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Psychosocial profiles identified in patients with HIV who use substances may improve outcomes for both conditions through tailored interventions.

“This research was driven by concern regarding the high rates of uncontrolled HIV infection and mortality among people living with HIV who use substances who may also be burdened with co-occurring mental health symptoms,” Renae Schmidt, MPH, tells Physician’s Weekly. “Despite the availability of advanced HIV treatments, this population continues to showcase disproportionately poor health outcomes.”

For a study published in AIDS and Behavior, Schmidt says she and her colleagues aimed “to identify and understand the psychosocial factors that may contribute to uncontrolled HIV infection and increased mortality among people with HIV who use substances.”

Specifically, they sought to understand the distinct psychosocial profiles within this population that may influence health outcomes, “with the ultimate goal of informing targeted interventions to reduce the risk of uncontrolled infection and mortality in this vulnerable group,” Schmidt notes.

Impact of Baseline Psychosocial Symptomatology

The analysis used data from 801 people with HIV who also use substances (average age, 44.2; 67.4% men; 72.0% Black). An estimated 22.0% of patients had a documented psychiatric history, and 37.2% were unstably housed.

The latent class analysis conducted by the researchers resulted in five “classes” of individuals “with unique baseline psychosocial symptomatology,” according to the study results. The classes included varying levels of mental health symptomatology (MHS):

• Class 1: Severe MHS (12.9%)
• Class 2: Moderate MHS with suicidality and without support (16.0%)
• Class 3: Moderate MHS (21.6%)
• Class 4: Mild MHS without support (20.5%)
• Class 5: Minimal MHS (29.1%)

“One of the most critical findings is the identification of psychosocial profiles that are associated with a higher risk for uncontrolled HIV infection and mortality,” Schmidt notes. “For example, individuals with high levels of suicidality, depressive and anxious symptoms, and reported trauma who also had the greatest substance use levels were found to be at the greatest risk for dying. Clinicians should be aware of these profiles, as patients who fit them may benefit from more intensive and tailored interventions, including enhanced mental health support, substance use treatment, and strategies to cope with trauma.”

Tailoring Interventions for Specific Psychosocial Profiles

The extent to which social support influenced health outcomes surprised Schmidt and colleagues.

“The strong influence of social dynamics—such as tangible support from peers and family to help with chores, getting medications, and transportation—highlights the importance of addressing these psychosocial factors in addition to clinical care,” she says. “This finding suggests that interventions aimed at enhancing social support may be as crucial as those addressing substance use.”

Based on the study results, clinicians treating patients with HIV and substance use can consider “a more holistic approach, taking into account not just the medical management of HIV and substance use but also the psychosocial symptoms these individuals have.”

Tailored interventions that address the specific psychosocial profiles identified in the study could lead to better health outcomes, Schmidt continues (Figure).

“For instance, integrating mental health services, enhancing social support systems, and implementing stigma reduction strategies within HIV care could be key components of a successful treatment plan. This research underscores the critical importance of assessing and addressing heightened mental health symptoms at intake to identify those at the highest risk of adverse outcomes.”

Future research should work to develop and test interventions tailored to the psychosocial profiles identified in the study.

“Additionally, longitudinal studies are needed to understand how changes in psychosocial factors over time affect HIV outcomes,” Schmidt explains. “Research should also investigate the effectiveness of integrating psychosocial interventions into standard HIV care and how these interventions can be scaled up to reach broader populations of people living with HIV who use substances.”