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Psychosocial Syndemic Classes and Longitudinal Transition Patterns Among Sexual Minority men Living with or Without HIV in the Multicenter AIDS Cohort Study (MACS)

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Abstract

Mental health and substance use epidemics interact to create psychosocial syndemics, accelerating poor health outcomes. Using latent class and latent transition analyses, we identified psychosocial syndemic phenotypes and their longitudinal transition pathways among sexual minority men (SMM) in the Multicenter AIDS Cohort Study (MACS, n = 3,384, mean age 44, 29% non-Hispanic Black, 51% with HIV). Self-reported depressive symptoms and substance use indices (i.e., smoking, hazardous drinking, marijuana, stimulant, and popper use) at the index visit, 3-year and 6-year follow-up were used to model psychosocial syndemics. Four latent classes were identified: “poly-behavioral” (19.4%), “smoking and depression” (21.7%), “illicit drug use” (13.8%), and “no conditions” (45.1%). Across all classes, over 80% of SMM remained in that same class over the follow-ups. SMM who experienced certain psychosocial clusters (e.g., illicit drug use) were less likely to transition to a less complex class. These people could benefit from targeted public health intervention and greater access to treatment resources.

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Data Sharing

Access to individual-level data from the MACS/WIHS Combined Cohort Study Data (MWCCS) may be obtained upon review and approval of a MWCCS concept sheet. Links and instructions for online concept sheet submission are on https://statepi.jhsph.edu/mwccs/work-with-us/.

Code Availability

Code used for the presented analysis are available upon request to the corresponding author.

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Acknowledgements

The contents of this publication are solely the responsibility of the authors and do not represent the official views of the National Institutes of Health (NIH). MWCCS (Principal Investigators): Atlanta CRS (Ighovwerha Ofotokun, Anandi Sheth, and Gina Wingood), U01-HL146241; Baltimore CRS (Todd Brown and Joseph Margolick), U01-HL146201; Bronx CRS (Kathryn Anastos, David Hanna, and Anjali Sharma), U01-HL146204; Brooklyn CRS (Deborah Gustafson and Tracey Wilson), U01-HL146202; Data Analysis and Coordination Center (Gypsyamber D’Souza, Stephen Gange and Elizabeth Golub), U01-HL146193; Chicago-Cook County CRS (Mardge Cohen and Audrey French), U01-HL146245; Chicago-Northwestern CRS (Steven Wolinsky), U01-HL146240; Northern California CRS (Bradley Aouizerat, Jennifer Price, and Phyllis Tien), U01-HL146242; Los Angeles CRS (Roger Detels and Matthew Mimiaga), U01-HL146333; Metropolitan Washington CRS (Seble Kassaye and Daniel Merenstein), U01-HL146205; Miami CRS (Maria Alcaide, Margaret Fischl, and Deborah Jones), U01-HL146203; Pittsburgh CRS (Jeremy Martinson and Charles Rinaldo), U01-HL146208; UAB-MS CRS (Mirjam-Colette Kempf, Jodie Dionne-Odom, and Deborah Konkle-Parker), U01-HL146192; UNC CRS (Adaora Adimora and Michelle Floris-Moore), U01-HL146194. The MWCCS is funded primarily by the National Heart, Lung, and Blood Institute (NHLBI), with additional co-funding from the Eunice Kennedy Shriver National Institute Of Child Health & Human Development (NICHD), National Institute On Aging (NIA), National Institute Of Dental & Craniofacial Research (NIDCR), National Institute Of Allergy And Infectious Diseases (NIAID), National Institute Of Neurological Disorders And Stroke (NINDS), National Institute Of Mental Health (NIMH), National Institute On Drug Abuse (NIDA), National Institute Of Nursing Research (NINR), National Cancer Institute (NCI), National Institute on Alcohol Abuse and Alcoholism (NIAAA), National Institute on Deafness and Other Communication Disorders (NIDCD), National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institute on Minority Health and Health Disparities (NIMHD), and in coordination and alignment with the research priorities of the National Institutes of Health, Office of AIDS Research (OAR). MWCCS data collection is also supported by UL1-TR000004 (UCSF CTSA), UL1-TR003098 (JHU ICTR), UL1-TR001881 (UCLA CTSI), P30-AI-050409 (Atlanta CFAR), P30-AI-073961 (Miami CFAR), P30-AI-050410 (UNC CFAR), P30-AI-027767 (UAB CFAR), and P30-MH-116867 (Miami CHARM). In addition to WIHS funding, this analysis was supported by the career development awards of NIH (Chichetto, K01AA029042, Lahiri K23AI124913, Hanna K01HL137557, Muntner/Wise (PI/Awardee) K12HL143958) and T32 postdoctoral fellowship support (Ramos, T32DA023356). Lastly, this analysis was partly supported by the NIAID under Award Number R01AI145552 (Co-PIs: Salemi, Prosperi) and Award Number R01MD010680 (PI: Friedman/Plankey). The authors gratefully acknowledge the contributions of the study participants and dedication of the staff at the MWCCS sites.

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Author notes

  1. Michael Plankey and Natalie E Chichetto are joint anchor authors on this work.

Authors and Affiliations

  1. University of Florida, Gainesville, FL, USA

    Yiyang Liu & Natalie E Chichetto

  2. University of California – San Diego, San Diego, La Jolla, CA, USA

    Stephen D Ramos

  3. Albert Einstein College of Medicine, Bronx, NY, USA

    David B Hanna

  4. University of Miami Miller School of Medicine, Miami, FL, USA

    Deborah L Jones

  5. SUNY-Downstate Medical Center, Brooklyn, NY, USA

    Jason M Lazar

  6. San Francisco Veterans Affairs Health Care System, University of California, San Francisco, CA, USA

    Jorge R Kizer

  7. Stroger Hospital, Cook County Health and Hospitals System, Chicago, IL, USA

    Mardge H Cohen

  8. Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

    Sabina A Haberlen

  9. UNC-Chapel Hill, Chapel Hill, NC, USA

    Adaora A Adimora

  10. Department of Medicine, Division of Infectious Diseases, Emory University, Atlanta, GA, USA

    Cecile D Lahiri

  11. University of Alabama at Birmingham, Birmingham, AL, England

    Jenni M Wise

  12. School of Public Health. Newark, Rutgers, the State University of New Jersey, New Brunswick, NJ, Canada

    Mackey R Friedman

  13. Georgetown University Medical Center, Washington, DC, USA

    Michael Plankey

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  1. Yiyang Liu
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Contributions

N.E.C., Y.L., and M.P. conceived of the research question. N.E.C., Y.L., M.P., and S.R. contributed to the analytic design of the study. A.A.A., M.H.C., D.L.J., D.B.H. are study site Principal Investigators and contributed to the implementation of the cohort or data collection. N.E.C., S.A.H., D.B.H., M.P., J.R.K., C.D.L., J.M.L, M.R.F., and J.M.W. are Study Site Investigators and contribute to site and working group management. S.A.H. contributed to data planning, management, and cleaning. Y.L., N.E.C., and M.P. contributed to data analyses and table/figure construction. Y.L., N.E.C., M.P. and S.R. created the first draft of the paper. All authors contributed to the edits of the manuscript, and critically reviewed and approved the final version.

Corresponding author

Correspondence to Natalie E Chichetto.

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Competing Interests

Dr. Liu receives grant funding from Merck. Dr. Kizer reports stock ownership in Abbott, Bristol Myers Squibb, Johnson & Johnson, Medtronic, Merck, and Pfizer. Dr. Lahiri receives grant funding from Merck and serves on the Advisory Board for Theratechnologies, Inc. Dr. Adimora has received fees for consulting from Merck and Gilead. Merck and Gilead have provided her institution with funding for her research. None of the other authors had any financial or other conflicts of interest.

Ethics Approval and Informed Consent

The primary MACS study was approved by the institutional review boards (IRB) of each study center (John Hopkins, Northwestern University, University of California Los Angeles, and University of Pittsburgh). Written informed consent was provided by participants. The University of Florida IRB approved the described secondary analyses of MACS data.

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Appendix

Appendix

Table 1 Model fit statistics for cross-sectional latent class analysis at the index visit, three and six years follow-up (FU) visits
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Liu, Y., Ramos, S.D., Hanna, D.B. et al. Psychosocial Syndemic Classes and Longitudinal Transition Patterns Among Sexual Minority men Living with or Without HIV in the Multicenter AIDS Cohort Study (MACS). AIDS Behav 27, 4094–4105 (2023). https://doi.org/10.1007/s10461-023-04123-y

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