Substance Use and Treatment Utilization Among Women of Reproductive Age with and without HIV in the Southern United States
Abstract Authors
Ayako Wendy Fujita, Christina Mehta, Qian Yang, Tina Tisdale, Maria Alcaide, Aadia Rana, Debbie Konkle-Parker, Daniel Westreich, Seble Kassaye, Elizabeth F. Topper, Anandi Sheth
Author Affiliations
Emory University, Atlanta, GA - Fujita, Mehta, Yang, Tisdale, Sheth University of North Carolina, Chapel Hill, NC - Westreich Georgetown University, Washington, D.C. - Kassaye Johns Hopkins University, Baltimore, MD - Topper The University of Alabama at Birmingham, Birmingham, AL - Rana University of Mississippi Medical Center, Jackson, MS - Konkle-Parker University of Miami, Miami, FL - Alcaide
Background
Women with HIV (WWH) who engage in substance use (SU) have worse HIV-related outcomes compared with men with SU or women without SU. Mortality associated with overdose extends beyond WWH, and has increased among pregnant and postpartum persons in recent years. We previously found higher than expected prevalence of SU treatment among women >50 years with SU. We characterized SU and treatment among cisgender, reproductive age women enrolled in the Study for Treatment And Reproductive outcomes (STAR) cohort.
Methods
Baseline data from participants with/without HIV enrolled in STAR from 2021-2022 were analyzed to determine non-medical drug use in the past year. Alcohol, tobacco, and only-marijuana were included as covariates. SU treatment utilization was self-reported use of any drug treatment program in the past year among those with current SU. We assessed the proportion of SU and treatment among participants, stratified by current/recent pregnancy, and compared treatment by HIV status using Fisher’s exact test. Recent pregnancy was defined as having a pregnancy outcome in the past 2 years.
Results
Among 519 women (354 WWH, 165 HIV-), median age was 36 years, 75% identified as non-Hispanic Black, 11% were currently pregnant, and 10% recently pregnant. Overall, 12% (n=63) reported current SU (10% WWH, 16% HIV-). Among those, 67% reported crack/cocaine use, 24% benzodiazepines/barbiturates, 14% methamphetamines, 8% opioids, 3% used ≥2 drugs, and 10% injected drugs; 8% used tobacco, 24% daily alcohol use, and 64% marijuana. Among women without SU, 21% used tobacco, 7% daily alcohol, and 45% marijuana. Among women with SU, 19% (n=12) utilized treatment (25% WWH, 11% HIV-; p=0.20). Among women with SU, treatment in the past year was 25% (3/12) among currently/recently pregnant women and 16% (8/49) among those neither currently/recently pregnant. There was no statistically significant difference in SU treatment by HIV status within the stratified groups.
Conclusion(s)
In a contemporary cohort of reproductive age women with/without HIV in the Southern US, current SU was common, less than 1/3rd utilized SU treatment, irrespective of HIV status, lower than previously reported from demographically similar women >50 years. Implementation strategies to tailor SU treatment to pregnant/postpartum women are needed.