Mental Health Consequences of HIV Disease in Substance Users: The Mediating Effects of Physical Health Status, Social Support and Substance Use

Objectives: To examine the prevalence of mental health disorders and to explore the relationship between mental health and physical health status, social support, and substance use among a sample of HIV positive substance abusers over time. Methods: Data from a five year, longitudinal study of over 300 HIV positive clients referred to a program for enhanced substance abuse services are used to explore changes in mental health status. Follow-up data were collected at six month and twelve months after referral, and follow up rates exceed 70 percent (we are in the last six months of data collection). A fixed effects model is used to analyze the association between key variables over time. Results: Mental health disorders are pervasive among this sample. Very few individuals are receiving mental health treatment, although mental health status does improve over time. Physical health status also improves, perhaps due to a significant decrease in substance use. Levels of social support (both partner support and friend and family support) also increase over time. However, social support does not account for improved mental health status. While controlling for other variables, the only factor which results in a significant decrease in mental health disorders is increased drug use. Conclusions: These results have important implications for treatment of HIV positive substance users. Substance use is obviously an important coping mechanism; therefore, substance abuse treatment interventions may consider teaching alternative mental distress coping strategies.