Mental health pathways from interpersonal violence to health-related outcomes in HIV-positive sexual minority men

Abstract

Objective: We examined mental health pathways between interpersonal violence (IPV) and health-related outcomes in HIV-positive sexual minority men engaged with medical care.

Method: HIV-positive gay and bisexual men (N = 178) were recruited for this cross-sectional study from 2 public HIV primary care clinics that treated outpatients in an urban setting. Participants (M age = 44.1 years, 36% non-White) filled out a computer-assisted survey and had health-related data extracted from their electronic medical records. We used structural equation modeling to test associations among the latent factors of adult abuse and partner violence (each comprising indicators of physical, sexual, and psychological abuse) and the measured variables: viral load, health-related quality of life (HRQOL), HIV medication adherence, and emergency room (ER) visits. Mediation was tested for the latent construct mental health problems, comprising depression, anxiety, symptomatology of posttraumatic stress disorder, and suicidal ideation.

Results: The final model demonstrated acceptable fit, chi(2)(123) = 157.05, p = .02, CFI = .95, TLI = .94, RMSEA = .04, SRMR = .06, accounting for significant portions of the variance in viral load (13%), HRQOL (41%), adherence (7%), and ER visits (9%), as well as the latent variable mental health problems (24%). Only 1 direct link emerged: a positive association between adult abuse and ER visits.

Conclusions: Findings indicate a significant role of IPV and mental health problems in the health of people living with HIV/AIDS. HIV care providers should assess for IPV history and mental health problems in all patients and refer for evidence-based psychosocial treatments that include a focus on health behaviors.

Figure 1

Hypothesized path model. Paths where a positive association was predicted are represented with a plus sign (+) and paths where a negative association was predicted are represented with a minus sign (−). PTSD = posttraumatic stress disorder; HRQOL = health-related quality of life; ER = emergency room.

Figure 2

Path model and standardized path coefficients for prediction of health outcomes. Paths estimated in the model that are not pictured in figure: Error covariance between depression and anxiety (β = −.24**). PTSD = posttraumatic stress disorder; HRQOL = health-related quality of life; ER = emergency room. *p < .05. ** p < .01. *** p < .001.