Life Instability and its Effects on Psychosocial Syndemic Problems and HIV-Care Outcomes in People Living with HIV in Care in South Florida

J Acquir Immune Defic Syndr. 2025 Oct 9. doi: 10.1097/QAI.0000000000003777. Online ahead of print.

ABSTRACT

BACKGROUND: Structural life instability may negatively affect HIV-care outcomes in people living with HIV (PLWH), particularly in South Florida, a U.S. HIV epidemic “hotspot” with high rates of poverty, immigration, and inconsistent healthcare access.

SETTING: PLWH (N = 241) receiving care at a community clinic in Miami were assessed at two points.

METHODS: Sequential mediation regression analyses were employed to explore the relationships between additive indices of structural life instability (indicators: unemployment, low educational attainment, incarceration history, history of immigration as an adult, housing instability, and lack of a significant other) and psychosocial syndemic burden (indicators: depression, anxiety, trauma history, interpersonal violence, and substance use), self-reported antiretroviral therapy (ART) adherence, and documented HIV RNA viral load (VL) collected via medical records.

RESULTS: Participants reported an average of 2.23 indicators of life instability at baseline and 3.05 psychosocial syndemic problems at follow-up. Each additional indicator of life instability at baseline predicted a 0.23 increase in syndemic count at follow-up and each additional psychosocial problem at follow-up was associated with a 1.37 percentage point decrease in self-reported ART adherence covarying for baseline life instability. Self-reported adherence was, in turn, significantly inversely associated with participants’ continuous log RNA VL when holding variables constant. Finally, there was a significant indirect effect of baseline structural life instability on log RNA VL at follow-up sequentially through psychosocial syndemic burden and ART adherence.

CONCLUSIONS: Results suggest a temporal relationship between baseline life instability and psychosocial problems that negatively impacts HIV-related care outcomes among PLWH in South Florida.

PMID:41114723 | DOI:10.1097/QAI.0000000000003777