Examination of Substance Use Patterns and ART Adherence Among People Living with HIV

Introduction: Research suggests that alcohol use accelerates HIV disease progression directly through interference with antiretroviral therapy (ART) and indirectly via decreased ART adherence. Despite the relatively high prevalence of alcohol and marijuana use among PLWH, few studies have utilized prospective daily reports of substance use and ART adherence.  Furthermore, there is a relative scarcity of research on patterns of alcohol consumption pre-and post-HIV diagnosis and perceptions of alcohol’s effect on health outcomes among PLWH.

Methods: Data come from a mixed methods pilot study examining substance use and ART adherence among PLWH through ecological momentary assessment. Participants completed daily reports for two weeks on smartphones along with a qualitative interview. The first study aim is to describe substance abuse patterns among PLWH (e.g., quantity, time, location) and reasons for alcohol and marijuana use. The second aim is to examine qualitatively the reasons for drinking and describe drinking patterns pre- and post-HIV diagnosis.

Results: Most daily reports indicated that 3-4 drinks were consumed in the previous 24 hours beginning in the afternoon (range =12-4pm) and ending at 3pm for earlier-initiating drinkers or 10pm for later-initiating drinkers (sample= 152 reports from 15 participants). Alcohol was consumed mainly in a personal home (55%) or a friend’s house (28%). The most common reasons for drinking were to relax/fit in (57%) and enjoy a social situation better (48%). Reasons cited for marijuana use were to relax/fit in (almost 79%) and reduce the stress of their illness (about 45%). The majority of reports indicated that this sample was considerably intoxicated (33%) and high (50%). Key themes from qualitative interviews regarding reasons why participants drank alcohol include: drinking as a part of daily life (e.g., drinks with food, easy access to alcohol), drinking with others (e.g., “drinking alone is depressing”, drinks while playing games with friends), and drinking as a tool (e.g., needs to entertain self, “drinks to forget”). Other main themes focus on 1) the variability in drinking patterns over time (e.g. drank more after diagnosis, was “wild” before diagnosis), 2) defiance of HIV (e.g. “wasn’t going to let diagnosis stop me”, diagnosis didn’t affect drinking habits) and 3) awareness of alcohol’s potential impact on medication adherence (e.g. need to let alcohol get out of system before taking medication, can’t drink and take ART without getting sick).

Conclusion: Study findings have important implications for the development of behavioral interventions targeting substance use and ART adherence among PLWH.