality of life (HRQoL) among a clinical cohort of virally stable people living with HIV.Design:We used data from the University of North Carolina Center for AIDS Research HIV clinical cohort. Our analysis was limited to participants with an undetectable viral load (<200) and those who completed the Clinical, Sociodemographic, and Behavioral Survey between 2008 and 2017 (n = 284).Methods:A path analysis was used to test our primary hypothesis that the effect of cumulative violence on HRQoL would be mediated through symptoms of post-traumatic stress disorder (PTSD), depressive symptoms, and HIV symptom distress.Results:The impact of cumulative violence on HRQoL was fully mediated by symptoms of PTSD, depressive symptoms, and HIV symptom distress. Greater exposure to violence was associated with higher odds of PTSD symptoms (P <0.001), increased depressive symptoms (P <0.001), and increased HIV symptom distress (P < 0.01). HIV symptom distress displayed the largest association with HRQoL (P < 0.001), followed by depressive symptoms (P = 0.001) and PTSD symptoms (P < 0.001). These factors explained approximately 51% of the variance in HRQoL (R2 = 0.51, P < 0.001).Conclusions:Our findings indicate that addressing physical and mental health symptoms rooted in violent victimization should be a point of focus in efforts to improve HRQoL among people living with HIV who are virally stable.

A Trauma-Informed, Geospatially Aware, Just-in-Time Adaptive mHealth Intervention to Support Effective Coping Skills Among People Living With HIV in New Orleans: Development and Protocol for a Pilot Randomized Controlled Trial

“…This study aims to advance knowledge on temporally fluctuant and place-based stressors endured by people living with HIV in New Orleans and assess the acceptability, feasibility, and preliminary efficacy of NOLA GEM, a JITAI-consistent mHealth intervention responsive to these stressors. Key to the significance of NOLA GEM is its capacity to capture and intervene in real time on a holistic range of time-variant psychosocial and behavioral variables [10,15,21,60,61] alongside crucial neighborhood-level factors known to affect CoC outcomes and well-being among people living with HIV [11,12,23,[44][45][46][47][48], particularly violence-affected people living with HIV [1,4,7,15]. To our knowledge, NOLA GEM is the first smartphone-delivered, trauma-informed intervention tailored for people living with HIV.…”

“…Women living with HIV endure PTSD at rates as high as 35% (nearly 10 times the estimated national prevalence among adults in the United States) [5,6], with up to 97.1% reporting lifetime trauma histories in clinic-based samples [7], including cumulative adverse childhood experiences [8,9]. Early-life adversities are often compounded by syndemic food insecurity [10,11]; poverty [12]; and chronic prolonged exposure to relational, sexual [1,2,13,14], and community violence [15], particularly among Black people living with HIV, who are diagnosed at 22 to 33 times the rate of White American individuals [16]. Among seropositive young Black men who have sex with men enrolled in the Chicago-based Project nGage, which studied personalized social support as facilitator of antiretroviral therapy (ART) adherence, 40% had a close friend or relative die in violent circumstances; most had endured secondhand violence exposure-hearing gunshots (78%) and witnessing a physical assault (59%) [17].…”