INTERSECTIONAL discrimination may reduce HIV viral suppression by increasing stimulant and tobacco use among sexual minoritized men living with HIV, according to a new U.S. national analysis. The study examined 1,000 participants in the American Remote Contact HIV Epidemiology Study and found that 86% were virally suppressed overall, but discrimination was indirectly linked to a lower probability of suppression through greater stimulant and tobacco use.
HIV Viral Suppression and Substance Use
The analysis focused on sexual minoritized men living with HIV and tested whether intersectional discrimination was associated with viral suppression through mental health, substance use, perceived stress, and social support. Participants had a mean age of 43 years, with 45.0% identifying as White, 39.8% as Black, and 20.9% as Hispanic or Latino.
What stood out most was the substance use pathway. Higher levels of intersectional discrimination were associated with increased stimulant use, which in turn was linked to a lower likelihood of HIV viral suppression. Tobacco use showed a similar indirect association. By contrast, the abstract highlights substance use, rather than mental health, stress, or social support, as the clearest route through which discrimination appeared to affect viral suppression in this model.
Why Discrimination Still Matters in HIV Care
The findings point to a broader clinical reality: HIV viral suppression is not shaped by treatment alone. Social experiences, particularly overlapping forms of stigma tied to HIV status, sexual orientation, and other identities, may influence whether patients remain fully supported in care. In this cohort, discrimination did not simply coexist with worse outcomes. It appeared to operate through behaviors that can directly disrupt consistent treatment engagement and long-term suppression.
For clinicians, the message is practical. Efforts to improve HIV viral suppression in sexual minoritized men may need to extend beyond adherence counseling alone. Screening for stigma related distress, recognizing the role of stimulant and tobacco use, and integrating mental health and substance use support into HIV care could help address barriers that are otherwise easy to miss. The investigators concluded that addressing intersectional stigma and supporting mental health and substance use treatment may improve viral suppression in this population.
Reference
Williams R et al. Associations Between Intersectional Discrimination and HIV Viral Suppression: Examining Indirect Pathways Through Mental Health, Substance Use, Stress, and Social Support among Sexual Minoritized Men Living with HIV. J Acquir Immune Defic Syndr. 2026;doi:10.1097/QAI.0000000000003890.
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