A new U.S. national analysis indicates that intersectional discrimination may be reducing HIV viral suppression. The study of 1,000 participants in the American Remote Contact HIV Epidemiology Study found that while 86% were virally suppressed overall, discrimination was indirectly linked to lower suppression rates through increased stimulant and tobacco use.
The research focused on sexual minoritized men living with HIV, examining how intersectional discrimination correlates with viral suppression via mental health, substance use, perceived stress, and social support. Participants had a mean age of 43, with significant representation from White, Black, and Hispanic or Latino individuals.
The most significant pathway identified was substance use. Higher levels of discrimination were associated with increased stimulant use, which in turn was linked to a lower likelihood of HIV viral suppression. Tobacco use demonstrated a similar indirect association. Substance use, more than mental health, stress, or social support, emerged as the clearest route through which discrimination impacted viral suppression.
These findings highlight that HIV viral suppression is influenced by more than just treatment. Social experiences, including stigma tied to HIV status, sexual orientation, and other identities, can affect patient support and adherence to care. Discrimination in this cohort did not merely coexist with adverse outcomes but appeared to directly disrupt consistent treatment engagement.
Clinically, this suggests that improving HIV viral suppression requires efforts beyond adherence counseling. Screening for stigma-related distress, recognizing the role of stimulant and tobacco use, and integrating mental health and substance use support into HIV care are crucial to address these barriers. Addressing intersectional stigma and supporting mental health and substance use treatment may significantly improve viral suppression in this population.