Associations between cannabis use, cannabis use motivations and past year polysubstance use among people living with HIV in Florida.

Polysubstance use (PSU) is common among people with HIV (PWH), and cannabis use, both medical and non-medical, is increasingly prevalent in this population. This study examined patterns of PSU by cannabis use status and motivation among 333 PWH who reported past-year substance use. The sample was 67.6% non-Hispanic Black/African American, 54.3% male, and 78% current cannabis use. PSU was defined as the number of non-cannabis substances used in the past 12 months (range: 0-9). Cannabis use was associated with significantly higher use of most substances (p < 0.05), particularly crack/cocaine and cigarettes. Those who use cannabis had a higher mean PSU count (M = 2.5, SD = 1.7) compared to non-users (M = 0.63, SD = 0.98; p < 0.001). Among those using cannabis regularly, latent class analysis identified three motivation groups: medical/emotional (24.4%), recreational (37.0%), and mixed (38.6%). Recreational use reported lower PSU compared to those in the medical/emotional group (β = -0.24, 95% CI [-0.47, - 0.01]); no significant difference was observed between the mixed and medical/emotional groups. These findings suggest that cannabis use motivations may be associated with broader substance use patterns among PWH. Understanding these patterns is critical for tailoring interventions, especially given the potential impact of PSU on HIV-related health outcomes.