3 - (SYM 16) Examining the Dose Response Relationship Between Syndemic Conditions and Internalized HIV Stigma

Syndemics, or the co-occurring synergistic effects of psychosocial and structural factors on disease risk and or burden, are directly linked to poor HIV care outcomes such as antiretroviral therapy (ART) adherence, viral load, and an individual’s ability to stay engaged in care. Further, data indicates that there is a dose response relationship between the number of syndemic factors an individual has and worse HIV-related health disparities. Sometimes considered a syndemic factor, internalized HIV stigma is related to several poor mental and physical health outcomes among people living with HIV (PLWH). Despite its relevance in exacerbating poor HIV care outcomes, few studies have specifically examined the relationship between syndemic conditions and HIV stigma and how social determinants of health may influence this relationship. Therefore, this study will examine how age may impact the relationship between syndemic conditions and internalized HIV stigma in a sample of mostly low-income and racially and ethnically diverse PLWH. The study consists of a sample of 1,343 PLWH receiving care at a large public HIV clinic in South Florida who completed a cross-sectional, interviewer-administered survey. Participants were diverse with respect to race and ethnicity (65% Black, 34% Latinx) and sexual orientation (about 26% sexual minority). Age at the time of survey completion ranged from 21 to 80 (M = 50). A traditional linear regression model approach was used to test the associations between the number of syndemic conditions (depression, anxiety, trauma, childhood sexual abuse, drug use, binge drinking, low education, unstable housing) may relate to internalized HIV stigma among this sample. Results indicate that number of syndemic conditions was significantly associated with internalized HIV stigma above and beyond the effects of age and sexual orientation (b = 0.23, SE = 0.03, CI: 0.17 - 0.29). Additionally, age (b = -0.02, SE = 0.01, CI: -0.04 - -0.01) and sexual orientation (b = -0.31, SE = 0.12, CI: -0.55 - -0.07) were significantly associated with internalized HIV stigma too. This study provides some insight into the relationship between syndemics and HIV stigma in a previously understudied sample. Considering the wealth of literature showing the harmful effects of HIV stigma, these findings can be used to inform future treatment targets for this population and others, such as by specifically working to reduce internalized HIV stigma for people with more syndemics conditions.