Dissertations & Theses (Open Access)

Date of Award

8-2020

Degree Name

Master of Science (MS)

Advisor(s)

Wenyaw Chan

Second Advisor

Kayo Fujimoto

Third Advisor

Eric Jones

Abstract

The community of young men who have sex with men (YMSM) has higher rates of substance use than the general population and the use of alcohol, cannabis, and illicit drugs has been shown to have a negative impact on the HIV care continuum. Our first aim was to understand the prevalence of substance use in the community through the use of self-reported, RDS-II, and RDS-SS estimates. We used multivariable logistic and negative binomial GEE with QIC selection to determine the factors important to having a prescription and staying adherent, respectively. Selected variables were included with a subset of substance use and network factors to understand the role drug use in YMSM networks impact the care continuum using logistic and NB GEE models. Participants for analysis were 755 YMSM from Chicago, IL and Houston, TX in 2014 – 2016. All prevalence estimates were similar in the two cities. The prevalence of illicit drugs in both cities was about 54% based on self-report, but RDS estimates were closer to 40%. The prevalence of cannabis and alcohol use was 85% and 96% in Chicago, respectively; the prevalence in Houston was 80% and 96%, respectively. Multivariable GEE showed black YMSM were found to be 96% less likely to have a prescription than their counterparts, and low trust in treatment providers was associated with lower odds of having a prescription (OR 0.19, 95% CCI 0.04, 0.82). Having insurance was the most important protective factor with missing fewer doses (OR 0.43 95% CI 0.23, 0.91). Cannabis use (OR 1.31 95% CI 1.07, 1.62) during sex and use of illegal drugs were significant in the outcome of staying adherent (OR 1.80 95% CI 1.0, 3.24). Venue exposures and drug use in YMSM networks were not significantly related. These analyses show that prevalence of drug use in the YMSM community is high and is an important factor to consider during treatment of HIV, particularly if use is associated with sex. Reducing the racial disparities in the HIV care continuum, however, continues to be of the highest importance.

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