Psychosocial Barriers to Viral Suppression in a Community-based Sample of Human Immunodeficiency Virus–infected Men Who Have Sex With Men and People Who Inject Drugs in India

Abstract

Background Little is known about the impact of psychosocial factors and substance use on viral suppression among human immunodeficiency virus (HIV)–infected key populations in resource-limited settings. Accordingly, we examined the association and interactions between depression, alcohol use, and recreational drug use on viral suppression among men who have sex with men (MSM) and people who inject drugs (PWID) in India. Methods MSM and PWID were recruited across India using respondent-driven sampling (RDS). Correlates of viral suppression were determined using Poisson regression models incorporating RDS-II weights. Two-way multiplicative interactions were assessed with separate models of all combinations of the 3 variables of interest using interaction terms; 3-way interactions were evaluated by stratifying 2-way interactions by the third variable. Results Among 1454 treatment-eligible HIV-infected MSM and 1939 PWID, older age (adjusted prevalence ratio [aPR], 1.14 for MSM; 1.41 for PWID) and higher HIV treatment literacy (aPR, 1.58 for MSM; 3.04 for PWID) were positively associated with viral suppression. Among MSM, there was evidence of a synergistic negative association between severe depression and recreational drug use (aPR, 0.37 [95% confidence interval {CI}, .16–.84]), alcohol dependence and recreational drug use (aPR, 0.45 [95% CI, .20–.99]), and severe depression, alcohol dependence, and recreational drug use (aPR, 0.23 [95% CI, .09–.57]). Among PWID, daily injection (aPR, 0.51 [95% CI, .31–.82]) was the primary barrier to suppression. Conclusions Incorporating psychosocial and harm-reduction services into differentiated care models targeting MSM and PWID in low-resource settings is critical to achieving the 90-90-90 HIV/AIDS targets.

Time for a more holistic approach to HIV prevention for men who have sex with men?

“…6 They often turn to substance use, including alcohol, as a coping mechanism, which can negatively affect HIV outcomes. 7,8 The advent of the COVID-19 pandemic is likely to only further aggravate this depression, substance use, and stress.…”

Substance use is associated with condomless anal intercourse among men who have sex with men in India: a partner-level analysis

“…There are currently millions of opiate and sedative users in India- this problem is likely to worsen in the coming years with the influx of party drugs, such as ecstasy, into the Indian market [ 32 ]. Interventions targeting these high levels of substance use including alcohol are needed among MSM in such settings as they have the potential to reduce transmission as demonstrated in these data and improve viral suppression as previously demonstrated [ 8 ]. The interventions must be designed with awareness about the current legal environment around these substances.…”

“…Providing accessible and acceptable prevention options aimed at reducing risky sexual behavior remain critical strategies for reducing HIV transmission in this population. The importance of interventions that integrate HIV care with substance use and mental health services has been suggested by prior work, including from our group [ 5 , 8 ].…”

A scoping review of lesbian, gay, bisexual, transgender, queer, and intersex (LGBTQI+) people’s health in India

“…Over one-fourth of the articles (27%; n=48) [95–142] reported on stigma, discrimination, violence, and their associations with physical and mental health. Among these, 16 articles focused on stigma-related aspects of LGBTQI+ health [96, 100–102, 109, 110, 112, 114, 119, 124–126, 129, 132, 137, 140], 3 on violence [97, 103, 118], 17 on mental health and its correlates, such as quality of life [95, 99, 105, 106, 108, 111, 115, 123, 127, 128, 130, 131, 135, 136, 138, 139, 142], two on resilience [122, 133] and one article each on coping skills [141] and promoting LGBTQI+ acceptance [134]. Three articles reported on stress [116], perceived psychological impact [120] and violence [121] associated with Section-377 of the Indian Penal Code, which until September 2018 criminalised adult consensual same-sex relationships.…”