# Minority Stress, Stimulant Use, and HIV among Sexual Minority Men: A Biopsychosocial Approach

> **NIH NIH F31** · SAN DIEGO STATE UNIVERSITY · 2024 · $38,984

## Abstract

PROJECT SUMMARY/ABSTRACT
Sexual minority men (SMM; i.e., non-heterosexual men) in the US are impacted by intertwining epidemics of HIV
and stimulant use (e.g., methamphetamine, powder cocaine, crack cocaine) at disparate rates compared to their
heterosexual peers. Findings from our team and others demonstrate that SMM with HIV who use stimulants
have greater difficulties successfully navigating the HIV care continuum as well as display substantially elevated
viral load, amplified HIV transmission risk, and faster clinical HIV progression. The dominant theory used to
explain health disparities among SMM is minority stress theory, which states that these disparities are the result
of stigma-related social stressors (e.g., discrimination, internalized homonegativity). While evidence of the
association between minority stress and stimulant use exists, few studies have directly examined associations
between minority stress and biological HIV outcomes, such as viral load, and many rely solely on self-report
measures (as opposed to laboratory testing) to assess these outcomes. The Biopsychosocial Minority Stress
Framework (BMSF) has been proposed to link minority stress to biological health, and posits that: (a) minority
stress directly affects the health behaviors and psychological health of SMM; (b) SMM’s health behaviors and
psychological health indicators are interrelated; and (c) these factors influence biological health among SMM via
the immune system. Applying the BMSF to SMM with HIV, stimulant use and ART nonadherence (health
behaviors) may serve as mediators through which minority stress impacts viral load (an outcome critical to
immune health) and, thereby, other health outcomes (e.g., opportunistic infections and cancers). Further,
consistent with intersectionality theory, racial/ethnic minority SMM may experience intensified effects of minority
stress that could contribute to the increased burden of HIV and stimulant use observed among SMM of color in
the US. Understanding the mechanisms through which minority stress impacts viral load, and thereby other
health outcomes, has important implications for intervention among SMM with HIV who use stimulants. As such,
we propose to systematically test associations posited by the BMSF in this high-priority population using a series
of mediation analyses. Specifically, we aim to examine BMSF components by testing longitudinal associations
between minority stress, stimulant use, ART nonadherence, and laboratory testing-derived viral load using
existing data from two independent samples of SMM with HIV who use stimulants: (1) 110 SMM residing in San
Francisco, CA and (2) 350 SMM recruited from across the US. Further, we aim to test whether the associations
between minority stress, stimulant use, ART nonadherence, and viral load differ among racial/ethnic minority
versus majority (i.e., non-Hispanic White) SMM with HIV who use stimulants, using multigroup analyses to
assess the invariance of effects ex...

## Key facts

- **NIH application ID:** 10889969
- **Project number:** 5F31DA059345-02
- **Recipient organization:** SAN DIEGO STATE UNIVERSITY
- **Principal Investigator:** Michael Joseph Miller-Perusse
- **Activity code:** F31 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $38,984
- **Award type:** 5
- **Project period:** 2023-08-17 → 2026-08-16

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10889969

## Citation

> US National Institutes of Health, RePORTER application 10889969, Minority Stress, Stimulant Use, and HIV among Sexual Minority Men: A Biopsychosocial Approach (5F31DA059345-02). Retrieved via AI Analytics 2026-05-25 from https://api.ai-analytics.org/grant/nih/10889969. Licensed CC0.

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