African American/Black and Latino Adults with Detectable HIV Viral Load Evidence Substantial Risk for Polysubstance Substance Use and Co-occurring Problems: A Latent Class Analysis

Abstract

Substance use problems are highly prevalent among persons living with (PLWH) in the United States and serve as serious barriers to engagement in HIV care. Yet, in contrast to studies of single substances, little is known about patterns of polysubstance use in this population. Moreover, other risk factors (e.g., financial hardship, incarceration, homelessness, and mental health distress) are also prevalent and complicate HIV management. The present study drew on a cross-sectional survey with African American/Black and Latino (AABL) adult PLWH from low socioeconomic status backgrounds in New York City who were insufficiently engaged in HIV care and evidenced detectable HIV viral load ( N = 512). We used latent class analysis (LCA) to explore patterns of polysubstance use and their relationships to financial hardship, incarceration, homelessness, and mental health. LCA yielded three substance use classes: Class 1, a high polysubstance use/high-risk substance use class (9%); Class 2, a polysubstance use/moderate substance use risk class (18%); and Class 3, a moderate polysubstance use/moderate-to-low-risk substance use class (74%). Mental health symptoms were prevalent in all classes, but Class 1 had greater mental health distress than the other two classes. Current homelessness was more prevalent in Classes 1 and 2. We cannot end the HIV epidemic without engaging and treating AABL PLWH who have serious barriers to engagement along the HIV care continuum, and who evidence polysubstance use along with co-occurring risk factors. Clinical settings can develop outreach and engagement approaches to bring this subpopulation of PLWH into care settings, and further, specialized services are needed to successfully screen, treat, and retain them.

Polysubstance use in a community sample of Black cisgender sexual minority men and transgender women in Chicago during initial COVID-19 pandemic peak

“…Polysubstance use, defined as using two or more substances, remains a health risk factor for sexual and gender minorities, with less known among Black SMM and transgender women [ 13 , 14 , 19 , 20 ]. Polysubstance use has been identified as part of a syndemic affecting sexual and gender minorities, contributing to the burden of disease, including HIV among this population [ 19 , 21 ].…”

Advancing behavioral interventions for African American/Black and Latino persons living with HIV using a new conceptual model that integrates critical race theory, harm reduction, and self-determination theory: a qualitative exploratory study

“…AABL-PLWH generally express satisfaction with their individual health care providers, but evidence dissatisfaction with the health care and social service systems and care settings [ 24 ]. Substance use at both non-hazardous and hazardous levels, past and present, are very common among AABL-PLWH [ 25 ] but treatment for hazardous substance use among AABL-PLWH has historically been influenced by the abstinence-only model, and by punitive approaches that are not generally acceptable to or effective for AABL-PLWH [ 26 ]. AABL-PLWH report that approaches guided by harm reduction and those that enhance dignity, communicate non-judgment, and support personal autonomy are generally lacking in health care settings, but sorely needed [ 14 , 27 ].…”

Advancing behavioral interventions for African American/Black and Latino persons living with HIV by integrating critical race theory, harm reduction, and self-determination theory: A qualitative exploratory study

“…AABL-PLWH on the whole express satisfaction with their health care providers, but evidence dissatisfaction with the health care and social service system and care settings [16]. Moreover, substance use at both non-hazardous and hazardous levels, past and present, are common among AABL-PLWH [17] but treatment for hazardous substance use among AABL-PLWH has historically been in uenced by the abstinence-only model, and by punitive approaches that are not generally acceptable to or effective for AABL-PLWH [18]. Social-level barriers to engagement along the HIV care continuum for this population include complex stigma [19].…”