Disparities in HIV treatment outcomes among youth living with HIV (YLWH) present a challenge for ending the HIV epidemic. Antiretroviral therapy (ART) adherence can be impacted by comorbidities such as mental health and substance use. Technology use has shown promise in increasing access to mental health and substance use services. Using a mixed-methods approach, we conducted formative research to describe the relationship between mental health, substance use, and medication adherence in 18-29 year-old YLWH, and explored technology use as an approach to supporting these services. Among 101 YLWH, ART adherence was significantly negatively associated with mental health measures such as depression, trauma, and adverse childhood experiences and marijuana and stimulants use. Depression had the highest level of relative importance in its association with ART adherence. During in-depth interviews with 29 participants, barriers to and facilitators of accessing and maintaining mental health services were identified. Most participants favored technology use for mental health and substance use service delivery, including videoconferencing with a counselor. Provision of ongoing mental health and substance use treatment is an important mechanism to achieving HIV treatment engagement. Technology, particularly videoconferencing, may have the capacity to overcome many barriers to care by increasing accessibility of these services.

In this paper, we develop the concept regimes of patienthood. Regimes of patienthood highlights the micro and macro dimensions of illness, paying close attention to how the interplay between the two creates expectations and points of intervention for people when they are ill. Such expectations may vary across time, place, and social position (e.g., age, class, ethnicity, gender, race, sexuality). Regimes of patienthood are always regimes of power and resistance, where the forms of resistance may vary based on individuals’ intersectional positions. We draw on two cases—a study of 45 mostly white, middle class adults living with autoimmune illnesses and a study of 20 Black women living with advanced cancer—to examine one dimension of regimes of patienthood—control. Although a number of social positions, such as age and race, co-produce illness experiences, we focus on three—class, insurance status, and gender—that are particularly salient in our data in relation to control. Such a move illustrates the theoretical power of regimes of patienthood for science and technology studies (STS).

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