Polysubstance Use, Social Drivers, and Mental Health in Persons with HIV
Overview
This study analyzed 171 persons with HIV (PWH) to examine how no, single, and polysubstance use relate to social drivers of health (SDOH) and mental health symptoms. Polysubstance users reported the highest risk across multiple SDOH domains and had significantly greater odds of mental health symptoms compared to non-users. These findings highlight the complex interplay between substance use patterns, social needs, and mental health in PWH.
Background
Substance use is prevalent among persons with HIV, with over half reporting recent marijuana or illicit drug use. Mental health disorders such as depression, anxiety, bipolar disorder, and PTSD are also more common in this population. Substance use is linked to poorer HIV outcomes including lower viral suppression and medication adherence. While prior research has focused on single substances or substance use disorders, less is known about how polysubstance use correlates with social determinants and mental health symptoms in PWH.
Data Highlights
Group
Participants (n)
Male (%)
Black (%)
Hispanic (%)
Income ≤$20,000 (%)
HIV-1 RNA ≤200 copies/mL (%)
Polysubstance
67
75
61
13
Higher proportion
91
Single substance
68
75
61
13
Higher proportion
91
Controls (no substance)
36
75
61
13
Lower proportion
91
Key Findings
Polysubstance users reported the greatest number of social drivers of health (SDOH) domains at risk compared to single substance users and controls.
Adjusted odds of transportation needs and food insecurity were 2 to 5 times higher in substance using groups versus controls.
Mental health symptom domains including depression, mania, anxiety, and PTSD were significantly more prevalent in substance using groups.
Polysubstance use is strongly associated with both increased social needs and mental health symptoms in PWH engaged in care.
Substance using groups were younger and had a higher proportion of transgender women and low income (≤$20,000/year).
Clinical Implications
Clinicians caring for persons with HIV should routinely assess for polysubstance use as it is linked to greater social vulnerabilities and mental health symptoms. Addressing transportation, food insecurity, and mental health in substance using PWH may improve engagement and outcomes. Integrated care models that consider substance use patterns alongside social and psychological needs are warranted.
Conclusion
Polysubstance use among persons with HIV is an important correlate of social drivers of health risk and mental health symptom burden. Targeted interventions addressing these interconnected factors are needed to optimize health outcomes in this population.
References
Investigators/2024 -- Investigating the Relationships Among Polysubstance Use, Social Determinants of Health, and Mental Health Symptoms in Individuals Living with HIV
