Patterns of Polysubstance Use in Young Black and Latinx Sexual Minority Men and Transgender Women and Its Association with Sexual Partnership Factors: The PUSH Study

Abstract

Background: Adult studies have demonstrated that polysubstance use increases HIV acquisition risk through increased sexual behaviors, however, few studies have examined polysubstance in young Black and Latinx sexual minority men (SMM) and transgender women (TW). Methods: We used cross-sectional data from 466 young Black and Latinx SMM and TW living in four high HIV-burden US cities enrolled in the PUSH Study, a status-neutral randomized control trial to increase HIV prevention and treatment adherence. We examined data for patterns of polysubstance use comparing age differences of use and explored associations between substance use and sexual partnership factors - inconsistent condom use, pressure to have condomless anal sex, and older partner, using bivariate and multivariate analyses. Results: Most participants described prior substance use with alcohol and cannabis being most common (76% each) and 23% described other illicit drug use, including stimulants, cocaine, hallucinogens, sedatives, opioids, and inhalants. Polysubstance use was common with nearly half (47%) of participants reporting alcohol and cannabis use, 20% reporting alcohol, cannabis, and one other illicit drug use, and 19% reporting alcohol or cannabis use plus one other illicit drug use. Polysubstance use was associated with greater adjusted odds of pressure to have condomless anal sex, older partner (>5 years older), and inconsistent condom use. Conclusions: Associations of polysubstance use with sexual practices and sexual partnerships that are known predictors of HIV acquisition or transmission among Black and Latinx SMM and TW underscore the need for combination interventions that include substance use treatment alongside antiretroviral-based and partner-based HIV prevention and treatment interventions.

Trial Registration: ClinicalTrials.gov Identifier: NCT03194477

Keywords:

• Young
• black
• Latinx
• sexual minority men
• transgender women
• polysubstance
• use

Acknowledgments

The authors acknowledge the contribution of the investigators and staff of the PUSH Study Group at participating research sites, including The Johns Hopkins University, Baltimore, MD (F Shorrock, J Conley, A Alvarenga); Philadelphia, PA (A Schlupp, A Lopez, W Vickroy); and Washington, DC (R Carr, J Leslie, B Smith). Additional thanks are owed to the Public Health Management Corporation (A Brooks, D Festinger, G Grimaldi for their collaboration on this work), the Johns Hopkins University, and Children’s Hospital of Philadelphia Adolescent Medicine Teen Advisory Boards who provided feedback on the study materials. Thank you to all the adolescents and young adults who participated in this project.

Declaration of interest

The authors declare there is no Complete of Interest at this study.

Disclosure statement

The authors report no conflict of interest.

Additional information

Funding

This work was supported by the National Institutes of Health (R01DA043089), the National Institute on Drug Abuse, and the Johns Hopkins University Center for AIDS Research (P30AI094189).