UCSF

Substance use and alcohol can have negative health consequences among both HIV-positive and -negative individuals, and are associated with behaviors that facilitate HIV transmission and acquisition, particularly among key affected populations disproportionately impacted by HIV, including transgender women, men who have sex with men (MSM) and adults from sub-Saharan Africa. Although there is a large body of literature documenting the overlap between substance use, alcohol and HIV, many gaps remain in our understanding of these intertwined conditions. For example, the relationship between HIV infection and different classes and patterns of substance use and alcohol consumption remain understudied among transgender women. On the other hand, those relationships are well-characterized for non-dependent substance-using and alcohol-drinking MSM, yet there are no evidence-based behavioral interventions efficaciously shown to reduce substance use, alcohol and associated harm exclusively for this population. Furthermore, among treatment-naïve HIV-positive individuals, there is limited longitudinal data characterizing the impact of anti-retroviral treatment (ART) initiation on alcohol consumption. The objective of this dissertation was to address these gaps in the literature and help elucidate the complex interplay between substance use, alcohol consumption and HIV with a special emphasis on key affected populations. The study populations and study designs in this dissertation include: 1) transgender women from San Francisco (n=314) from a Respondent Drive Sampling (RDS) study conducted in 2010; 2) HIV-negative, sexually-active, substance-using and alcohol-drinking MSM from San Francisco (n=326) from a randomized controlled trial (RCT) on the efficacy of a behavioral intervention, Personalized Cognitive Counseling (PCC), compared to rapid HIV testing to reduce HIV-related sexual risk behaviors conducted from 2009-2012; and 3) HIV-positive individuals from rural Uganda initiating ART (n=502) from a prospective cohort study followed from 2005-2011. The key findings of these studies are summarized below.