Stigma and the non-communicable disease syndemic in aging HIV positive and HIV negative MSM

Rutgers Biomedical And Health Sciences, Newark NJ

Investigators

Linked publications, trials & patents

Abstract

Abstract Over the next decade, more than 70% of people living with HIV will be older than 50, of whom the majority are men who have sex with men living with HIV (MLWH) The increasing burden of the non-communicable diseases (NCDs) hypertension, diabetes, and dyslipidemia has already begun to present key challenges to effective HIV care among aging PLWH. Because these NCDs often present together as comorbid conditions, interact with each other adversely, and are influenced by varying systemic and environmental factors, they may comprise a synergistic epidemic. In the U.S., there is variation in disease prevalence across demographic and geographic populations related to prevalence and/or control of NCDs and HIV. Behavioral and psychological stressors may contribute to observed differences in health outcomes through direct and indirect mechanisms. Directly, negative experiences in healthcare settings may contribute to healthcare avoidance, decreasing success rates along HIV and NCD continua of care domains of retention, treatment, adherence, and disease control. Indirectly, negative experiences in healthcare settings may contribute to co-occurring challenges such as emotional strain, depression, and substance use, thereby contributing to HIV and NCD incidence, prevalence, and poorer disease control. Very few if any studies have prospectively assessed the contribution of these factors in NCD incidence, prevalence, and control among MLWH; and few if any studies have rigorously assessed how behavioral and psychological stressors may influence the relationship between demographic factors and NCD and HIV outcomes. Collecting data over a four-year period, we will utilize the MACS/WIHS Combined Cohort Study, the longest-running cohort study of MLWH the U.S., to assess the following specific aims among MLWH and without HIV: 1) assess variation in behavioral and psychological stressors across demographic and geographic populations in the context of HIV; 2) assess variation in NCD incidence and prevalence across demographic and geographic populations in the context of HIV; and 3) assess how behavioral and psychological variables may act as risk and protective factors for geographic and demographic variance in NCD outcomes. Our key scientific premise is that behavioral and psychological stressors mediate differing health outcomes in NCD incidence, prevalence, and control by geography and demographics among men in the context of HIV. The proposed work will extend research on the HIV continuum of care to the NCD continuum of care. This study will provide critical data for informing the development of integrated interventions designed to improve care coordination and treatment adherence across geographically and demographically defined populations.