Department of Medicine, Center for AIDS Prevention Studies, University of California, San Francisco, CA.
Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA.
J Acquir Immune Defic Syndr. 2022 Feb 1;89(2):151-158. doi: 10.1097/QAI.0000000000002848.
Gender-based violence (GBV) is associated with poorer engagement in HIV care and treatment. However, there is a dearth of research on the psychological (eg, mental health) and structural (eg, food insecurity) factors that mediate and moderate this association. GBV could lead to poor mental health, which in turn affects adherence, whereas food insecurity could worsen the effect of GBV on engagement in care. This study uses data from the Women's Interagency HIV Study to address these gaps.
Women completed 6 assessments from 2013 to 2016 on GBV, mental health, food insecurity, adherence to antiretroviral therapy, and missed HIV care appointments in the past 6 months. Multilevel logistic regression models estimated associations between GBV and engagement in care and whether associations were mediated by depression, generalized anxiety disorder (GAD), and posttraumatic stress disorder (PTSD) and moderated by food insecurity.
GBV was associated with higher odds of suboptimal adherence (adjusted odds ratio: 1.88; 95% confidence interval: 1.24 to 2.87) and missed appointments (adjusted odds ratio: 1.76; 95% confidence interval: 1.16 to 2.67). The association between GBV and adherence was mediated by depressive symptoms, GAD, and PTSD, accounting for 29.7%, 15.0%, and 16.5%, respectively, of the total association. The association between GBV and missed appointments was mediated by depression and GAD, but not PTSD, with corresponding figures of 25.2% and 19.7%. Associations did not differ by food insecurity.
GBV is associated with suboptimal engagement in care, which may be explained by mental health. Interventions should address women's mental health needs, regardless of food insecurity, when improving engagement in HIV care.
基于性别的暴力（GBV）与较差的 HIV 护理和治疗参与度相关。然而，关于介导和调节这种关联的心理（例如，心理健康）和结构（例如，食物不安全）因素的研究很少。GBV 可能导致心理健康状况不佳，进而影响依从性，而食物不安全可能会加剧 GBV 对参与护理的影响。本研究使用妇女机构间艾滋病毒研究的数据来解决这些差距。
妇女在 2013 年至 2016 年期间完成了 6 次关于 GBV、心理健康、食物不安全、抗逆转录病毒治疗依从性和过去 6 个月内错过 HIV 护理预约的评估。多水平逻辑回归模型估计了 GBV 与护理参与之间的关联，以及这些关联是否通过抑郁、广泛性焦虑症（GAD）和创伤后应激障碍（PTSD）来介导，以及是否由食物不安全来调节。
GBV 与较差的依从性（调整后的优势比：1.88；95%置信区间：1.24 至 2.87）和错过预约（调整后的优势比：1.76；95%置信区间：1.16 至 2.67）的几率更高相关。GBV 与依从性之间的关联通过抑郁症状、GAD 和 PTSD 来介导，分别占总关联的 29.7%、15.0%和 16.5%。GBV 与错过预约之间的关联通过抑郁和 GAD 介导，但不是 PTSD，相应的比例分别为 25.2%和 19.7%。关联不受食物不安全的影响。
GBV 与护理参与度不理想相关，这可能是由心理健康状况引起的。在改善 HIV 护理的参与度时，干预措施应解决妇女的心理健康需求，无论其是否存在食物不安全问题。
