UCLA

BACKGROUND: Substance use drives worse HIV outcomes among men who have sex with men, while reducing substance use can improve physical and mental health. Despite this, there has been limited research on the outcomes that men who have sex with men experience in the community after they have exited treatment for substance use. This dissertation examines the factors that are associated with community-based men who have sex with men engaging with treatment for substance use, as well as the substance use and mental health outcomes that follow treatment.METHODS: This dissertation uses data from men who have sex with men participating in the mSTUDY cohort based in Los Angeles, CA (2014-2024). Chapter 2 examines the socioeconomic, substance use, and health factors that are associated with engaging with treatment for substance use. Chapter 3 assesses how treatment for substance use impacts reductions in the frequency of methamphetamine, cannabis, binge alcohol, and tobacco use over time. Chapter 4 examines the prevalence of high depression and anxiety symptoms in the time period after treatment for substance use, and analyzes the impact of 12-step group participation on mental health among men in recovery. RESULTS: Factors associated with treatment for substance use included homelessness, incarceration, methamphetamine use, and living with HIV. After adjusting for other factors, Black and Latinx men were less likely than white men to enter treatment for substance use during follow up. Treatment for substance use at different time points was associated with reduced frequency of methamphetamine and cannabis use, as well as increased high frequency binge alcohol use. Twelve-step group participation was associated with reduced frequency of methamphetamine, cannabis, and binge alcohol use. Men in recovery had worse depression and anxiety symptoms than men who had not received treatment, but 12-step participation was also associated with improved depression and anxiety symptoms. CONCLUSION: These analyses found that factors that are known to be syndemic with the HIV epidemic are also associated with engagement in and outcomes following treatment for substance use. Community-based, equity-focused interventions to support men who have sex with men who use substances could improve quality of life in recovery.