Substance Use Stigma Has a Negative Effect on Antiretroviral Adherence Among People Living With HIV

People living with HIV (PLWH) who use drugs face intersectional (e.g., multiple sources of) stigma that may negatively affect antiretroviral adherence. Researchers explored the impact of substance use (SU) stigma on antiretroviral adherence behaviors among 172 PLWH. Study participants completed surveys on SU, SU stigma, ART adherence, and HIV-related stigma. Multivariable logistic regression models were adjusted for sociodemographic characteristics, severity of alcohol and other drug use, HIV-related stigma, and social support.

• 66% of participants had moderate/high risk scores for cocaine, 65% for cannabis, and 66% for hazardous alcohol consumption.*
• 60% of patients reported less than optimal antiretroviral adherence.
• The adjusted odds ratios for optimal antiretroviral adherence among participants experiencing moderate levels of anticipated SU stigma (adjusted odds ratio [aOR], 0.36), and very high levels of anticipated SU stigma (aOR, 0.25) were significantly lower than among participants experiencing low levels of anticipated SU stigma (reference). No association was found for participants experiencing high anticipated SU stigma.

* Based on the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) for drugs, and the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) for alcohol.

Comments: In this study of self-reported antiretroviral adherence among PLWH who also use drugs, substance use stigma was associated with less than optimal adherence, even when controlling for HIV-related stigma. The impact of intersectional stigma on health outcomes remains an open question, and could be addressed in research that includes robust measures of adherence among PLWH who also use drugs.

Jeanette M. Tetrault, MD

Reference: Stringer KL, Marotta P, Baker E, et al. Substance use stigma and antiretroviral adherence among a drug-using population living with HIV. AIDS Patient Care STDS. 2019;33(6):282–293.