Continuous Traumatic Violence and the HIV Continuum of Care Outcomes Among BMSM

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Project Summary The goals of this project are to (1) examine how exposures to continuous traumatic violence are related to engagement and retention in HIV care; (2) illuminate the pathways through which violence exposures affect HIV engagement and retention to care; and (3) identify factors that promote resilience among people living with HIV who have been exposed to violence. Continuous traumatic violence is conceptualized as chronic violence exposure, continuous danger, or ongoing threats that can manifest as structural, economic, psychological, interpersonal and social violence. This study examines continuous traumatic violence as inclusive of community and police violence, intimate partner violence, race- and sexuality-based stigma and discrimination, and the lingering effects of childhood sexual abuse, and explore these types of violence through the syndemic framework. Each of these various dimensions of violence disproportionately affects Black males, including YBMSM and a syndemic approach to continuous traumatic violence itself, may, therefore, better explain disparities in HIV care outcomes. Experiences of violence have been identified as an important aspect of syndemics that significantly contribute to lower engagement in HIV care and lower rates of viral suppression among Black MSM. Yet, much like multiple syndemic conditions contribute to disparities in HIV risk and outcomes, the experience of violence is not monolithic. Various types of violence exposures may cluster to have negative interactive effects on HIV care outcomes. This study will promote a deeper understanding of how these multiple dimensions of violence may have an additive and interactive correlation to poor engagement and retention in HIV care of YBMSM, despite significant outreach and retention efforts. This study focuses on YBMSM, a high priority population with regard to improving HIV outcomes. We will test an empirically informed conceptual model describing mediating and moderating factors that link continuous traumatic violence exposure to HIV care cascade outcomes. This model is based on our two decades of focused research on how violence impacts HIV risks and health outcomes among Black youth and young adults and BMSM. Documenting significant correlations among various dimensions of violence across a single sample of YBMSM is a necessary first step before developing costly longitudinal studies and interventions. Study results will inform a trauma-informed R34 application for HIV positive YBMSM.