Evaluating Connections Between Polysubstance Use, Social Drivers of Health, and Mental Health Symptoms in People With HIV

Background We sought to understand how no, single, and polysubstance use correlate with social drivers of health (SDOH) and mental health symptoms in persons with HIV (PWH).Methods Cross-sectional analysis of PWH who use and do not use illicit substances and marijuana. Substance use was defined by self-report and toxicology (urine and hair). Surveys evaluated SDOH and mental health domains. Linear and logistic regression were used to assess the associations of polysubstance and single substance use with SDOH domains at risk and presence of mental health symptom domains compared to controls (no substance use).Results A total of 171 participants were enrolled (67 polysubstance, 68 single substance, and 36 controls): 75% were male, 61% were Black, and 13% were of Hispanic ethnicity. Substance using groups were younger, had more transgender women, and higher proportion with income <=$20 000/year. Ninety-one percent had HIV-1 RNA <= 200 copies/mL. Participants in the polysubstance group reported the most SDOH domains at risk. With adjustment, odds of transportation needs and food insecurity were 2 to 5 times higher for the substance using groups than controls. Odds of mental health symptom domains (depression, mania, anxiety, and posttraumatic stress disorder) were significantly higher in substance using groups than controls.Conclusions Substance use is strongly associated with SDOH domains at risk and mental health symptom domains in PWH. Polysubstance use appears to be an important correlate for SDOH domains at risk and this suggests more attention in both future research and clinical care is necessary to determine interventions that will improve SDOH and health-related outcomes. In this study, among persons with HIV who use substances, polysubstance use was common and was independently associated with reporting more SDOH domains at risk and more adverse childhood trauma than no substance use. PWH who use any substances reported more mental health symptoms than controls and whether polysubstance use or single-substance use appeared less important than for SDOH at risk.