UCLA

In the highly-active antiretroviral therapy (HAART) era, sexual minority men (SMM) have achieved high life expectancies. However, they continue to be disproportionately affected by aging-related outcomes (e.g., lung cancer) and low quality of life (e.g., high rates of hospitalization and mortality). Previous literature has shown that overlapping behavioral and psychosocial factors predict HIV infection, low HAART use, and sexual risk behaviors among SMM but whether these factors are linked to adverse health outcomes including hospitalization, lung cancer, and mortality remains unknown. In this dissertation, we used data from the Multicenter AIDS Cohort Study (MACS). The first study included men having sex with men (MSM) who completed at least two assessments between 2004 and 2019 in the Methamphetamine Substudy of the MACS, and we used generalized estimating equation (GEE) models to examine the synergistic effects of psychosocial factors on incident all-cause hospitalization. Our second study involved SMM who underwent at least two assessments in the MACS between 1996 and 2022, and we conducted survival analyses to examine the additive effects of behavioral and psychosocial factors on incident lung cancer. In the third study, we included SMM living with HIV who completed two or more assessments and initiated HAART for at least one year between 1996 and 2022. We examined the predictive capabilities of behavioral and psychosocial factors on all-cause mortality when these factors were added to the Veteran Aging Cohort Study (VACS) Index 2.0, which is a commonly used clinical tool to predict mortality among people living with HIV (PLWH). In our first study, we found synergistic effects of depression, stimulant use, smoking, heroin use, childhood sexual abuse, and intimate partner violence on hospitalization. In our second study, we found a dose-response relationship between the number of behavioral and psychosocial factors (depression, cigarette smoking, heavy alcohol use, and polydrug use) and lung cancer incidence. Our findings from the third study indicated that including depression enhanced the accuracy of the VACS Index 2.0 in predicting mortality. Future interventions should target behavioral and psychosocial factors to reduce healthcare costs and improve the quality of life and overall health among SMM in the US.