Alcohol Use, Intimate Partner Violence, and ART Adherence among Men Living with HIV who Have Sex with Men

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While there are many variables that impact adherence to antiretroviral therapy (ART) among men living with HIV who have sex with men (MLWHSM), alcohol use is one of the most prevalent and significant factors. Event-level studies have identified a temporal association between alcohol use, particularly heavy drinking, and ART nonadherence but have not examined the interactive effects of alcohol use and other psychosocial factors on ART nonadherence. One key factor that intersects with alcohol use is intimate partner violence (IPV), which is highly prevalent among MLWHSM. While the extant literature points to a potential relationship between IPV and poor HIV treatment outcomes among MLWHSM, research thus far has relied on cross- sectional designs and has produced mixed results. Cross-sectional research has also produced data that suggest an association between unhealthy alcohol use and IPV in this population. No research to date has attempted to capture event-level experiences of both alcohol use and IPV among MLWHSM, which could elucidate both temporal associations among these variables and the interactive effect of alcohol use and IPV on ART nonadherence. Identification of modifiable risk factors that precede ART nonadherence could be used to guide interventions aimed at improving the health of MLWHSM. Further, little is understood about the individual differences that enable some MLWHSM to be resilient in the face of risk factors for poor HIV treatment outcomes. Two factors that may contribute to resilience and merit examination are coping style and social support. Using a causal modeling analytic approach, the proposed study will examine temporal associations among alcohol use, IPV (perpetuation and victimization), and ART adherence among 100 MLWHSM. In addition, we will examine the moderating effect of protective factors (coping style and social support) and will explore the impact of other proximal and distal syndemic factors (drug use, mental health, sexual minority stress, HIV stigma, and childhood abuse). We propose a design consisting of a baseline assessment, followed by 60 consecutive days of daily diaries. There is an urgent need to sharpen our understanding of how alcohol use, IPV, and their interaction impact ART nonadherence among MLWHSM. Cross-sectional data can be used to identify candidate variables for intervention. However, event-level data are key to pinpointing the variables that most commonly precede ART nonadherence and could represent prime intervention targets to improve the health of MLWHSM. Further, there are striking examples in the literature of discrepant predictors of ART nonadherence when data are global and cross-sectional versus prospective, event-level data. The proposed study will be the first empirical test of temporal associations among alcohol use, IPV, other syndemic factors, protective factors, and ART adherence among MLWHSM. This line of research will be used to inform future intervention development to reduce the harms associated with syndemic factors and improve ART adherence.