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.

Keywords: Cigarette smoking; MSM; Minority; Psychiatric illness; Viral suppression.

Conflict of interest statement

Conflict of interest Dr. Hilary J. Aralis, Dr. Ron Brookmeyer, Amy Ragsdale, Dr. Robert Bolan and Dr. Pamina M. Gorbach declare that they have no conflict of interest. Dr. Steve Shoptaw receives clinical supplies for his research from Medicinova, Inc.

Figures

Fig. 1

Diagram depicting the distribution and overlap of psychiatric illness, cigarette smoking, and other drug use among the 128 HIV- positive MSM participating in The mSTUDY who indicated at least one of these three factors. Circles are scaled such that the area is proportional to the number of individuals with the particular factor

Fig. 2

Model-based predicted probabilities for the event of receiving a prescription for HIV medications (RX) and joint event predicted probabilities for the events of receiving a prescription and reporting recent adherence (ADH), and the events of receiving a prescription, reporting recent adherence, and attaining viral suppression (SUP) among HIV-positive MoCSM enrolled in The mSTUDY