Substance Use Among Older People Living With HIV: Challenges for Health Care Providers

Area of Science:

• Geriatric Medicine
• Infectious Diseases
• Addiction Medicine

Background:

• Older people living with HIV (OPLWH) exhibit higher rates of substance use (tobacco, alcohol, drugs) compared to HIV-negative individuals.
• Substance use complicates HIV care due to comorbidities, medication interactions (including antiretroviral therapy - ART), reduced ART adherence, and increased risky behaviors.
• Individuals using substances experience disparities across the HIV care continuum, leading to lower viral suppression and poorer health outcomes, exacerbated by stigma and stress.

Purpose of the Study:

• To highlight the challenges in addressing the healthcare needs of OPLWH who use substances.
• To emphasize the impact of substance use on HIV treatment and care outcomes in older adults.
• To provide recommendations for healthcare providers managing this population.

Main Methods:

• Review of existing literature and clinical considerations regarding OPLWH and substance use.
• Analysis of the intersection between substance use, comorbidities, ART, and health disparities.
• Synthesis of recommendations for healthcare providers.

Main Results:

• Substance use is associated with significant challenges in managing OPLWH, including increased comorbidities and medication management difficulties.
• Reduced adherence to ART and increased risky behaviors are linked to substance use in OPLWH.
• Disparities in the HIV care continuum and poorer health outcomes are evident in OPLWH who use substances.

Conclusions:

• Healthcare providers need to screen for and refer OPLWH who use substances for associated conditions.
• Enhanced training and continuing education are essential for healthcare providers to improve care management and health outcomes for this population.
• Addressing substance use is critical for optimizing HIV treatment and care for older adults living with HIV.