Drug use disorder treatment is critical for improving health among people living with HIV. Rates of treatment utilization and corresponding health outcomes among women living with HIV is not as well understood as those of men. To help inform the unique needs of women with HIV, this study examined patterns of drug use and treatment among a sample of women with HIV.
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In the US, as many as half of people living with HIV also report current drug use or problems with drug use. Drug use is associated with poorer HIV-related outcomes (e.g., higher viral loads), and worse overall health. Substance use, therefore, is an important clinical and public health target for individuals living with HIV. Research suggests that direct linkages from HIV care can enhance addiction treatment seeking in this vulnerable group.
To date the scope of drug use and treatment utilization among women with HIV is not well understood, which is particularly problematic given their unique health needs. It is plausible that rates of substance use disorder treatment among women with HIV are lower than the general population of people living with HIV since they experience additional barriers to substance use disorder treatment access. For instance, women with HIV face increased social stigmatization when seeking out treatment compared to people without HIV and face potential loss of parental custody. These barriers underscore the necessity of specific interventions designed to facilitate treatment among women with HIV who use drugs. To inform such interventions, the current study examined patterns of drug use and treatment utilization among a sample of women.
This study analyzed data from the Women’s Interagency HIV Study (WIHS). This prospective cohort study began in 1993 to monitor the health of women with HIV and women at risk of contracting HIV. Participants were recruited from 10 sites across the US (Bronx, NY, Brooklyn, NY, Chicago, IL, Los Angeles, CA, Miami, FL, Atlanta, GA, Chapel Hill, NC, Birmingham, AL, Jackson, MS, and the District of Columbia). The WIHS has since merged with the Multicenter AIDS Cohort Study (MACS) and is now known as the MACS-WIHS Combined Cohort Study (MACS-WIHS CCS). Data for the current analysis came from participants who completed a baseline visit and at least one follow-up visit from October 2013 – March 2020.
Participants in the current analysis (1802 women with HIV and 757 HIV negative women) came from multiple cohorts recruited throughout the WIHS project’s lifespan. Initial inclusion criteria were: (1) 18+ years old; (2) female; (3) able to complete an interview in English or Spanish; (4) able to travel to research site every 6 months for an interview/examination/blood draw. These criteria were later expanded in 2001 to recruit more HIV positive women and women at risk of contracting HIV. These additional criteria included: (i) proof of HIV serostatus (e.g., documented results from an HIV enzyme-linked immunosorbent assay) obtained within 30 days prior to enrollment and a confirmatory HIV test; (ii) no history of clinical AIDS-related conditions (confirmed via medical records); (iii) documentation of laboratory reports of HIV RNA levels and CD4 counts surrounding the period of HIV medication initiation for those on HIV medications; and (iv) consent to have specimens stored in the WIHS national repository. In addition, to ensure recruited HIV negative women were at risk of contracting HIV, the researchers included HIV negative women who reported one or more of the following: (a) injection drug use; (b) having a sexually transmitted disease (sans HIV); (c) having unprotected sex with three or more men or protected sex with more than five men; or (d) having exchanged sex for drugs, money, or shelter.
Data for the study were collected from study visit interviews and were therefore self-reported. The primary independent variable was HIV status at the most recent follow-up visit. Variables controlled for in the analyses included participants’ age, race/ethnicity, region, and education. Gender was not controlled for since there was only 1 non-cisgender participant. For HIV positive participants models also controlled for HIV-relevant indicators including CD4 count, viral suppression (i.e., HIV RNA level <200 copies/mL), and current use of HIV medications.
The study had 2 primary outcomes: drug use, and substance use treatment utilization. Drug use was defined as self-reported nonmedical use of drugs (e.g., crack/cocaine, methamphetamine, opioids, and/or tranquilizers). Drug use was categorized as either current (<1 year pre-assessment), recent (1-4.9 years pre-assessment), or prior (≥5 years pre-assessment). Marijuana and alcohol use alone were not considered drug use for these analyses but were controlled for in statistical models. Substance use disorder treatment was self-reported utilization of any drug treatment. The researchers used a broad operational definition of treatment including both inpatient (e.g., detoxification programs) and outpatient (e.g., methadone) services. The researchers also classified usage of non-professional, community-based mutual-help organizations (e.g., Narcotics Anonymous) as substance use treatment. Substance use treatment usage was classified as either current (<1 year pre-assessment), recent (1-4.9 years pre-assessment), or prior (≥5 years pre-assessment).
Participants in the sample predominately self-identified as non-Hispanic Black (71.1%) women with a mean age of 51.7 years. Almost two-thirds of participants were unemployed (63.0%), nearly three-quarters had an annual household income ≤$24000/year (72.1%), and about two-thirds had completed high school (65.1%). Alcohol and marijuana use was significantly high among participants; 27.1% reported current marijuana use, and 10.1% reported drinking >7 drinks/week.
HIV positive women were less likely to report current drug use.
Rates of current drug use were 12.8% among women with HIV and 18.1% among women without HIV, respectively. When the researchers controlled for covariates (e.g., employment, history of incarceration, etc.), women with HIV were less likely to currently use drugs than women without HIV.
HIV status had no impact on substance use treatment utilization.
Among women who reported current drug use, HIV positive women were just as likely to utilize substance use treatment as women without HIV. Women with HIV and women without HIV reported 40% and 45% current substance use treatment utilization, respectively.
Among women with HIV substance use treatment was not associated with HIV-related clinical outcomes.
Women with HIV who utilized substance use treatment had similar HIV-related health outcomes as women with HIV who did not utilize substance use treatment. This included similar rates of HIV care, HIV medication use, HIV viral load, and CD4 counts.
The results of this study suggest that women with HIV were less likely to report current drug use than women without HIV. However, this research also suggests that among women who use drugs, those with HIV and those without HIV had similar rates of treatment engagement. These results may suggest that when women with HIV have access to healthcare, they are more likely to utilize substance use treatment.
The results of the current study somewhat contradict the extant literature. Although substance use treatment usage among women with HIV is understudied, the work that has been conducted proposes that women with HIV are less likely to utilize it. For example, one study found that women with HIV are less likely to utilize alcohol use treatment services. It is unknown why this discrepancy in results was seen, however high rates of alcohol and marijuana use among the sample may have been a factor. Alternatively, the observed discrepancy may be due to measurement inconsistencies within the field. For example, varied definitions of treatment utilization across research studies. It is also plausible that the higher rate of substance use treatment utilization seen in the current sample was due to sampled participants receiving healthcare. All participants in the current sample were recruited from healthcare clinics in the US. Therefore, participants were more likely to receive referrals for substance use treatment from healthcare providers.
The results of this study may have been impacted by where participants were recruited. The context of this study is somewhat unique- all participants were recruited from healthcare settings across multiple years. This means that all sampled women were already linked to regular care. Women living with HIV generally experience additional barriers to substance use treatment including social stigmatization and loss of parental custody. Given that all participants in the current research were already linked into a healthcare system, the sampled women with HIV may have had greater access to healthcare than is true generally. This may explain why there was no observed difference in substance use treatment by HIV status.
The fact that there was no observed difference in substance use treatment utilization between women with HIV and those without HIV may suggest there was a missed opportunity for health intervention. It can be theorized based on the health beliefs model that those with HIV who concurrently had a substance use disorder would have been more inclined to seek treatment. That is, women with two health conditions (HIV and a substance use disorder) may have perceived their health as being more precarious and thus would be more inclined to seek treatment. Had providers targeted women with HIV who used drugs for a behavioral intervention, it is possible these women would have sought substance use treatment more than women with a substance use disorder alone. This is plausible given that access was not a barrier to treatment for this sample- given participants’ involvement in healthcare settings, they had a high degree of access to substance use treatment services.
Another implication of the current research may be that more comprehensive services are needed to address the complexities of living with HIV and using drugs. That is, the researchers found that treatment engagement was not associated with any of the HIV clinical makers (e.g., HIV viral load). This was surprising given that past research suggests that substance use treatment among people living with HIV may improve HIV-clinical outcomes. This may suggest that the treatment that women with HIV received was not integrated with their HIV care limiting its efficacy in this regard, though more research is needed to examine this.
Taken together, the findings of this study suggest that access to healthcare is critical for improving substance use treatment among women with HIV. Increasing healthcare access in the US is necessary to improving the overall health of the population. This is especially true for those who have chronic conditions such as HIV. Efforts to ensure access to care like the Ryan White Foundation should be expanded.
The researchers of this study found that women with HIV were less likely to report current drug use compared to women who did not have HIV. However, it was also found that women with HIV who did report current substance use were just as likely to utilize substance use treatment services. Furthermore, women with HIV recruited from large urban healthcare centers who received substance use treatment had similar HIV-related health outcomes to women who did not seek treatment. Given prior research showing women with HIV may be less likely to seek treatment, understanding the contexts in this study where they were just as likely to seek treatment may be important to addressing health disparities in this at-risk group.
Fujita, A. W., Ramakrishnan, A., Mehta, C. C., Yusuf, O. B., Wilson, T., Shoptaw, S., . . . & Sheth, A. N. (2023, January). Substance Use Treatment Utilization Among Women With and Without Human Immunodeficiency Virus. Open Forum Infectious Diseases, 10(1), ofac684. doi: 10.1093/ofid/ofac684
l
In the US, as many as half of people living with HIV also report current drug use or problems with drug use. Drug use is associated with poorer HIV-related outcomes (e.g., higher viral loads), and worse overall health. Substance use, therefore, is an important clinical and public health target for individuals living with HIV. Research suggests that direct linkages from HIV care can enhance addiction treatment seeking in this vulnerable group.
To date the scope of drug use and treatment utilization among women with HIV is not well understood, which is particularly problematic given their unique health needs. It is plausible that rates of substance use disorder treatment among women with HIV are lower than the general population of people living with HIV since they experience additional barriers to substance use disorder treatment access. For instance, women with HIV face increased social stigmatization when seeking out treatment compared to people without HIV and face potential loss of parental custody. These barriers underscore the necessity of specific interventions designed to facilitate treatment among women with HIV who use drugs. To inform such interventions, the current study examined patterns of drug use and treatment utilization among a sample of women.
This study analyzed data from the Women’s Interagency HIV Study (WIHS). This prospective cohort study began in 1993 to monitor the health of women with HIV and women at risk of contracting HIV. Participants were recruited from 10 sites across the US (Bronx, NY, Brooklyn, NY, Chicago, IL, Los Angeles, CA, Miami, FL, Atlanta, GA, Chapel Hill, NC, Birmingham, AL, Jackson, MS, and the District of Columbia). The WIHS has since merged with the Multicenter AIDS Cohort Study (MACS) and is now known as the MACS-WIHS Combined Cohort Study (MACS-WIHS CCS). Data for the current analysis came from participants who completed a baseline visit and at least one follow-up visit from October 2013 – March 2020.
Participants in the current analysis (1802 women with HIV and 757 HIV negative women) came from multiple cohorts recruited throughout the WIHS project’s lifespan. Initial inclusion criteria were: (1) 18+ years old; (2) female; (3) able to complete an interview in English or Spanish; (4) able to travel to research site every 6 months for an interview/examination/blood draw. These criteria were later expanded in 2001 to recruit more HIV positive women and women at risk of contracting HIV. These additional criteria included: (i) proof of HIV serostatus (e.g., documented results from an HIV enzyme-linked immunosorbent assay) obtained within 30 days prior to enrollment and a confirmatory HIV test; (ii) no history of clinical AIDS-related conditions (confirmed via medical records); (iii) documentation of laboratory reports of HIV RNA levels and CD4 counts surrounding the period of HIV medication initiation for those on HIV medications; and (iv) consent to have specimens stored in the WIHS national repository. In addition, to ensure recruited HIV negative women were at risk of contracting HIV, the researchers included HIV negative women who reported one or more of the following: (a) injection drug use; (b) having a sexually transmitted disease (sans HIV); (c) having unprotected sex with three or more men or protected sex with more than five men; or (d) having exchanged sex for drugs, money, or shelter.
Data for the study were collected from study visit interviews and were therefore self-reported. The primary independent variable was HIV status at the most recent follow-up visit. Variables controlled for in the analyses included participants’ age, race/ethnicity, region, and education. Gender was not controlled for since there was only 1 non-cisgender participant. For HIV positive participants models also controlled for HIV-relevant indicators including CD4 count, viral suppression (i.e., HIV RNA level <200 copies/mL), and current use of HIV medications.
The study had 2 primary outcomes: drug use, and substance use treatment utilization. Drug use was defined as self-reported nonmedical use of drugs (e.g., crack/cocaine, methamphetamine, opioids, and/or tranquilizers). Drug use was categorized as either current (<1 year pre-assessment), recent (1-4.9 years pre-assessment), or prior (≥5 years pre-assessment). Marijuana and alcohol use alone were not considered drug use for these analyses but were controlled for in statistical models. Substance use disorder treatment was self-reported utilization of any drug treatment. The researchers used a broad operational definition of treatment including both inpatient (e.g., detoxification programs) and outpatient (e.g., methadone) services. The researchers also classified usage of non-professional, community-based mutual-help organizations (e.g., Narcotics Anonymous) as substance use treatment. Substance use treatment usage was classified as either current (<1 year pre-assessment), recent (1-4.9 years pre-assessment), or prior (≥5 years pre-assessment).
Participants in the sample predominately self-identified as non-Hispanic Black (71.1%) women with a mean age of 51.7 years. Almost two-thirds of participants were unemployed (63.0%), nearly three-quarters had an annual household income ≤$24000/year (72.1%), and about two-thirds had completed high school (65.1%). Alcohol and marijuana use was significantly high among participants; 27.1% reported current marijuana use, and 10.1% reported drinking >7 drinks/week.
HIV positive women were less likely to report current drug use.
Rates of current drug use were 12.8% among women with HIV and 18.1% among women without HIV, respectively. When the researchers controlled for covariates (e.g., employment, history of incarceration, etc.), women with HIV were less likely to currently use drugs than women without HIV.
HIV status had no impact on substance use treatment utilization.
Among women who reported current drug use, HIV positive women were just as likely to utilize substance use treatment as women without HIV. Women with HIV and women without HIV reported 40% and 45% current substance use treatment utilization, respectively.
Among women with HIV substance use treatment was not associated with HIV-related clinical outcomes.
Women with HIV who utilized substance use treatment had similar HIV-related health outcomes as women with HIV who did not utilize substance use treatment. This included similar rates of HIV care, HIV medication use, HIV viral load, and CD4 counts.
The results of this study suggest that women with HIV were less likely to report current drug use than women without HIV. However, this research also suggests that among women who use drugs, those with HIV and those without HIV had similar rates of treatment engagement. These results may suggest that when women with HIV have access to healthcare, they are more likely to utilize substance use treatment.
The results of the current study somewhat contradict the extant literature. Although substance use treatment usage among women with HIV is understudied, the work that has been conducted proposes that women with HIV are less likely to utilize it. For example, one study found that women with HIV are less likely to utilize alcohol use treatment services. It is unknown why this discrepancy in results was seen, however high rates of alcohol and marijuana use among the sample may have been a factor. Alternatively, the observed discrepancy may be due to measurement inconsistencies within the field. For example, varied definitions of treatment utilization across research studies. It is also plausible that the higher rate of substance use treatment utilization seen in the current sample was due to sampled participants receiving healthcare. All participants in the current sample were recruited from healthcare clinics in the US. Therefore, participants were more likely to receive referrals for substance use treatment from healthcare providers.
The results of this study may have been impacted by where participants were recruited. The context of this study is somewhat unique- all participants were recruited from healthcare settings across multiple years. This means that all sampled women were already linked to regular care. Women living with HIV generally experience additional barriers to substance use treatment including social stigmatization and loss of parental custody. Given that all participants in the current research were already linked into a healthcare system, the sampled women with HIV may have had greater access to healthcare than is true generally. This may explain why there was no observed difference in substance use treatment by HIV status.
The fact that there was no observed difference in substance use treatment utilization between women with HIV and those without HIV may suggest there was a missed opportunity for health intervention. It can be theorized based on the health beliefs model that those with HIV who concurrently had a substance use disorder would have been more inclined to seek treatment. That is, women with two health conditions (HIV and a substance use disorder) may have perceived their health as being more precarious and thus would be more inclined to seek treatment. Had providers targeted women with HIV who used drugs for a behavioral intervention, it is possible these women would have sought substance use treatment more than women with a substance use disorder alone. This is plausible given that access was not a barrier to treatment for this sample- given participants’ involvement in healthcare settings, they had a high degree of access to substance use treatment services.
Another implication of the current research may be that more comprehensive services are needed to address the complexities of living with HIV and using drugs. That is, the researchers found that treatment engagement was not associated with any of the HIV clinical makers (e.g., HIV viral load). This was surprising given that past research suggests that substance use treatment among people living with HIV may improve HIV-clinical outcomes. This may suggest that the treatment that women with HIV received was not integrated with their HIV care limiting its efficacy in this regard, though more research is needed to examine this.
Taken together, the findings of this study suggest that access to healthcare is critical for improving substance use treatment among women with HIV. Increasing healthcare access in the US is necessary to improving the overall health of the population. This is especially true for those who have chronic conditions such as HIV. Efforts to ensure access to care like the Ryan White Foundation should be expanded.
The researchers of this study found that women with HIV were less likely to report current drug use compared to women who did not have HIV. However, it was also found that women with HIV who did report current substance use were just as likely to utilize substance use treatment services. Furthermore, women with HIV recruited from large urban healthcare centers who received substance use treatment had similar HIV-related health outcomes to women who did not seek treatment. Given prior research showing women with HIV may be less likely to seek treatment, understanding the contexts in this study where they were just as likely to seek treatment may be important to addressing health disparities in this at-risk group.
Fujita, A. W., Ramakrishnan, A., Mehta, C. C., Yusuf, O. B., Wilson, T., Shoptaw, S., . . . & Sheth, A. N. (2023, January). Substance Use Treatment Utilization Among Women With and Without Human Immunodeficiency Virus. Open Forum Infectious Diseases, 10(1), ofac684. doi: 10.1093/ofid/ofac684
l
In the US, as many as half of people living with HIV also report current drug use or problems with drug use. Drug use is associated with poorer HIV-related outcomes (e.g., higher viral loads), and worse overall health. Substance use, therefore, is an important clinical and public health target for individuals living with HIV. Research suggests that direct linkages from HIV care can enhance addiction treatment seeking in this vulnerable group.
To date the scope of drug use and treatment utilization among women with HIV is not well understood, which is particularly problematic given their unique health needs. It is plausible that rates of substance use disorder treatment among women with HIV are lower than the general population of people living with HIV since they experience additional barriers to substance use disorder treatment access. For instance, women with HIV face increased social stigmatization when seeking out treatment compared to people without HIV and face potential loss of parental custody. These barriers underscore the necessity of specific interventions designed to facilitate treatment among women with HIV who use drugs. To inform such interventions, the current study examined patterns of drug use and treatment utilization among a sample of women.
This study analyzed data from the Women’s Interagency HIV Study (WIHS). This prospective cohort study began in 1993 to monitor the health of women with HIV and women at risk of contracting HIV. Participants were recruited from 10 sites across the US (Bronx, NY, Brooklyn, NY, Chicago, IL, Los Angeles, CA, Miami, FL, Atlanta, GA, Chapel Hill, NC, Birmingham, AL, Jackson, MS, and the District of Columbia). The WIHS has since merged with the Multicenter AIDS Cohort Study (MACS) and is now known as the MACS-WIHS Combined Cohort Study (MACS-WIHS CCS). Data for the current analysis came from participants who completed a baseline visit and at least one follow-up visit from October 2013 – March 2020.
Participants in the current analysis (1802 women with HIV and 757 HIV negative women) came from multiple cohorts recruited throughout the WIHS project’s lifespan. Initial inclusion criteria were: (1) 18+ years old; (2) female; (3) able to complete an interview in English or Spanish; (4) able to travel to research site every 6 months for an interview/examination/blood draw. These criteria were later expanded in 2001 to recruit more HIV positive women and women at risk of contracting HIV. These additional criteria included: (i) proof of HIV serostatus (e.g., documented results from an HIV enzyme-linked immunosorbent assay) obtained within 30 days prior to enrollment and a confirmatory HIV test; (ii) no history of clinical AIDS-related conditions (confirmed via medical records); (iii) documentation of laboratory reports of HIV RNA levels and CD4 counts surrounding the period of HIV medication initiation for those on HIV medications; and (iv) consent to have specimens stored in the WIHS national repository. In addition, to ensure recruited HIV negative women were at risk of contracting HIV, the researchers included HIV negative women who reported one or more of the following: (a) injection drug use; (b) having a sexually transmitted disease (sans HIV); (c) having unprotected sex with three or more men or protected sex with more than five men; or (d) having exchanged sex for drugs, money, or shelter.
Data for the study were collected from study visit interviews and were therefore self-reported. The primary independent variable was HIV status at the most recent follow-up visit. Variables controlled for in the analyses included participants’ age, race/ethnicity, region, and education. Gender was not controlled for since there was only 1 non-cisgender participant. For HIV positive participants models also controlled for HIV-relevant indicators including CD4 count, viral suppression (i.e., HIV RNA level <200 copies/mL), and current use of HIV medications.
The study had 2 primary outcomes: drug use, and substance use treatment utilization. Drug use was defined as self-reported nonmedical use of drugs (e.g., crack/cocaine, methamphetamine, opioids, and/or tranquilizers). Drug use was categorized as either current (<1 year pre-assessment), recent (1-4.9 years pre-assessment), or prior (≥5 years pre-assessment). Marijuana and alcohol use alone were not considered drug use for these analyses but were controlled for in statistical models. Substance use disorder treatment was self-reported utilization of any drug treatment. The researchers used a broad operational definition of treatment including both inpatient (e.g., detoxification programs) and outpatient (e.g., methadone) services. The researchers also classified usage of non-professional, community-based mutual-help organizations (e.g., Narcotics Anonymous) as substance use treatment. Substance use treatment usage was classified as either current (<1 year pre-assessment), recent (1-4.9 years pre-assessment), or prior (≥5 years pre-assessment).
Participants in the sample predominately self-identified as non-Hispanic Black (71.1%) women with a mean age of 51.7 years. Almost two-thirds of participants were unemployed (63.0%), nearly three-quarters had an annual household income ≤$24000/year (72.1%), and about two-thirds had completed high school (65.1%). Alcohol and marijuana use was significantly high among participants; 27.1% reported current marijuana use, and 10.1% reported drinking >7 drinks/week.
HIV positive women were less likely to report current drug use.
Rates of current drug use were 12.8% among women with HIV and 18.1% among women without HIV, respectively. When the researchers controlled for covariates (e.g., employment, history of incarceration, etc.), women with HIV were less likely to currently use drugs than women without HIV.
HIV status had no impact on substance use treatment utilization.
Among women who reported current drug use, HIV positive women were just as likely to utilize substance use treatment as women without HIV. Women with HIV and women without HIV reported 40% and 45% current substance use treatment utilization, respectively.
Among women with HIV substance use treatment was not associated with HIV-related clinical outcomes.
Women with HIV who utilized substance use treatment had similar HIV-related health outcomes as women with HIV who did not utilize substance use treatment. This included similar rates of HIV care, HIV medication use, HIV viral load, and CD4 counts.
The results of this study suggest that women with HIV were less likely to report current drug use than women without HIV. However, this research also suggests that among women who use drugs, those with HIV and those without HIV had similar rates of treatment engagement. These results may suggest that when women with HIV have access to healthcare, they are more likely to utilize substance use treatment.
The results of the current study somewhat contradict the extant literature. Although substance use treatment usage among women with HIV is understudied, the work that has been conducted proposes that women with HIV are less likely to utilize it. For example, one study found that women with HIV are less likely to utilize alcohol use treatment services. It is unknown why this discrepancy in results was seen, however high rates of alcohol and marijuana use among the sample may have been a factor. Alternatively, the observed discrepancy may be due to measurement inconsistencies within the field. For example, varied definitions of treatment utilization across research studies. It is also plausible that the higher rate of substance use treatment utilization seen in the current sample was due to sampled participants receiving healthcare. All participants in the current sample were recruited from healthcare clinics in the US. Therefore, participants were more likely to receive referrals for substance use treatment from healthcare providers.
The results of this study may have been impacted by where participants were recruited. The context of this study is somewhat unique- all participants were recruited from healthcare settings across multiple years. This means that all sampled women were already linked to regular care. Women living with HIV generally experience additional barriers to substance use treatment including social stigmatization and loss of parental custody. Given that all participants in the current research were already linked into a healthcare system, the sampled women with HIV may have had greater access to healthcare than is true generally. This may explain why there was no observed difference in substance use treatment by HIV status.
The fact that there was no observed difference in substance use treatment utilization between women with HIV and those without HIV may suggest there was a missed opportunity for health intervention. It can be theorized based on the health beliefs model that those with HIV who concurrently had a substance use disorder would have been more inclined to seek treatment. That is, women with two health conditions (HIV and a substance use disorder) may have perceived their health as being more precarious and thus would be more inclined to seek treatment. Had providers targeted women with HIV who used drugs for a behavioral intervention, it is possible these women would have sought substance use treatment more than women with a substance use disorder alone. This is plausible given that access was not a barrier to treatment for this sample- given participants’ involvement in healthcare settings, they had a high degree of access to substance use treatment services.
Another implication of the current research may be that more comprehensive services are needed to address the complexities of living with HIV and using drugs. That is, the researchers found that treatment engagement was not associated with any of the HIV clinical makers (e.g., HIV viral load). This was surprising given that past research suggests that substance use treatment among people living with HIV may improve HIV-clinical outcomes. This may suggest that the treatment that women with HIV received was not integrated with their HIV care limiting its efficacy in this regard, though more research is needed to examine this.
Taken together, the findings of this study suggest that access to healthcare is critical for improving substance use treatment among women with HIV. Increasing healthcare access in the US is necessary to improving the overall health of the population. This is especially true for those who have chronic conditions such as HIV. Efforts to ensure access to care like the Ryan White Foundation should be expanded.
The researchers of this study found that women with HIV were less likely to report current drug use compared to women who did not have HIV. However, it was also found that women with HIV who did report current substance use were just as likely to utilize substance use treatment services. Furthermore, women with HIV recruited from large urban healthcare centers who received substance use treatment had similar HIV-related health outcomes to women who did not seek treatment. Given prior research showing women with HIV may be less likely to seek treatment, understanding the contexts in this study where they were just as likely to seek treatment may be important to addressing health disparities in this at-risk group.
Fujita, A. W., Ramakrishnan, A., Mehta, C. C., Yusuf, O. B., Wilson, T., Shoptaw, S., . . . & Sheth, A. N. (2023, January). Substance Use Treatment Utilization Among Women With and Without Human Immunodeficiency Virus. Open Forum Infectious Diseases, 10(1), ofac684. doi: 10.1093/ofid/ofac684
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