Psychiatric Illness, Substance Use, and Viral Suppression Among HIV-Positive Men of Color Who Have Sex with Men in Los Angeles

Abstract

For individuals living with human immunodeficiency virus (HIV), viral suppression positively affects quality and length of life and reduces risks for HIV transmission. Men of color who have sex with men (MoCSM) who have been diagnosed with HIV have disproportionately low rates of viral suppression, with concomitant increases in incidence. We identified specific social, structural, and psychiatric factors associated with viral suppression among a sample of 155 HIV-positive MoCSM. Cigarette smoking and biological markers of recent drug use were significantly associated with detectable viral load. In contrast, individuals reporting a history of psychiatric illness during medical examination were more likely to be virally suppressed. Further analyses demonstrated that psychiatric illness may affect virologic outcomes through increased probability of being prescribed HIV medications. Alternatively, cigarette smoking and drug use appear to negatively affect subsequent HIV Care Continuum milestones such as medication adherence. Findings provide support for comprehensive intervention programs that emphasize prevention and treatment of cigarette, methamphetamine, and other drug use, and promote improved connection to psychiatric care. Continual achievement of this goal may be a crucial step to increase rates of viral suppression and slow HIV incidence in communities of MoCSM in Los Angeles and other urban areas.

Investigating possible syndemic relationships between structural and drug use factors, sexual HIV transmission and viral load among men of colour who have sex with men in Los Angeles County

“…The methodology of our ongoing prospective cohort study (‘mSTUDY’) has been described in detail elsewhere . Briefly, it is a National Institute of Drug Abuse‐funded program with the overall objective of measuring factors linking substance use with dynamics of HIV transmission and progression (e.g.…”

HIV Care Outcomes among Hispanics/Latinos with Diagnosed HIV in the United States by Place of Birth-2015–2018, Medical Monitoring Project

“…Mainland-US-born Hispanics/Latinos were more likely than PR-born and non-US-born Hispanics/Latinos to report the use of drugs and were more likely than non-US-born Hispanics/Latinos to report symptoms of anxiety and depression. Psychiatric illnesses combined with substance use are associated with poor HIV outcomes [22,23]. Persons with diagnosed HIV who are using drugs are less likely to adhere to treatment and achieve viral suppression [22], and those who are experiencing current symptoms of depression combined with the use of cocaine or methamphetamine were found to have lower odds of virologic suppression [23].…”

Tobacco dependence treatment for special populations: challenges and opportunities

“…These populations have consistently higher smoking rates than the general population, 1 have several shared vulnerabilities, 2 and are often more refractory to treatment. 3 Continued smoking has important negative impacts on treatment of their primary disease and their prognosis for recovery, 4 and special care is often needed for successful tobacco dependence treatment. 5 These ''forgotten groups'' continue to smoke in significant numbers and experience significant health disparities because they have not been receiving the needed protection from tobacco control policies.…”

“…Smoking has been associated with poor medication adherence and prognosis among PLWHA, 16 and a study found that medication adherence was negatively influenced by smoking in an HIV-positive sample of men of color who have sex with men. 4 The authors of this study point out that smoking prevention and treatment is one of the most important interventions that can be provided to PLWHA, especially among minorities. Smoking may also complicate treatment of many mental health disorders by reducing blood levels of neuroleptics, such as olanzapine, clozapine, haloperidol, chlorpromazine, and fluphenazine, 17 making it likely that smokers will require higher doses to achieve a therapeutic effect, which exposes them to an increased risk of side effects from psychotherapeutic medications.…”