Psychosocial Adversity and Health Service Utilization Among Men Who Have Sex with Men Who Use Stimulants: A Latent Class Analysis

PURPOSE: This study sought to identify latent classes of psychosocial adversity among men who have sex with men (MSM) who use stimulants, examine sociodemographic correlates of class membership, and assess differences in health service utilization across classes. METHODS: This secondary analysis used baseline data from 205 MSM who use stimulants in Boston, Massachusetts, and Miami, Florida (March 2018-March 2024). Latent class analysis was applied to identify patterns of psychosocial adversity based on childhood sexual abuse (CSA), four forms of interpersonal violence (IPV), and three types of sexual minority stress. Sociodemographic characteristics included age, sexual orientation, race and ethnicity, and socioeconomic status. Outcomes were binary (any/none) indicators of mental health care, substance use care, emergency department (ED) encounters, and inpatient admissions in the past 4 months. RESULTS: A three-class solution was selected: Low Psychosocial Adversity (n = 107; 52.2%), Past-Year IPV-sexual orientation discrimination (SOD; n = 56; 27.3%), and Prior IPV-CSA (n = 42; 20.5%). Lower socioeconomic status was associated with higher odds of membership in the Past-Year IPV-SOD class compared with the Low Psychosocial Adversity class (odds ratio = 2.30; 95% confidence interval = 1.04-5.23, P = 0.046). In exploratory pairwise comparisons, participants in the Prior IPV-CSA class had a higher prevalence of any ED encounters (47.6%) than those in the Low Psychosocial Adversity class (28.1%; χ2[1,204] = 4.44; P = 0.035). CONCLUSION: Among MSM who use stimulants, configurations of psychosocial adversity varied by sociodemographic context, with socioeconomic status distinguishing patterns of adversity, and showed limited differentiation in health service utilization. These findings underscore the role of structural conditions and support syndemic-informed, person-centered approaches to inform more equitable prevention and service strategies.