Original Article

Stigma, Social Support, and Substance Use in Diverse Men Who Have Sex With Men and Transgender Women Living with HIV in the US Southeast

Authors: Katherine R. Schafer, MD, Amanda E. Tanner, PhD, MPH, Lilli Mann-Jackson, MPH, Jorge Alonzo, JD, Eunyoung Y. Song, PhD, Scott D. Rhodes, PhD, MPH

Abstract

Objectives: Human immunodeficiency virus (HIV) rates in the southeast United States are high and substance use is common among people living with HIV (PLWH). This study used baseline data from the weCare intervention study to examine factors associated with the use of alcohol, tobacco, and marijuana among racially and ethnically diverse young gay, bisexual, and other men who have sex with men (GBMSM) and transgender women in the southeast who were newly diagnosed as having HIV, not linked to care, out of care, and/or not virally suppressed.

Methods: Self-reported data were collected from 196 GBMSM and transgender women living with HIV via Audio Computer-Assisted Self-Interview at enrollment. Measures assessed demographics; stigma; social support; basic and clinical service needs; HIV disclosure; social media use; and recent use of alcohol, tobacco, and marijuana. Logistic regression identified correlates of past 30-day substance use.

Results: In multivariable analysis, increased age and needing basic support services were associated with past 30-day tobacco, cigarette, electronic cigarette, and/or hookah use. Increased HIV-related stigma and needing basic support services were associated with past 30-day marijuana use. Being White and needing clinical support services were associated with infrequent or no past 30-day marijuana use.

Conclusions: HIV-related stigma and needing basic support services were associated with substance use among GBMSM and transgender women living with HIV in the southeastern United States. Routine screening for basic needs could identify GBMSM and transgender women living with HIV at risk for substance use and offer insight into intervention leverage points.
Posted in: Infectious Disease136

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References

1. Schuler MS, Rice CE, Evans-Polce RJ, et al. Disparities in substance use behaviors and disorders among adult sexual minorities by age, gender, and sexual identity. Drug Alcohol Depend 2018;189:139–146.
 
2. Substance Abuse and Mental Health Services Administration. National survey on drug use and health: lesbian, gay, & bisexual (LGB) adults. https://www.samhsa.gov/data/report/2019-nsduh-lesbian-gay-bisexual-lgb-adults. Accessed February 27, 2020.
 
3. Jamal A, Phillips E, Gentzke AS, et al. Current cigarette smoking among adults—United States, 2016. MMWR Morb Mortal Wkly Rep 2018;67:53–59.
 
4. Chou FY, Armstrong HL, Wang L, et al. A longitudinal analysis of cannabis use and mental health symptoms among gay, bisexual, and other men who have sex with men in Vancouver, Canada. J Affect Disord 2019;247:125–133.
 
5. Dawson-Rose C, Draughon JE, Zepf R, et al. Prevalence of substance use in an HIV primary care safety net clinic: a call for screening. J Assoc Nurses AIDS Care 2017;28:238–249.
 
6. Moore CL, Gidding HF, Jin F, et al. Patterns of drug use and drug-related hospital admissions in HIV-positive and -negative gay and bisexual men. AIDS Behav 2016;20:2372–2386.
 
7. Shariati H, Armstrong HL, Cui Z, et al. Changes in smoking status among a longitudinal cohort of gay, bisexual, and other men who have sex with men in Vancouver, Canada. Drug Alcohol Depend 2017;179:370–378.
 
8. Lachowsky NJ, Dulai JJ, Cui Z, et al. Lifetime doctor-diagnosed mental health conditions and current substance use among gay and bisexual men living in Vancouver, Canada. Subst Use Misuse 2017;52:785–797.
 
9. Lehavot K, Huh D, Walters KL, et al. Buffering effects of general and medication-specific social support on the association between substance use and HIV medication adherence. AIDS Patient Care STDS 2011;25: 181–189.
 
10. Reback CJ, Runger D, Fletcher JB. Drug use is associated with delayed advancement along the HIV care continuum among transgender women of color. AIDS Behav 2021;25(suppl 1):107–115.
 
11. Rosen JG, Malik M, Cooney EE, et al. Antiretroviral treatment interruptions among Black and Latina transgender women living with HIV: characterizing co-occurring, multilevel factors using the gender affirmation framework. AIDS Behav 2019;23:2588–2599.
 
12. Xavier Hall CD, Morgan E, Bundy C, et al. Substance use predicts sustained viral suppression in a community cohort of sexual and gender minority youth living with HIV. AIDS Behav 2021;25:3303–3315.
 
13. Cook RL, Zhou Z, Kelso-Chichetto NE, et al. Alcohol consumption patterns and HIV viral suppression among persons receiving HIV care in Florida: an observational study. Addict Sci Clin Pract 2017;12:22.
 
14. Pence BW, Thielman NM, Whetten K, et al. Coping strategies and patterns of alcohol and drug use among HIV-infected patients in the United States Southeast. AIDS Patient Care STDS 2008;22:869–877.
 
15. Williams EC, Hahn JA, Saitz R, et al. Alcohol use and human immunodeficiency virus (HIV) infection: current knowledge, implications, and future directions. Alcohol Clin Exp Res 2016;40:2056–2072.
 
16. Volkow ND, Baler RD, Compton WM, et al. Adverse health effects of marijuana use. N Engl J Med 2014;370:2219–2227.
 
17. Hall W, Degenhardt L. Adverse health effects of non-medical cannabis use. Lancet 2009;374:1383–1391.
 
18. Jha P, Ramasundarahettige C, Landsman V, et al. 21st-century hazards of smoking and benefits of cessation in the United States. N Engl J Med 2013; 368:341–350.
 
19. Chatham-Stephens K, Roguski K, Jang Y, et al. Characteristics of hospitalized and nonhospitalized patients in a nationwide outbreak of e-cigarette, or vaping, product use-associated lung injury—United States, November 2019. MMWR Morb Mortal Wkly Rep 2019;68:1076–1080.
 
20. Centers for Disease Control and Prevention. HIV surveillance report. Volume 29. Diagnoses of HIV infection in the United States and dependent areas, 2017. https://www.cdc.gov/hiv/pdf/library/reports/surveillance/cdc-hiv-surveillancereport-2017-vol-29.pdf. Published November 2018. Accessed March 2020.
 
21. Hernandez D, Kalichman SC, Katner HP, et al. Psychosocial complications of HIV/AIDS-metabolic disorder comorbidities among patients in a rural area of southeastern United States. J Behav Med 2018;41:441–449.
 
22. Skalski LM, Watt MH, MacFarlane JC, et al. Mental health and substance use among patients in a North Carolina HIV clinic. NC Med J 2015;76: 148–155.
 
23. Centers for Disease Control and Prevention. HIV and AIDS in the United States by region. https://www.cdc.gov/hiv/statistics/overview/geographicdistribution. html. Updated May 11, 2015. Accessed April 19, 2016.
 
24. Amico KR, Konkle-Parker DJ, Cornman DH, et al. Reasons for ART nonadherence in the Deep South: adherence needs of a sample of HIV-positive patients in Mississippi. AIDS Care 2007;19:1210–8.
 
25. Fredericksen RJ, Edwards TC, Merlin JS, et al. Patient and provider priorities for self-reported domains of HIV clinical care. AIDS Care 2015;27:1255–1264.
 
26. Glynn TR, Llabre MM, Lee JS, et al. Pathways to health: an examination of HIV-related stigma, life stressors, depression, and substance use. Int J Behav Med 2019;26:286–296.
 
27. Kempf MC, McLeod J, Boehme AK, et al. A qualitative study of the barriers and facilitators to retention-in-care among HIV-positive women in the rural southeastern United States: implications for targeted interventions. AIDS Patient Care STDS 2010;24:515–520.
 
28. Sweeney SM, Vanable PA. The association of HIV-related stigma to HIV medication adherence: a systematic review and synthesis of the literature. AIDS Behav 2016;20:29–50.
 
29. Giordano TP, Gifford AL, White AC Jr, et al. Retention in care: a challenge to survival with HIV infection. Clin Infect Dis 2007;44:1493–1439.
 
30. Reif S, Wilson E, McAllaster C, et al. The relationship of HIV-related stigma and health care outcomes in the US Deep South. AIDS Behav 2019; 23(suppl 3):242–250.
 
31. Novak NL, Baquero B, Askelson NM, et al. Health equity in midsize rural communities: challenges and opportunities in a changing rural America. Am J Public Health 2020;110:1342–1343.
 
32. US Census Bureau, 2011-2015 ACS 5-year estimates. https://www.census. gov/programs-surveys/acs/technical-documentation/table-and-geographychanges/2015/5-year.html. Accessed March 11, 2021.
 
33. Bekele T, Rourke SB, Tucker R, et al. Direct and indirect effects of perceived social support on health-related quality of life in persons living with HIV/ AIDS. AIDS Care 2013;25:337–346.
 
34. Qiao S, Li X, Stanton B. Social support and HIV-related risk behaviors: a systematic review of the global literature. AIDS Behav 2014;18:419–441.
 
35. Utz S. The function of self-disclosure on social network sites: not only intimate, but also positive and entertaining self-disclosures increase the feeling of connection. Comput Hum Behav 2015;45:1–10.
 
36. Medich M, Swendeman DT, Comulada WS, et al. Promising approaches for engaging youth and young adults living with HIV in HIV primary care using social media and mobile technology interventions: protocol for the SPNS Social Media Initiative. JMIR Res Protoc 2019;8:e10681.
 
37. Centers for Disease Control and Prevention. Linkage to, Retention in, and Re-engagement in HIV Care (LRC) Chapter. https://www.cdc.gov/ hiv/research/interventionresearch/compendium/lrc/index.html. Accessed January 2020.
 
38. Tanner AE, Mann L, Song E, et al. weCARE: a social media-based intervention designed to increase HIV care linkage, retention, and health outcomes for racially and ethnically diverse young MSM. AIDS Educ Prev 2016;28: 216–230.
 
39. Tanner AE, Song EY, Mann-Jackson L, et al. Preliminary impact of the weCare social media intervention to support health for young men who have sex with men and transgender women with HIV. AIDS Patient Care STDS 2018;32:450–458.
 
40. Centers for Disease Control and Prevention. HIV/AIDS Prevention Research Synthesis Project. Compendium of Evidence-Based Interventions and Best Practices for HIV Prevention. https://www.cdc.gov/hiv/research/ interventionresearch/compendium/index.html. Updated April 14, 2020. Accessed April 21, 2020.
 
41. Tanner AE, Mann-Jackson L, Song EY, et al. Supporting health among young men who have sex with men and transgender women with HIV: lessons learned from implementing the weCare intervention. Health Promot Pract 2020;21:755–763.
 
42. Berger BE, Ferrans CE, Lashley FR. Measuring stigma in people with HIV: psychometric assessment of the HIV stigma scale. Res Nurs Health 2001;24: 518–529.
 
43. Hosmer D, Lemeshow S. Applied Logistic Regression. New York: John Wiley & Sons; 1989.
 
44. Altman D, Aggleton P, Williams M, et al. Men who have sex with men: stigma and discrimination. Lancet 2012;380:439–445.
 
45. The National Academies of Sciences, Engineering, and Medicine. Integrating Social Care into the Delivery of Health Care: Moving Upstream to Improve the Nation’s Health. Washington DC: The National Academies Press; 2019.
 
46. Lupez EL, Lammert T, Davis G, et al. “I’ll take gender identity for 500.” Changing knowledge and comfort in the care of LGBTQ patients with a novel training approach. https://www.acponline.org/system/files/ documents/membership/residents/competitions-awards/nationalabstract-competition/student-winners-2018.pdf. Published 2018. Accessed November 7, 2021.
 
47. Fuster-RuizdeApodaca MJ, Castro-Granell V, Garin N, et al. Prevalence and patterns of illicit drug use in people living with HIV in Spain: a crosssectional study. PLoS One 2019;14:e0211252.
 
48. Centers for Disease Control and Prevention. HIV in the southern United States. https://www.cdc.gov/hiv/pdf/policies/cdc-hiv-in-the-south-issuebrief.pdf. Updated September 2019. Accessed February 13, 2020.