Multi-Level Factors Related to Mental Health Services Utilization Among HIV+ Methamphetamine-Using Sexual Minority Men

Background and Purpose: Substance abuse, unstable housing, and mental health issues are syndemic features detrimental to the well-being of many sexual minority men (SMM), particularly those living with HIV. Research suggests that HIV-positive SMM are more prone to hospitalizations than their HIV-negative counterparts. SMM are more likely to be hospitalized for substance use-related reasons than their heterosexual counterparts. Housing instability is a contributing factor to HIV disease progression and deleterious effects on SMM’s physical and mental health. Social support has often been reported as a protective factor when with regards to mental health management. The main objective of this study was to explore structural, health and relational factors associated with mental health services utilization among HIV-positive, methamphetamine-using sexual minority men.

Methods: Participants completed the baseline visit for a trial in San Francisco, CA. Our sample consists of 161 HIV-positive SMM who reported recent methamphetamine use. The sample was predominantly white (46.6%), middle-aged (M= 43.8; SD = 8.97), and 50.3% were accessing disability benefits. This cross-sectional analysis examined experiences of homelessness in the past year and any hospitalizations and/or visits to the emergency room in the past six months as correlates of accessing mental health services in the past six months. Subsequent models examined the potential confounding and modifying effects of social support around methamphetamine use on accessing mental health services in the past six months. We employed logistic regression analysis adjusted for age, ethnicity, education, income, and enrollment in disability benefits.   

Results: Experiencing homelessness was independently associated with accessing mental health services ([AOR]: 2.81; 95% CI = 1.20, 6.56; p = 0.20). Similarly, having been hospitalized and/or admitted to the emergency room was independently associated with accessing mental health services ([AOR]: 2.4; 95% CI = 1.12, 5.16; p = 0.03). Although social support around methamphetamine use did not serve as a confounder in our second model, the introduction of an interaction variable between social support and hospitalization and/or emergency room admissions in our third model had modifying effects. In that third model, homelessness was interpedently associated with accessing mental health services ([AOR]: 3.41; 95% CI = 1.38, 8.47; p = 0.01) and hospitalization and/or emergency room admissions were independently associated with accessing mental health services ([AOR]: 34.79; 95% CI = 2.44, 496.84; p = 0.01). The interaction variable between social support and hospitalization and/or emergency room was independently associated with accessing mental health services ([AOR]: 0.89; 95% CI = 0.76, 0.99; p = 0.04).

Conclusions and Implications: These data suggest that there is a strong association between experiencing homelessness, as well as having been hospitalized, and accessing mental health services among this population. Additionally, having someone in their social network with whom to talk to about their methamphetamine use seems to be associated with being less likely to access mental health services. Methamphetamine-using HIV-positive sexual minority men experience precarious situations at different levels of their lived experiences. Social workers could intervene at the micro, meso and macro levels by promoting social skills, triaging assistance, and advocating for housing reform, respectively.