Syndemic Factors, Suicidal Ideation and HIV Treatment Adherence Among Gay Men Living with HIV in Taiwan

Background and Purpose:

Men who have sex with men (MSM) living with HIV have been disproportionately affected by mental health problems compared to their heterosexual counterparts. Previous research has found that MSM living with HIV who have experienced syndemic factors, such as intimate partner violence, internalized HIV stigma, crystal meth use, and childhood sexual abuse, were more likely to report treatment non-adherence than those who have not experienced such syndemic factors. Suicidal ideation is the first step towards suicide and has been shown to predict later suicide plans and it has been a significant mental health issue among MSM living with HIV in Taiwan. Therefore, this study aimed to determine the association between syndemic factors and HIV treatment adherence by self-reported suicidal ideation among MSM living with HIV in Taiwan.

Methods:

From December 2021 to April 2022, 568 MSM living with HIV completed a cross-sectional online survey through collaborative partnerships with seven AIDS Services Organization in Taiwan. Informed consent was obtained prior to the survey. The online survey included socio-demographic characteristics, suicidal ideation, and four syndemic factors, such as childhood sexual abuse, intimate partner violence, internalized HIV stigma, and crystal meth use. HIV treatment adherence was measured on a 5- point Likert scale and then dichotomized into good or bad treatment adherence. Multivariable logistic regression analysis was conducted with HIV treatment adherence, controlling for socio-demographic characteristics. We compared the results based on suicidal ideation (yes/no, last week).

Results:

Participants’ mean age was 36.5 years. Majority of them lived with someone (69.9%), had a college degree or more (76.5%), had a full-time job (81.1%), and were single (60.9%). Among participants, 76.8% of them had no suicidal ideation, while almost a quarter of them reported having suicidal ideation (23.2). A majority of participants reported good HIV treatment adherence (81.9%). The prevalence of each syndemic factor was: childhood sexual abuse (31.3%, before age of 18), intimate partner violence (25.8%, last five years), high internalized HIV stigma (31.5%, present), and crystal meth use (29.9%, last six months). In multivariable logistic regression, among group without suicidal ideation, younger (AOR=0.95, 95% CI=0.92–0.99) and childhood sexual abuse (AOR=2.23, 95% CI=1.28–3.89) were associated with higher odds of HIV treatment non-adherence. Among group reporting suicidal ideation, detectable viral load (AOR=9.63, 95% CI=2.50–37.17) and internalized HIV stigma (AOR=2.87, 95% CI=1.02–8.06) were associated with higher odds of HIV treatment non-adherence.

Conclusions and Implications:

Our findings suggest that there is an intersection between HIV treatment adherence and suicidal ideation. Moreover, syndemic factors, such as childhood trauma and internalized HIV stigma, could deteriorate the association between treatment adherence and suicidal ideation. These results may have implications for social work practice. In order to enhance HIV treatment adherence, Taiwanese MSM living with HIV would benefit from the trauma-informed counselling and competent screening of suicidal ideation by social workers. Additionally, evidence-based research among MSM living HIV in Taiwan should further examine the effect of other syndemic factors on HIV treatment adherence.