Syndemic effect of mental illness and substance use on viral suppression among recently-incarcerated, HIV-infected individuals in the CARE+ Corrections study

ABSTRACT

Few studies on HIV-related syndemics of co-occurring and mutually reinforcing psychosocial conditions have assessed clinical outcomes in criminal justice (CJ)-involved populations. Baseline data from the CARE+ Corrections study were used to quantify co-occurring mental illness and substance use and examine syndemic effects on viral suppression among 106 CJ-involved HIV-infected individuals. Ninety-one (86%) reported a mental illness diagnosis, 30 (28%) reported hazardous alcohol use, and 61 (58%) were drug dependent. Eighteen (17%) experienced all three conditions. Drug dependence was clustered with mental illness (prevalence odds ratio [POR] 3.20, 95% CI 1.01–10.14) and hazardous alcohol use (POR 2.61, 95% CI 1.03–6.56). The association between syndemic score, representing the number of conditions reported by each individual, and viral suppression was not statistically significant, although 86% of participants with none of these conditions were virally suppressed, compared to 56% of those with all three (p = 0.56). Mental illness and substance use were concentrated in this sample, indicating a need for integrated care services.

KEYWORDS:

• Criminal justice system
• HIV
• syndemics
• mental illness
• substance use

Acknowledgements

We would like to acknowledge funding from the National Institutes of Health, National Institute on Drug Abuse (R01DA030747), and institutional support from the Providence-Boston Center for AIDS Research P30AI42853 and the District of Columbia Center for AIDS Research P30AI117970. We would also like to acknowledge our District of Columbia Department of Corrections partners (Drs. Beth Mynett and Reena Chakraborty) and community­ based partners for their support and assistance in conducting this work. Lastly, we would like to thank the study participants without whom we could not do this work.

Disclosure statement

No potential conflict of interest was reported by the authors.

ORCID

Hannah Yellin http://orcid.org/0000-0002-4880-3270

Additional information

Funding

This work was supported by the National Institutes of Health, National Institute on Drug Abuse [grant number R01DA030747]. Institutional support was received from the Providence-Boston Center for AIDS Research [grant number P30AI42853] and the District of Columbia Center for AIDS Research [grant number P30AI117970].