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Substance Use and Drug Treatment Among Reproductive-Age Women With and Without HIV in the Southern United States

Ayako Wendy Fujita¹, C Christina Mehta¹, Qian Yang¹

¹Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.

Open Forum Infectious Diseases

|April 28, 2025

Background:

Women with human immunodeficiency virus (HIV; WWH) and with substance use (SU) have poorer HIV-related outcomes. We characterized SU and treatment across reproductive life stages among Study of Treatment And Reproductive Outcomes (STAR) participants.

Methods:

The STAR is a prospective cohort of WWH and women without HIV (WWoH) across 6 Southern US sites. We analyzed baseline participant data (2021-2024) on self-reported past-year SU (nonmedical drug use, hazardous alcohol use, tobacco use, and nonmedical cannabis use), as well as drug and alcohol use treatment. We assessed SU and treatment by HIV and pregnancy status.

Results:

Among 891 women (526 WWH and 362 WWoH), 12% (9% of WWH and 15% WWoH; P = .02) reported past-year drug use; 15%, hazardous alcohol use (11% and 20%, respectively; P < .001); 37%, tobacco use (34% and 41%; P = .10); and 45%, cannabis use (40% and 52%; P = .001). The most frequently used drug was crack/cocaine (61%). Among pregnant women, 7% reported past-year drug use, 12% hazardous alcohol use, 28% tobacco use, and 39% cannabis use. Among women with past-year drug use (n = 102), 16% reported experiencing accidental overdose, and 23% had used any drug treatment program in the past year. There was no statistically significant difference in drug treatment by HIV or pregnancy status.

Conclusions:

Among reproductive-age WWH and WWoH in the Southern United States, SU was common, predominantly stimulant use with high rates of co-occurring cannabis and tobacco use. Implementation studies are needed to understand barriers and facilitators to integrating SU disorder care into HIV settings tailored to the needs of reproductive-age women.

Keywords:

HIV drug use reproductive-age women substance use disorders women women with HIV

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