Background: Pre-exposure prophylaxis (PrEP) is efficacious for HIV prevention. Black men who have sex with men (MSM) accounted for the largest proportion of new HIV diagnoses in the United States relative to other racial/ethnic groups. Black MSM who use substances are at an increased risk for HIV infection and are ideal candidates for PrEP, but barriers to maintaining PrEP adherence remain a concern. We assessed whether substance use behaviors are associated with initiation and adherence to PrEP among a sample of black MSM in the United States. Methods: Data for this analysis come from the HIV Prevention Trails Network Study 073 (HPTN 073). Substance use behaviors—including alcohol, marijuana, poppers (ie, alkyl nitrites), and stimulants (ie, methamphetamine/cocaine use) including use of these substances before/during condomless anal intercourse (CAI)—were assessed longitudinally through self-report. PrEP adherence was assessed by pharmacological testing in blood. Generalized estimating equations were used to evaluate association between substance use behaviors and PrEP initiation and adherence. Results: Among 226 HIV-negative black MSM, the majority (60%) were 25+ years of age. Most of the substance use behaviors were not significantly associated with PrEP initiation or adherence. However, stimulant use before/during CAI was significantly associated with lower odds of PrEP adherence (adjusted odds ratio = 0.21, 95% confidence interval = 0.07 to 0.61; P = <0.01). Conclusions: These findings suggest that PrEP adherence is feasible among black MSM who use substances. However, black MSM who engage in stimulant use before/during CAI may present a unique group for additional study and support with enhanced behavioral health and support services.

Conversion therapies to minimize same-sex attractions are classified as a dangerous practice by numerous scientific institutions in the United States. These practices may contribute to poor long-term psychosocial health, thereby interrupting processes of healthy aging. Few studies have examined psychosocial differences between persons with and without prior experiences of conversion therapy. We assessed associations between prior conversion therapy experiences and psychosocial health among midlife and older men who have sex with men (MSM; age 40+ years). Participants included a multicity sample of MSM (N = 1,156) enrolled in the Multicenter AIDS Cohort Study who completed health surveys (2016–2019) as part of their biannual study visits. Using multivariable regressions, we investigated the associations of prior conversion therapy with current depressive symptoms, internalized homophobia, post-traumatic stress, and cumulative psychosocial conditions. Using a trait-level measure (e.g., life purpose and perseverance), we tested whether resilience moderated these associations. The full sample was predominantly non-Hispanic white with a mean age of 62.6 years. Fifteen percent of men (n = 171/1,156) reported prior conversion therapy. In multivariable models, men exposed to conversion therapy were more likely to have depressive symptoms and above-average internalized homophobia. Men exposed to conversion therapy had 2–2.5 times the odds of reporting 1 and ≥2 psychosocial conditions, respectively, compared with those who reported 0 conditions. Resilience did not moderate these associations. Conversion therapies are nonaffirming social stressors for MSM and may compromise critical psychosocial aspects of healthy aging among MSM.

Men who have sex with men (MSM) experience high rates of homophobic victimization, which is linked to myriad chronic physical and mental health disparities. Social adversity such as rejection, isolation, and racial discrimination can induce a conserved transcriptional response to adversity (CTRA) involving upregulation of proinflammatory genes and downregulation of type I interferon and antibody synthesis genes. This study specifically examines whether homophobic victimization is associated with expression of CTRA profiles in Black and Latino MSM living in Los Angeles. Analyses linked behavioral survey data with quantified RNA from leukocytes from blood samples of 70 participants over 12 months. CTRA gene expression was increased by 3.1-fold in MSM who experienced homophobic victimization while adjusting for major leukocyte subsets and sociodemographics. Accounting for all these factors, CTRA gene expression was significantly enhanced in MSM who identified as Black compared to Latino. Our findings identify experiences of homophobic victimization as drivers of inflammatory and type I interferon gene expression profiles, which can contribute to physical and mental health challenges in Black and Latino MSM.

Policies to reduce the spread of COVID-19 are negatively impacting the psychological well-being of the general population. This cross-sectional study explores the associations of coping strategies with symptoms of depression and anxiety among adults residing in the United States. Our results showed that participants who turned to religion were less depressed or anxious. Those engaging in substance use, behavioral disengagement, and seeking social support for emotional reasons had increased odds of feelings of depression and anxiety about the future. These findings can be used to tailor intervention and policy-making efforts to reduce the mental health toll in the general population.

Many persons living with HIV (PLWH) either reduced their employment capacity or stopped work completely due to disease progression. With the advent of effective antiretroviral therapy, some PLWH were able to return to the workforce and many are now transitioning into retirement. We examined the histories of employment, retirement and disability status on depression among 1,497 Participants living with HIV from 1997 to 2015 in the Multicenter AIDS Cohort Study. Data were collected on depressive symptoms, employment, retirement, disability status as well as HIV-related and sociodemographic characteristics. Employment, retirement and disability status were lagged 2 years to assess whether the risk of depression at a given observation were temporally predicted by each respective status, adjusting for prior depressive symptoms and covariates. Being employed (aOR: 0.76; 95% CI: 0.71–0.82) had lower odds of depression risk two years later compared to those unemployed. There were higher odds of depression risk associated with disability (aOR: 1.43; 95% CI: 1.32–1.54) versus those not on disability. Retirement status was not associated with the risk of depressive symptoms. These findings could help inform policies and employment programs to facilitate the return to work for PLWH who are willing and able to work.

Cannabis is among the most frequently used substance in United States (U.S.). Studies evaluating the association between cannabis use and inflammation in humans have been few and have not explored potential sex-dependent effects. To examine the relationship between self-reported cannabis use and high-sensitivity C-reactive protein (hsCRP), Interleukin 6 (IL-6) and fibrinogen. We used Wave 1 of the Population Assessment of Tobacco and Health (PATH) – a nationally representative sample of adults in the U.S. Weighted linear regression models were used to determine associations of self-reported cannabis use with natural log-transformed hs-CRP, IL-6 and fibrinogen adjusting for sociodemographic and psychosocial factors. Self-reported cannabis use, particularly cannabis use within the past 30 days, was associated with lower levels of each biomarker of systemic inflammation, although findings were imprecise. Specifically, in multivariable models, the associations between respondents who self-reported cannabis use in the past 30 days compared to never use was imprecise for hs-CRP (β= −0.15, 95% confidence interval (CI): −0.32, 0.00), IL-6 (β= - 0.02, 95% CI: −0.10, 0.05) and fibrinogen (β= - 0.01, 95% CI: −0.04, 0.02). We did not find that these associations differed significantly by sex. Data from this nationally representative study suggest potential anti-inflammatory effects of recent cannabis use. Additional studies that biologically measure the THC and CBD concentrations of the cannabis used and employ prospective and or experimental study designs investigate cannabis and inflammation associations are needed.