CAHSS Faculty Articles

Title

Environmental Influences on HIV Medication Adherence: The Role of Neighborhood Disorder

Department

Department of Family Therapy; Department of Justice and Human Services

Publication Date

1-30-2015

Publication Title

American Journal of Public Health

ISSN or ISBN

0090-0036

Volume

105

Issue

8

First Page

1660

Last Page

1666

Abstract

Objectives. We hypothesized that highly disordered neighborhoods would expose residents to environmental pressures, leading to reduced antiretroviral (ARV) medication adherence. Methods. Using targeted sampling, we enrolled 503 socioeconomically disadvantaged HIV-positive substance users in urban South Florida between 2010 and 2012. Participants completed a 1-time standardized interview that took approximately 1 hour. We tested a multiple mediation model to examine the direct and indirect effects of neighborhood disorder on diversion-related nonadherence to ARVs; risky social networks and housing instability were examined as mediators of the disordered neighborhood environment. Results. The total indirect effect in the model was statistically significant (P = .001), and the proportion of the total effect mediated was 53%. The model indicated substantial influence of neighborhood disorder on nonadherence to ARVs, operating through recent homelessness and diverter network size. Conclusions. Long-term improvements in diversion-related ARV adherence will require initiatives to reduce demand for illicit ARV medications, as well as measures to reduce patient vulnerability to diversion, including increased resources for accessible housing, intensive treatment, and support services.

DOI

10.2105/AJPH.2015.302612