Life Instability Associated with Lower ART Adherence and Other Poor HIV-Related Care Outcomes in Older Adults with HIV

Elliott R. Weinstein, Audrey Harkness, Gail Ironson, Cho Hee Shrader, Dustin T. Duncan, Steven A. Safren

Research output: Contribution to journalArticlepeer-review


Background: Life instability may be an important factor for HIV-related care outcomes in older adults living with HIV (OALWH). This study examined the degree to which an 11-item life instability index (LII) composed of individual- and community-level indicators was associated with HIV-related care outcomes—viral load, antiretroviral (ART) medication adherence, rates of detectable viral load, and HIV care appointment non-adherence among OALWH in the Miami area. Methods: Six hundred twenty-three OALWH completed an interviewer-administered assessment (English or Spanish), which was matched with medical record data. Results: Participants reported about six LII indicators each (M = 6.08, SD = 1.44). Greater index scores were associated with worse self-reported ART adherence (b = − 1.14, p = 0.03), lower observed appointment adherence (b = 0.02, p < 0.01), higher viral load (b = 0.09, p = 0.02), and greater odds of viral detection (OR = 1.22, p = 0.01). Regarding health behaviors, life instability was significantly associated with increased illicit substance use among participants and not associated with depression or anxiety. The association of life instability to ART adherence remained significant (although attenuated) when controlling for the significant effects of substance use (b = − 0.40, BSTP [− 0.87, − 0.09]). Conclusion: This present study is the first to examine an additive life instability index and its association with HIV-related behavioral and biomedical health outcomes among a population of OALWH. Greater indicators of life instability among OALWH may lead to poorer HIV-related health outcomes above and beyond the net of the effects of depression, anxiety, and substance use.

Original languageEnglish (US)
Pages (from-to)345-355
Number of pages11
JournalInternational Journal of Behavioral Medicine
Issue number3
StatePublished - Jun 2023


  • Behavioral medicine
  • Health disparities
  • Life instability
  • Older adults

ASJC Scopus subject areas

  • Applied Psychology


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