The syndemic of psychosocial predictors of retention in care

Stream: Rapid Papers 1
Date: Thursday, 31 March 2016
Time: 3.30 pm – 4.45 pm


The HIV Treatment Cascade outlines the sequence for people living with HIV (PLWHIV), from acquiring the infection through to viral suppression. Long term adherence to antiretroviral treatment is necessary for viral suppression, which optimises individual health and is associated with significant public health benefits in the form of reduced risk of HIV transmission. Retaining people in HIV care to maintain and monitor medication adherence is therefore a priority. A multidisciplinary approach to treating HIV is considered the ‘gold standard’, and it is widely understood that psychosocial factors are critical to PLWHIV’s ongoing engagement in care; however little remains known about the relationships between psychosocial predictors of retention in care. High rates of psychiatric illness (including substance abuse), as well as an HIV diagnosis, have the potential to marginalise PLWHIV either independently or as a syndemic (the additive impact of multiple unique, yet associated, health problems which interact to increase the burden of illness). The resulting stigma and/or discrimination can be debilitating and have the potential to interfere with a person’s functioning, including their ability to effectively manage their healthcare. The current presentation offers findings from a systematic review of the literature into predictors of retention in HIV care, with a particular focus on the syndemic of psychosocial factors including (but not limited to) substance use, other psychiatric illness, self-efficacy and stigma. Based on the data a model illustrating the interrelationships among syndemic factors will be developed, as well as strategies for optimising retention in care.


Shiraze Bulsara (Presenter), The Albion Centre/University of Technology Sydney
Shiraze Bulsara is a clinical psychologist who works The Albion Centre. She also currently works at the University of Technology Sydney (UTS) as a Lecturer/clinical supervisor within the Masters of Clinical Psychology course. She has experience in psychological counselling for HIV/AIDS-related issues and various mental health presentations, including supporting HIV-affected people. Shiraze has also worked in community mental health and private practice settings as a clinical psychologist. Shiraze holds a Bachelor of Psychology with Honours from Macquarie University, and a Masters of Clinical Psychology from UNSW. Shiraze is currently enrolled in a PhD at UTS on the topic of retention in HIV care.

Milton Wainberg, Columbia University, NYC
Milton Wainberg is A/Professor of Psychiatry at Columbia University/NY State Psychiatric Institute, Director of NIMH-funded Columbia University Global Mental Health Implementation Science T32-Post Doctoral Fellowship, NIMH/Fogarty International-funded Portuguese-speaking African countries Mental Health Implementation Research Training Program, and Founding Chair of the Caucus of Global Mental Health and Psychiatry of the APA. He is Medical Director of Columbia University HIV Mental Health Training Project, Chair of Mental Health HIV Clinical Guidelines Committee of the NY State Department of Health/AIDS Institute, and Principal investigator/investigator of NIMH, NIAAA, NIDA and CDC research targeting HIV prevention/adherence to treatment, AOD, HIV-associated fatigue, and mental disorders.

Toby Newton-John, University of Technology Sydney
Toby Newton-John completed his undergraduate psychology degree and postgraduate clinical psychology training at the University of Sydney. He completed a PhD in pain psychology at the University of London. In 2014 was appointed Senior Lecturer in Clinical Psychology at the University of Technology Sydney and maintains a clinical practice part time. He was a series editor for the Clinical Management of Pain textbook, has over 40 peer reviewed publications, articles and book chapters on psychological aspects of pain, and has lectured in Canada, Malaysia, USA and the UK on this topic.