Stimulants, Opioids, and HIV Care Engagement: Findings Among Older Black People with HIV.

BACKGROUND

Although substance use continues to increase among people living with HIV (PLWH), it is often overlooked among older PLWH and may explain poor engagement in care and the increase in overdose deaths, particularly among Black PLWH. The purpose of this study was to assess the relationship between stimulant and opioid use and visit and medication non-adherence among African American older adults with HIV.

METHODS

An online survey was completed among 52 older PLWH in Ohio, who identified as Black, living with HIV, and 50 years of age and older. Past three-month use of cocaine, amphetamines, and opioids were self-reported. Visit non-adherence was defined as missing at least one clinic visit in the past 12-months and medication non-adherence was defined as missing all medications for ≥4 days in the past 3-months, both self-reported. Inverse probability weighting was used to adjust for confounding and odds ratios (OR) and 95% confidence intervals (CI) were calculated.

RESULTS

The study sample was predominately male (94%). Cocaine use was the most prevalent substance reported (56.0%), followed by amphetamine (54.0%) and opioid use (52.0%). Visit non-adherence was associated with amphetamine (OR: 20.42; 95% CI: 2.35, 177.35), cocaine (OR: 21.81; 95% CI: 2.54, 186.99), and opioid use (OR: 11.93; 95% CI: 3.74, 38.05). There were no statistically significant associations between substance use and medication non-adherence.

CONCLUSIONS

Stimulant and opioid use impedes optimal engagement in HIV care among older Black PLWH.