Abstract
People living with HIV (PLWH) have a higher risk of experiencing sexual assault compared to populations without HIV. Prior studies have shown independent associations between sexual assault, depression, and antiretroviral therapy (ART) adherence. However, research analyzing the potential mediating effects of depressive symptoms between sexual assault and ART adherence, and the associated age and sex disparities, especially among PLWH in the Southern United States, is lacking. Therefore, the current study sought to determine whether depressive symptoms mediate the association between sexual assault and ART adherence and to evaluate the associated age and sex disparities among PLWH in South Carolina. Data were collected from 337 individuals who received HIV care from an immunology center in South Carolina. Crude and adjusted path analysis models stratified by age and sex were used to determine the association between sexual assault, depressive symptoms, and ART adherence. Depressive symptoms were associated with ART adherence among adults aged 18–34 (β = − 0.281, p = .018) and 35–49 (β = − 0.185, p = .005), and men (β = − 0.205, p = .011). Sexual assault was associated with depressive symptoms (β = 0.211, p = .001) and with ART adherence (β = − 0.172, p = .010) among adults 35–49. Among men (β = − 0.238; p = .029) and women (β = − 0.344, p = .001), sexual assault was associated with ART adherence; among women, sexual assault was associated with depressive symptoms (β = 0.280, p = .006). Depressive symptoms mediated the association between sexual assault and ART adherence among adults 35–49 (β = − 0.039, p = .035). Interventions addressing depressive symptoms may improve ART adherence among adults aged 18–34 and 35–49 and men. Programs also addressing depressive symptoms and using trauma-informed approaches may improve ART adherence, especially among middle-age populations, men, and women.
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Acknowledgements
We would like to thank the following individuals who coordinated and participated in survey instrument development and data collection: Joi Anderson, Amir Bhochhibhoya, Akeen Hamilton, LaDrea Ingram, and Crystal Stafford as well as the administrative staff of the immunology clinic where this study was conducted. Finally, we are deeply grateful for the willingness of study participants to share their time and experiences with us. We take seriously our commitment to use study findings to improve outcomes for people living with HIV in South Carolina and recognize that this work could not be done without their participation and contributions.
Funding
This study was funded by the South Carolina SmartState Program®. M. J. Brown is supported by Grant K01MH115794 from the National Institute of Mental Health. S. Harrison is supported by Grant K01MH118073. The sponsors had no role in the design, analysis or decision to publish these findings. The content is solely the responsibility of the authors and does not necessarily represent the official views of the South Carolina SmartState Program® or the National Institutes of Health.
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Brown, M.J., Qian, Y., Harrison, S. et al. Age and Sex Disparities in Sexual Trauma, Depressive Symptoms, and Antiretroviral Adherence Among People Living with HIV in the Deep South: A Mediation Analysis. Arch Sex Behav 50, 1805–1816 (2021). https://doi.org/10.1007/s10508-020-01811-x
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DOI: https://doi.org/10.1007/s10508-020-01811-x