Psychiatric Illness, Substance Use, and Viral Suppression Among HIV-Positive Men of Color Who Have Sex with Men in Los Angeles
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.
KeywordsMinority MSM Viral suppression Psychiatric illness Cigarette smoking
The mSTUDY was funded by the National Institute of Drug Abuse (NIDA) under Project Number 5U01DA036267 awarded to Dr. Pamina Gorbach and Dr. Steve Shoptaw at the University of California Los Angeles (UCLA). Additional support for this research was provided by National Institutes of Health (NIH) Grant Number P30 MH058107 awarded to Principal Investigator Dr. Steve Shoptaw at the UCLA Center for HIV Identification, Prevention and Treatment Services (CHIPTS).
Compliance with Ethical Standards
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.
All procedures performed in this study were in accordance with the Ethical Standards of the Institutional Research Committee and with the 1964 Helsinki Declaration and its later amendments. This article does not contain any studies with animals performed by any of the authors.
Informed consent was obtained from all individual participants included in the study.
- 1.Centers for Disease Control and Prevention. HIV in the United States: the stages of care. https://www.cdc.gov/nchhstp/newsroom/docs/HIV-Stages-of-Care-Factsheet-508.pdf. Accessed 13 Jan 2017.
- 9.Centers for Disease Control and Prevention. HIV surveillance report. Diagnoses of HIV infection in the United States and dependent areas, vol 6. 2014. https://www.cdc.gov/hiv/pdf/library/reports/surveillance/cdc-hiv-surveillance-report-us.pdf. Accessed 3 Feb 2017.
- 12.Mugavero MJ, Raper JL, Reif S, Whetton K, Leserman J, Thielman NM, Pence BW. Overload: the impact of incident stressful events on antiretroviral medication adherence and virologic failure in a longitudinal, multi-site HIV cohort study. Psychosom Med. 2009;71(9):920–6.CrossRefPubMedPubMedCentralGoogle Scholar
- 19.Nelson G, Aubrey T, Lafrance A. A review of the literature on the effectiveness of housing and support, assertive community treatment, and intensive case management interventions for persons with mental illness who have been homeless. Am J Orthopsychiatry. 2007;77(3):350–61.CrossRefPubMedGoogle Scholar
- 27.Arnsten JH, Demas PA, Farzadegan H, Grant RW, Gourevitch MN, Cheng CJ, Buono D, Eckholdt H, Howard AA, Schoenbaum EE. Antiretroviral therapy adherence and viral suppression in HIV-infected drug users: comparison of self-report and electronic monitoring. Clin Infect Dis. 2001;33:1417–23.CrossRefPubMedPubMedCentralGoogle Scholar
- 38.Sheevan DV, Lecrubier Y, Sheevan KH, Amorim P, Janavs J, Weiller E, Hergueta T, Baker R, Dunbar GC. The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry. 1998;59(S20):22–33.Google Scholar
- 39.First M, Spitzer R, Gibon M, Williams J. Structured clinical interview for DSM-IV-TR Axis I, Research Version, Non-patient Edition (SCID-I/NP). Biometrics Research, New York State Psychiatric Institute. 2002.Google Scholar
- 43.O’Cleirigh C, Valentine SE, Pinkston M, Herman D, Bedoya CA, Gordon JR, Safren SA. The unique challenges facing HIV-positive patients who smoke cigarettes: HIV viremia, ART adherence, engagement in HIV care, and concurrent substance use. AIDS Behav. 2015;19:178–85.CrossRefPubMedPubMedCentralGoogle Scholar
- 44.Centers for Disease Control and Prevention. Current cigarette smoking among adults—United States, 2005–2014. https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6444a2.htm. Accessed 26 Jan 2017.