Brazilian Journal of Infectious Diseases (Jul 2023)

Reproductive health syndemics impact retention in care among women living with HIV in Rio de Janeiro, Brazil

  • Christine M. Zachek,
  • Lara E. Coelho,
  • Jesse L. Clark,
  • Rosa M.S.M. Domingues,
  • Paula M. Luz,
  • Ruth K. Friedman,
  • Ângela C. Vasconcelos de Andrade,
  • Valdilea G. Veloso,
  • Jordan E. Lake,
  • Beatriz Grinsztejn,
  • Raquel B. De Boni

Journal volume & issue
Vol. 27, no. 4
p. 102779

Abstract

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Syndemic psychosocial and reproductive factors affecting women's retention in HIV care remain understudied. We analyzed correlates of non-retention in a cohort of women with HIV in Brazil from 2000‒2015. Participants self-reported exposure to physical/sexual violence, illicit drug use, adolescent pregnancy, or induced abortion. Lifetime history of these psychosocial stressors were used to create a syndemic score based on the presence or absence of these conditions. All dichotomous variables were summed (range 0 to 4), with greater scores indicating more syndemic factors experienced. Logistic regression models identified predictors of non-retention, defined as < 2 HIV viral load or CD4 results within the first year of enrollment. Of 915 women, non-retention was observed for 18%. Prevalence of syndemic factors was adolescent pregnancy (53.2%), physical/sexual violence (38.3%), induced abortion (27.3%), and illicit drug use (17.2%); 41.2% experienced ≥ 2 syndemic conditions. Syndemic scores of 2 and 3 were associated with non-retention, as well as low education, years with HIV and seroprevalent syphilis. Psychosocial and reproductive syndemics can limit women's retention in HIV care. Syphilis infection predicted non-retention and could be explored as a syndemic factor in future studies.

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