Background: Studies of relationships between drug use and HIV treatment have primarily focused on methamphetamine, cocaine or heroin use. Few studies, however, have focused on younger Black men who have sex with men (YBMSM) who have less drug use in aggregate when compared to other MSM, but likely have higher rates of marijuana use. We examine associations between marijuana use and key treatment continuum metrics in a population based sample of YBMSM in Chicago. Improving treatment continuum outcomes for YBMSM is critical to controlling the HIV epidemic domestically.
Methods: From 2013-2014 a representative sample of YBMSM 16-29 years old in Chicago (n=626) was generated using Respondent Driven Sampling (RDS). HIV antibody/Ag and RNA testing were performed from dried blood spots. RDS-weighted models examined associations between marijuana use (never, intermittent or daily), HIV testing, and downstream treatment continuum metrics. Models were adjusted for age, education, condomless sex, group sex, EtOH use, depression and other drug use.
Results: YBMSM had a 28% seropositivity rate; 31% of positives were virally suppressed. 32% of YBMSM reported using marijuana daily or multiple times daily, 27% never used and 41% reported intermittent use (weekly or less). MJ use was mildly correlated with ecstasy use (r=0.15; p<0.001) and popper use (r= 0.11; p=0.008), but not methamphetamine use (r=0.07; p=0.09)). In adjusted regression models, YBMSM who used marijuana were more likely to be HIV seropositive (aOR, 3.56; p<0.05) and HIV positive unaware (12.80, p<0.001). Among HIV seropositive individuals, compared to no use, intermittent but not daily marijuana use was associated with worse retention in HIV care (2 or more visits 3 months apart in previous year) (aOR, 6.10; p=0.021). Marijuana use was not associated with linkage to care, adherence to ARVs or viral suppression. Covariates in these models including alcohol and other drug use were also not associated with any of the continuum metrics.
Conclusions: Critical HIV treatment continuum components such as knowing one’s status and retention in care are related to intermittent marijuana use. Specific marijuana use information should be collected from clients engaging in care that includes frequency of use which may help target HIV treatment interventions. A focus on drugs used by most affected populations such as YBMSM and their nuanced relationship with continuum metrics is warranted, particularly in the context of increasing social acceptability of marijuana.