Violence and viral suppression among men living with HIV

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PROJECT SUMMARY/ABSTRACT There is increasing evidence that men who have sex with men (MSM) experience dual epidemics of HIV and intimate partner violence (IPV), yet understanding of the synergies between these two epidemics is underdeveloped. Gay, bisexual and other men who have sex with men (GBMSM) continue to be the risk group most severely affected by HIV in the United States. In parallel, estimated prevalence for receipt of IPV among MSM range from 12% to 78%. Emergent evidences demonstrates associations between the experience of IPV among MSM and the risk of HIV acquisition or participation in risk behaviors that heighten the risk of HIV (i.e. substance use), but the relationship between the experience of IPV for MSM living with HIV and HIV clinical care is less understood. The overwhelming majority of evidence linking IPV and sub-optimal HIV care comes from studies of heterosexual women. A recent meta-analysis showed that women's experience of IPV was associated with 55% lower odds of self-reported adherence and 36% decreased odds of viral suppression. The four studies that have looked at associations between clinical care and IPV for men living with HIV have all been hampered by methodological limitations: cross-sectional study designs with clinic-based populations that limit the ability to draw conclusions as to how IPV affects engagement in HIV care for partnered men living with HIV. We propose an innovative 24-month cohort study of HIV-positive MSM, coupled with nested qualitative data, to identify the pathways and points of intervention between IPV and HIV care for US MSM. The proposed research activities include a prospective 24-month cohort of 300 HIV-positive partnered MSM (>18 years) recruited through a combination of online and venue-based recruitment methods in Atlanta, GA and Detroit, MI. The cohort study will employ a measure of IPV developed specifically to capture IPV as experienced by MSM, and will consider the experience of IPV (victimization, perpetration and bidirectional IPV), and severity and frequency of IPV as drivers of engagement in HIV care. Biomarkers of viral load and adherence to ARV will be collected from all participants. The overall aim of the proposed activities is to provide new knowledge of how victimization or perpetration of IPV shapes engagement in HIV care and is associated with the ability to achieve and maintain viral suppression.