Differential Socioeconomic, Psychosocial, and Behavioral Factors Associated with Psychological Distress and Uncontrolled Blood Pressure among Women with and without HIV in the U.S

Jenni M Wise^1*Emily B Levitan²Elizabeth Jackson³Paul Muntner^2,4Edgar T Overton^3,5Liang Shan¹Jessica Blair²Andres Azuero¹Jennifer Ware¹Maria L Alcaide⁶David B Hanna⁷Andrew Edmonds⁸Sheri Weiser⁹Seble G Kassaye¹⁰Aruna Chandran¹¹Gina Wingood¹²Deborah Konkle-Parker¹³Tracey Wilson¹⁴Kathleen M Weber¹⁵Mirjam-Colette Kempf^1,2,3

• ¹School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, United States
• ²Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, United States
• ³Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States
• ⁴Perisphere Real World Evidence, LLC., Austin, United States
• ⁵ViiV Healthcare, North Carolina, United States
• ⁶Leonard M. Miller School of Medicine, University of Miami, Miami, Florida, United States
• ⁷Department of Medicine, Albert Einstein College of Medicine, Bronx, New York, United States
• ⁸Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
• ⁹School of Medicine, University of California San Francisco, San Francisco, California, United States
• ¹⁰Georgetown University, Washington, DC, United States
• ¹¹Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States
• ¹²Mailman School of Public Health, Columbia University, New York City, New York, United States
• ¹³Schools of Nursing, Medicine, and Population Health Sciences, University of Mississippi Medical Center, Jackson, United States
• ¹⁴School of Public Health, Downstate Health Sciences University, Brooklyn, New York, United States
• ¹⁵Hektoen Institute of Medicine, Chicago, United States

Women with HIV (WWH) have a higher risk of hypertension compared to women without HIV (WWoH). Exposure to adverse socioeconomic (e.g., area level deprivation) and psychosocial factors (e.g., stigma, inadequate social support) may contribute to inequities in hypertension through their influence on health behaviors (e.g., substance use, diet, physical activity) and psychophysiological (e.g., stress) responses. We examined the association between socioeconomic and psychosocial factors, psychological distress, and current uncontrolled blood pressure among WWH (n=998) and WWoH (n=353) enrolled in the Women’s Interagency HIV Study (WIHS) at a single visit between April and September 2019. Socioeconomic and psychosocial factors were similar among WWH and WWoH. Among WWH and WWOH, 50.2% had current uncontrolled blood pressure, defined as a systolic blood pressure ≥130 mmHg or diastolic pressure ≥ 80 mmHg at the time of the study visit. Among WWH, socioeconomic, psychosocial, and behavioral factors explained 3% of the variance in blood pressure with self-reported health risk behaviors (r=0.15), and use of antihypertensive medication (r=0.09) had weak to moderate impact. Among WWoH, socioeconomic, psychosocial, and behavioral factors explained 10% of the variance in blood pressure, with self-reported health risk behaviors (r=0.19), use of antihypertensive medication (r=0.19), area-level social vulnerability (r=-0.17), and social support (r=0.16) demonstrating weak to moderate impacts. Tailored interventions that address socioeconomic and psychosocial stressors at the individual and societal levels may improve outcomes and reduce disparities in uncontrolled blood pressure.