Taking antiretroviral therapy (ART) consistently is essential for viral suppression, which keeps people with HIV healthy and prevents transmission. In 2018, the estimated rate of new HIV infections among Hispanic and Latino people in the U.S. was four times that of non-Hispanic White people, and Hispanic and Latino men who have sex with men (MSM) were 24% of all U.S. MSM living with diagnosed HIV. National data on what keeps them from taking ART, though, have been lacking.
CDC's Medical Monitoring Project — nationally representative interviews with adults diagnosed with HIV — filled that gap with data from 2015–2019, covering Hispanic and Latino MSM currently on ART.
How well they took their medicine
In the previous month:
| Took every dose | 57.4% |
| Said they did an "excellent" job taking their medicine | 52.9% |
| Always took it as recommended | 69.2% |
| High adherence (a score of 85 or more out of 100 on a three-item scale) | 77.3% |
Who had lower adherence
| Group | High adherence |
|---|---|
| Used drugs in the past year | 67.2% (vs 81.9%) |
| Recent depression | 66.3% (vs 79.9%) |
| Unmet needs for ancillary services | 71.6% (vs 83.0%) |
Younger men and those at or below the poverty line were also less likely to report high adherence. Anxiety and homelessness weren't linked once other factors were considered.
Sustained viral suppression was more common with high adherence: 75.3% vs 59.7%.
Why doses were missed
Among the 348 men (in the 2018 cycle) who had ever missed a dose:
| Reason for the most recent missed dose | |
|---|---|
| Forgot | 63.1% |
| Change in routine or travel | 42.3% |
| Fell asleep early or overslept | 33.6% |
63.9% gave more than one reason.
What could help
- Ancillary services — mental health and substance use counseling, financial help, food and housing assistance and more — may lower barriers, especially when offered where people get HIV care, as in the Ryan White HIV/AIDS Program's patient-centered medical home model. In one study of African American and Hispanic/Latino MSM, younger men reported better adherence when their clinic also offered such services.
- Reminders: in a review of adherence research, text-message interventions were among the most successful at improving both adherence and viral load. Peer support and cognitive behavioral therapy have also helped. Programs combining several strategies worked better, though effects often faded.
- Ending the HIV Epidemic, the federal plan announced in 2019, counts early diagnosis and treatment to viral suppression among its four pillars. CDC-supported interventions include Sin Buscar Excusas/No Excuses, a video program for Hispanic/Latino MSM promoting safer sex, testing and care, and HEART (Helping Enhance Adherence to Antiretroviral Therapy), which builds a personal adherence plan with a support partner.
Culturally tailored programs for Hispanic and Latino MSM who are younger, poor, use drugs or have unmet service needs could improve viral suppression, health and prevention.
Limits
Adherence was self-reported and open to recall and social-desirability bias; some nonresponse bias may remain despite weighting; and the list of reasons for missed doses may not be complete.
Sources
Based on Crim SM, Tie Y, Beer L, Weiser J, Dasgupta S, "Barriers to Antiretroviral Therapy Adherence Among HIV-Positive Hispanic and Latino Men Who Have Sex with Men — United States, 2015–2019," MMWR volume 69, number 40, Centers for Disease Control and Prevention; a work of the United States government in the public domain. The report gives a prevalence ratio of 0.61 for viral suppression by adherence, which its own percentages (75.3% and 59.7%) do not produce, so only the percentages are given.
Licence: CC0 1.0 (public domain) · Adapted from www.cdc.gov
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