Neighborhood Resources Indirectly Linked to HIV Medication Adherence Through Social Determinants of Health Among Digitally Surveyed Partnered Men Who Have Sex with Men

Abstract Despite advances in antiretroviral (ARV) medications, the most common regimens require daily pill-taking. While there is consensus that social determinants of health (SDoH) hinder ARV adherence, these are typically measured and intervened upon at the individual level. Meanwhile, the relationship among neighborhood conditions, individual exposure to SDoH, and HIV medication adherence is not well understood. To explore pathways among them, we used structural equation modeling (SEM), linking a neighborhood disadvantage index (NDI) to baseline data from a national cohort study of intimate partner violence among partnered gay, bisexual and other men who have sex with men living with HIV. Among 371 participants, SEM analysis supported an indirect association of NDI to low ARV adherence ( b =0.03; 95% confidence interval [0.01, 0.06]), through cumulative exposure to SDoH. Understanding the contribution of neighborhood conditions to SDoH exposure may improve HIV medication interventions, destigmatizing disclosure of non-adherence and the selection of correspondingly forgiving regimens.