Exploring the Mediating Role of Negative Affect in the Relationship between Violence Exposure and ART Engagement Among Young Black and Latinx Men Who Have Sex with Men: An Ecological Momentary Assessment Study Using Bayesian Analysis

Background: Young Black and Latinx men who have sex with men and are living with HIV (MSMLWH) face a disproportionate HIV burden due to the cumulative and reinforcing impacts of structural racism and homonegativity, which manifest as violence exposure and negatively impact HIV care engagement and outcomes. Few studies have simultaneously examined the potential pathways through which interpersonal, community and structural violence exposure impacts antiretroviral therapy (ART) maintenance. This study aims to address this gap, while also exploring how substance use and negative affect influence both daily and long-term ART maintenance.

Method: Participants (N = 41), aged 18-34, completed a 90-day ecological momentary assessment (EMA) on a daily basis using a mobile diary app. Data collection occurred between May 2021 and March 2023. Multilevel path analyses with Bayesian estimation were used to examine within- and between-person differences in ART maintenance. These analyses assessed the effects of daily violence exposure and substance use, with negative affect included as a mediator.

Results: Daily witnessed and directly experienced violence were associated with lower odds of ART maintenance, mediated by negative affect. In our final model, violence exposure increased negative affect, which, in turn, reduced ART maintenance odds by 50% within the same day, even after adjusting for race/ethnicity, violence exposure type, housing support, and substance use. Daily cannabis use increased the odds of ART maintenance by 3.1 times, but more frequent use decreased these odds over time. Non-Hispanic Black men and men living in HASA housing were more likely to maintain ART use compared to their respective counterparts.

Conclusion: These findings suggest that both witnessed and directly experienced violence are associated with lower ART maintenance, mediated by negative affect. Future research should explore specific manifestations of negative affect, such as PTSD symptoms, emotional distress, or depression. Further investigation is needed to understand the differential effects of daily versus frequent, long-term cannabis use on HIV care engagement.