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Structural Inequities, Syndemics, and Resilience: The Critical Role of Social Support in Overcoming Barriers and Empowering Engagement in HIV Care for Young Black Sexual-Minority Men in the US South

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Abstract

Young Black sexual minority men (YBSMM) living in the US South are among those most disproportionately impacted by HIV in the USA. This health inequity is, in part, due to lower rates of sustained engagement in the HIV care continuum, resulting in a lower prevalence of viral suppression and higher overall community-level viral load. Social, structural, and economic inequities have previously been linked with poorer HIV care engagement among YBSMM. HIV-related social support, individual-level resilience, and healthcare empowerment have been shown to be independently associated with improved HIV care engagement. The current study sought to assess the relative contribution of individual, structural, and economic factors on engagement in HIV care and to elucidate the potentially mediating role of healthcare empowerment. Data from 224 YBSMM with HIV in the US South indicated that greater levels of socioeconomic distress, intimate partner violence, and depressive symptoms were associated with lower levels of engagement in HIV care, while greater levels of individual-level resilience and healthcare empowerment were associated with higher levels of HIV care engagement. Importantly, healthcare empowerment mediated the association between resilience and engagement in HIV care and the association between social support and engagement in HIV care. Findings emphasize the critical role that HIV-related social support plays in fostering resilience and overcoming syndemic factors to promote empowerment and engagement in HIV care for YBSMM in the USA.

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Acknowledgements

The authors would like to thank the participants of the cohort study as well as Ben Zovod, without whom this study would not have been possible.

Funding

This project was funded by grant R21DA053164 (PI: Storholm) from the National Institute on Drug Abuse and grant R01MH102171 (PI: Kegeles) from the National Institute of Mental Health. Wilson Vincent was also supported by a National Institute of Mental Health career development award K23MH111402 (PI: Vincent). Additional support for Drs. Storholm and Siconolfi was provided by grant R01MH126691 (PI: Storholm) from the National Institute of Mental Health.

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Authors and Affiliations

  1. School of Public Health, San Diego State University, San Diego, CA, USA

    Erik D. Storholm

  2. RAND Corporation, Santa Monica, CA, USA

    Erik D. Storholm

  3. RAND Corporation, Pittsburgh, PA, USA

    Daniel E. Siconolfi

  4. Herbert Wertheim School of Public Health & Human Longevity Science, University of California San Diego, La Jolla, CA, USA

    Chadwick K. Campbell

  5. Center for AIDS Prevention Studies, Division of Prevention Science, Department of Medicine, University of California, San Francisco, San Francisco, San Francisco, CA, USA

    Lance M. Pollack, Susan M. Kegeles, Greg M. Rebchook & Scott Tebbetts

  6. Department of Psychology, Temple University, Philadelphia, CA, USA

    Wilson Vincent

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Contributions

All authors contributed to the study conception and design. Material preparation and data collection were conducted by EDS, DES, LMP, SMK, GMR, ST, and WV. Data analysis was performed by WV, LMP, and EDS. The first draft of the manuscript was written by EDS with the results, tables, and figures drafted by WV. All authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Erik D. Storholm.

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Storholm, E.D., Siconolfi, D.E., Campbell, C.K. et al. Structural Inequities, Syndemics, and Resilience: The Critical Role of Social Support in Overcoming Barriers and Empowering Engagement in HIV Care for Young Black Sexual-Minority Men in the US South. J. Racial and Ethnic Health Disparities (2023). https://doi.org/10.1007/s40615-023-01869-y

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