The Importance of Addressing Drug Use During HIV Treatment

The previously understudied underlying mechanisms associated with illicit drug use among patients with HIV and the lack of engagement in the HIV care continuum were revealed during a recent study.

The qualitative study, published in Frontiers in Public Health, primarily focused on Black and Hispanic persons living with HIV (PLWH) who had delayed, declined, or discontinued antiretroviral treatment (ART) and were generally poorly engaged in health care.

In order to have maximum variation on HIV indices, researchers purposely sampled participants (N=37) from a larger sample study of 95 PLWH.

Data was collected in 2012 to 2013, while a trained and experienced research staff conducted an in-depth, semi-structured interview in a confidential location until data saturation was reached on core constructs.

To analyze the transcriptions, a systematic content analysis approach in the Dedoose platform was used in phases to identify the processes and mechanisms of action within the interview transcripts.

Participants in the study were mostly black males, ranging from 26 to 64-years-old with a median age of 48.7.

These HIV patients lived on average for 13.88 years with the disease. About half had taken ART at least once prior to the study and none were on ART at the start of enrollment.

The results of the study found that participants’ decisions and experiences with ART were highly complex and emotionally charged, but discussion of HIV attendance patterns were of less significance.

Heavy substance use, but not necessarily causal or social use, was found to impede ART uptake mostly by undermining medication management abilities and could trigger depression.

Other barriers to ART initiation dealt with Black or Hispanic race, poverty, and drug use that was associated with higher levels of perceived stigma and inferior treatment in health care settings compared with their peers because of drug use.

Lastly, there was a distrust between patients and providers described as frequently assuming participants were selling their HIV medications to buy illicit drugs, putting a strain on the relationships.

Also, the high levels of medical distrust common within this population created fears of ART related to negative interactions between street drugs and ART. However, because of the distrust, this concern was not easily discussed with health care providers.

These barriers were embedded in other structural and social challenges as well, which disproportionally affected low-income Black and Hispanic PLWH, however, HIV management was cyclical.

Participants were commonly found to reduce substance use and initiate or reinitiate ART after collaboration with trusted providers and ancillary staff.

To address some of these barriers to ART initiation and engagement in HIV care for this population, the study suggests the need to adapt care pathways to address the patient experience, as well as altering interventions to better convey adherence as a continuous and changing process instead of a fixed state.

Furthermore, enhancing substance abuse training to care providers in HIV clinics, as well as ancillary and complementary services and interventions in HIV clinics, has the potential to reduce stigma experiences and improve engagement.