Addressing the Role of Violence on HIV Care and Viral Suppression

Presenter:

Dianne Rausch, Ph.D.
Division of AIDS Research

Goal:

The goals of this initiative are to (1) advance understanding of the role of violence on engagement and retention in HIV care, HIV medication adherence, and viral suppression, and (2) develop and test novel interventions to improve HIV outcomes for individuals who have experienced violence.

Rationale:

HIV treatment requires engagement and retention in HIV care, medication adherence, and viral suppression. Viral suppression leads to improved health and longevity for individuals living with HIV and reduces their likelihood of transmitting HIV. Despite substantial public health attention devoted to the HIV care continuum, a significant proportion of persons living with HIV do not link to care, drop out of care, do not achieve optimal levels of medication adherence, and/or do not achieve viral suppression.

There are numerous psychosocial factors associated with HIV infection that can negatively impact HIV treatment and health outcomes. Experience of violence represents one important psychosocial factor that impacts HIV. Rates of past (e.g., childhood abuse) and current violence (e.g., intimate partner violence) are high among individuals living with HIV. Although a large body of research documents associations between violence and HIV risk, comparatively less is known about whether and how the experience of violence impacts the HIV care continuum for individuals living with HIV. Emerging evidence suggests that experiences of violence can impact retention in HIV care, HIV medication adherence, and viral suppression.

Prior research addressing the effect of violence on HIV care has been limited by cross-sectional designs, inadequate measures of violence, and inattention to important psychosocial and structural factors that co-occur with both violence and HIV (e.g., poverty, stigma, substance use). Research on the intersection of violence and HIV care has also focused primarily on cisgender women; little is known about the impact of violence on HIV care for other populations such as men who have sex with men and transgender women. Finally, there are few empirically supported interventions that address the intersection of violence and HIV care. Given the high rates of violence among individuals infected with HIV, additional research is needed to explicate the relation between violence and the HIV continuum of care, to understand the modifiable mechanisms that may underlie this relationship, and to develop interventions that address violence to improve the HIV continuum of care for individuals living with HIV.

This initiative would solicit research to target gaps in knowledge regarding the intersection of violence and the HIV continuum of care, and to develop and test interventions that address violence to improve engagement and retention in HIV care, medication adherence, and viral suppression.

Research topics may include, but are not limited to:

• Studies to better characterize and understand the relation between violence and the HIV care continuum, including engagement and retention in HIV care, HIV medication adherence, and viral suppression;
• Studies to understand resilience among people living with HIV who have experienced violence, and how resilience may impact the HIV continuum of care; and
• Studies to understand HIV provider- and clinic-level barriers to screening and providing services for violence-related treatment.