UCLA

The introduction of Antiretroviral Therapy (ART) in the late 1980s has transformed HIV from a fatal disease into a manageable chronic condition, although challenges like adherence to treatment and broader socio-economic factors continue to impact viral suppression and overall health status among people living with HIV (PLWH). The objective of this dissertation is to examine social (community environments), biological (pain), and psychological (self-perceived quality of life) factors associated with viral suppression among PLWH.The first paper investigates the association between neighborhood and sociodemographic factors and viral suppression among PLWH in Southern California, focusing on areas served by Ryan White clinics. Contrary to expectations, higher walkability scores were associated with lower levels of viral suppression. In line with our hypotheses, longer commute times were negatively associated with viral suppression. Employment showed a positive association with viral suppression, while higher poverty levels and longer work hours negatively impacted viral suppression rates. Additionally, no significant relationships were found between education level, public transportation score, and viral suppression. Given that PLWH often report higher instances of pain and substance use compared to the general population, the second paper explores the association between pain and viral suppression and how substance use modifies this relationship. We found that there was no substantial association between pain and viral suppression among women living with HIV (WLWH) in our cohort. Furthermore, we saw no modification by any type of substance use. The third paper examines the role of quality of life (QoL) on viral suppression and any disparities in this association by race/ethnicity. QoL encompassing physical health, psychological well-being, and socioeconomic stability, has been consistently linked to viral suppression. We found a significant positive association between QoL and viral suppression (aOR: 1.17, 95% CI [1.10, 1.25]). However, the magnitude of this association was shown to vary by racial and ethnic group. The increase in odds of viral suppression per one-point rise in QoL score was greatest among White WLWH and least among Black WLWH. Understanding the individual impact of each factor examined allows for the development of targeted, effective interventions. These findings not only advance our knowledge of HIV management but also emphasize the need for a multi-faceted approach that addresses the specific needs and circumstances of individuals living with HIV.