Abstract
Background: HIV, stimulant use, and depression are interacting syndemic conditions that synergistically amplify risks for negative health outcomes. Among sexual minority men (SMM), greater syndemic burden has been consistently associated with HIV acquisition and difficulties with HIV disease management. The overarching goals of this project were to examine if greater syndemic burden predicted: 1) difficulties with completing two doses of a COVID-19 vaccine; 2) lower SARS-CoV-2 spike protein IgG antibody titers; and 3) greater odds of SARS-CoV-2 exposure.
Methods: COVID-19 Research for Understanding the role of Substance use and HIV (CRUSH) is 6-month prospective cohort study enrolling SMM with and without HIV. Participants completed a baseline assessment to measure self-reported use of stimulants (i.e., methamphetamine, powder cocaine, and crack cocaine) and depressive symptoms. At in-person biospecimen visits, participants provided urine samples for on-site toxicology testing, nasal swabs for SARS-CoV-2 RNA testing, and blood samples for SARS-CoV-2 IgG testing. The Syndemic risk index was an additive count variable calculated for those who were living with HIV, with any recent stimulant use and reported moderate or greater depressive symptoms. Sera samples were used to perform quantitative IgG antibody ELISAs with spike protein and nucleocapsid targets.
Results: Among the 57 participants with COVID-19 vaccine information over the 6-month follow-up, those with 2+ syndemic conditions were less likely to receive at least 2 COVID-19 vaccination doses. In 43 participants with sera samples, receiving 2+ COVID-19 vaccine doses was independently associated with higher spike protein IgG levels at 6 months. Greater syndemic burden was not directly associated with spike protein IgG levels or evidence of exposure to SARS-CoV-2.
Conclusion: Expanded efforts are needed to support completion of recommended COVID-19 vaccines in sexual minority men with greater syndemic burden.