Adherence to HIV treatment in US gay men differs by race and ethnicity

Levels of adherence to HIV treatment differ significantly between racial groups, US investigators report in the online edition of the Journal of Acquired Immune Deficiency Syndromes. They also found that the factors affecting adherence differed between racial groups. Furthermore, different levels of adherence were seen within racial groups according to ethnicity.

“Adherence is multifactorial and varies significantly by race and ethnicity”, comment the investigators.

A number of factors can have an impact on a patient’s ability to adhere to their HIV treatment. These can include health status, side-effects, socioeconomic circumstances, and drug and alcohol use.

Although some research has suggested that racial minorities have lower rates of adherence, there is little information on possible reasons for this.

Furthermore, black and Hispanic are often used as separate, uniform categories without taking into account the important ethnic differences that can exist within these groups.

Both black and Hispanic people are disproportionately affected by HIV in the US. Therefore, investigators from the Multicenter AIDS Cohort Study investigated how adherence differs according to race and ethnicity, and the factors affecting adherence.

The study involved 1102 gay men. All were HIV-positive and taking antiretroviral therapy. They were asked to define their race (white; black; Hispanic; or other) and to select one of 19 categories that they felt best described their family’s national or ethnic background.

Individuals were also asked to provide details of their adherence to their antiretroviral therapy.

To determine which factors affected adherence, the men were asked to provide details of their socioeconomic circumstances, drug use, viral load and CD4 count, and symptoms.

Overall, most of the men were white (58%), with 26% being black and 14% Hispanic.

There were marked differences in the economic circumstances of these racial groups, with 48% of black men reporting that they had an annual income of $10,000 or less, compared to 31% of Hispanic men, and 10% of white men.

Drug use patterns also differed significantly. Crack cocaine use was higher amongst black men (22%) than either whites (8%) or Hispanics (4%). However, white men were more likely to report the use of poppers (34%) than either Hispanics (19%) or blacks (13%).

Complete adherence to their HIV treatment was reported by 44% of white men, 32% of Hispanic men and 28% of black men.

After controlling for factors including socioeconomic circumstances and drug use, white men were the group least likely to report non-adherence. Compared to whites, Hispanics were 2.16 times more non-adherent, and black men 1.37 times more non-adherent.

Factors associated with non-adherence differed between the racial groups.

For white men, younger age, joint pain and viral load were all significantly associated with non-adherence. For Hispanic men the factors also included younger age and viral load. The factors associated with non-adherence amongst black men were complex. Neither younger age nor viral load were significant. However, financial difficulties, a doubling of the cost of prescription medications, a new skin rash, and use of crack cocaine were.

Finally the investigators looked at adherence according to the self-reported national and ethnic identity of Hispanic and black men.

Amongst Hispanic men, adherence was higher amongst men who described European descent (44%), than amongst men who said their family origins were either in Central or South America (28%) or the Caribbean (22%).

Similarly, adherence was highest amongst black men who said their origins were European (38%), than those reporting African (28%) or Caribbean (13%) descent.

“We found that blacks and Hispanics are more likely to be nonadherent and that individuals from Central and South America and the Caribbean are especially at risk of nonadherence,” write the authors. They conclude, “further adherence research and interventions should focus not solely on racial groups but also the ethnic differences within groups.”