CROI 2016 Abstract eBook

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Poster Abstracts

Results: Of the 2,938 individuals, 673 were HIV positive at baseline. One hundred and six appeared recently infected resulting in an HIV incidence estimate of 12.9/100 person- years (95% CI: 10.1-15.7) at baseline. Among the 1,722 individuals who had a follow-up time point between 4-12 months post enrollment, 1,197 were initially HIV negative and 40 seroconverted by their 1 st visit (longitudinal HIV incidence of 5.4/100 person-years [95% CI: 3.9-7.4]). At baseline, 82% (87/106) of the recent group and 35% (14/40) in the seroconverter group were male. Additionally, those <30 years of age had the highest HIV incidence, 18.5/100 person-years (95% CI: 12.7-24.3) at baseline, and at 1 st follow-up (9.2 [5.2-15.2]). Drug use practices (injecting cocaine, using speed ball, injecting at a shooting gallery, sharing needles) decreased 50% between baseline and follow-up. Conclusions: Annual HIV incidence in this cohort of PWID was much higher in the months before enrollment than in the first year of the study (12.9% vs. 5.4%). At baseline, most of those with recent infection were men; in contrast, the seroconversion rate was higher in women than men after enrollment. The difference in HIV incidence at vs. after enrollment was not explained by differential loss-to-follow-up, but may have been explained by a decline in drug use practices after study enrollment. 918 Gender-Specific Factors Related to HIV Risks Among PeopleWho Inject Drugs in India Bushra Sabri 1 ; Aylur K. Srikrishnan 2 ; Sunil S. Solomon 1 ; Allison M. McFall 1 ; C.K.Vasudevan 2 ; Santhanam Anand 2 ; David Celentano 1 ; Shruti H. Mehta 1 ; Suresh Kumar 2 ; Gregory M. Lucas 1 1 Johns Hopkins Univ, Baltimore, MD, USA; 2 YRG Cntr for AIDS Rsr and Educ, Taramani, India Background: People who inject drugs (PWIDs) in India are at high risk for HIV infection and transmission, with women being at elevated risk. Research is needed to examine gender differences in factors contributing to HIV risk. Using a socio-ecological framework, this study identified factors at individual, relationship, and community/institutional levels that were differentially or similarly associated with HIV risk behaviors in men and women PWIDs. Methods: 6453 PWIDs (5677 men and 797 women) from 7 cities in North-east India were recruited using a respondent-driven sampling. Participants completed a survey and point-of-care HIV testing. We used multi-level logistic regression models to assess factors associated with 2 injection-related (daily use and sharing needles/syringes) and 3 sex- related (multiple partners, exchange sex and unprotected sex) HIV risk behaviors separately in men and women. Results: Women (52.8%) were more likely to be HIV positive than men (18.4%). Women were significantly more likely to report multiple recent sex partners, whereas men were significantly more likely to report recent exchange sex. Among women, factors associated with HIV risks included: younger age ( aOR =0.76 per 5 years older, CI =0.61-0.93), earlier initiation of injection drug use ( aOR =0.70 per 5 years older, CI =0.57-0.87), low education ( aOR =2.05, CI =1.09-3.84), marital status ( a OR=1.87, CI =1.13-3.09), and frequent financial stress ( aOR =2.32, CI =1.46-3.69). In contrast, for men, factors associated with HIV risks were older age ( aOR =1.22 per 5 years older, CI =1.03-1.45), later initiation of injection drug use ( aOR =1.24 per 5 years older, CI =1.10-1.38), and higher levels of internalized stigma ( aOR =1.42, CI =1.09-1.84) and enacted stigma (a OR =2.56, CI =1.77-3.69). Conclusions: The findings highlight the need for gender-specific contextually-integrated HIV prevention and intervention efforts among PWIDs. For example, programs that include economic empowerment, and build skills in addressing gender power dynamics in safe sex negotiation may be effective in preventing HIV among women. Stigma free services and programs that include coping skills training and mental health counseling to address the negative attitudes and behaviors resulting from stigma, may reduce HIV risk, particularly among men. 919 Depression and Social Isolation Mediate Effect of HIV Stigma onWomen’s ART Adherence Janet M. Turan 1 ; BulentTuran 1 ;Whitney Smith 1 ; Mardge Cohen 2 ;Tracey E.Wilson 3 ; Ada Adimora 4 ; Daniel Merenstein 5 ; Adebola Adedimeji 6 ; Lisa R. Metsch 7 ; SheriWeiser 8 1 Univ of Alabama at Birmingham, Birmingham, AL, USA; 2 John H. Stroger Jr. Hosp of Cook County and Rush Med Coll, Chicago, IL, USA; 3 State Univ of New York Downstate Med Cntr, Brooklyn, NY, USA; 4 Univ of North Carolina at Chapel Hill, Chapel Hill, NC, USA; 5 Georgetown Univ, Washington, DC, USA; 6 Albert Einstein Coll of Med, Bronx, NY, USA; 7 Columbia Univ Mailman Sch of PH, New York, NY, USA; 8 Univ of California San Francisco, San Francisco, CA, USA Background: Internalization of HIV-related stigma may inhibit a person’s ability to manage HIV disease through adherence to treatment regimens. Studies, mainly with white men, have suggested an association between internalized HIV-related stigma and suboptimal antiretroviral therapy (ART) adherence. However, there is a scarcity of research with women of different racial/ethnic backgrounds and on mediating mechanisms in the association between internalized HIV-related stigma and ART adherence. Methods: The Women’s Interagency HIV Study (WIHS) is a multi-center cohort study. Women living with HIV complete interviewer-administered questionnaires semi-annually. Cross-sectional analyses for the current article included 1168 women on ART for whom data on medication adherence were available from their last study visit between April 2013 and March 2014, when the measure of internalized stigma was initially introduced. Results: The association between internalized HIV stigma and self-reported sub-optimal ART adherence was significant for those in racial/ethnic minority groups (AOR = 0.689, p = .009, CI [0.521,0.911]), but not for non-Hispanic whites (AOR = 2.150, p = .188, CI [0.687,6.725]). Depressive symptoms, loneliness, and low perceived social support mediated the association between internalized stigma and non-adherence in the whole sample, as well as in the subsample of minority participants. In serial mediation models, internalized stigma predicted less perceived social support (or higher loneliness), which in turn predicted more depressive symptoms, which in turn predicted sub-optimal medication adherence (see Figure 1). Conclusions: These findings suggest that interconnected psychosocial mechanisms affect ART adherence, and that improvements in adherence may require multi-faceted interventions addressing both mental health and interpersonal factors, especially for minority women.

Poster Abstracts

388

CROI 2016