Beyond the high: exploring socioecological influences on cannabis use in older women with and without HIV

Cannabis use among older adults in the United States is increasing. While prior research has examined motives and impacts among older adults generally, less attention has focused on women living with HIV. The study examines the experiences and perspectives of cannabis use among older women living with HIV compared with women without HIV.

The Social Ecological Model (SEM) guided qualitative interviews and thematic analysis to examine cannabis use. We interviewed 30 participants (20 women with HIV and 10 women without HIV) enrolled in the Multicenter AIDS Cohort Study/Women's Interagency HIV Study Combined Cohort Study.

Factors influencing cannabis use were similar across groups including relief from psychological distress, pain management, sleep assistance, and reduction or replacement of other substances. Women with HIV more often reported greater mental health symptom burden, along with appetite stimulation and energy enhancement as motives for use. Across both groups, motives shifted over time from social to therapeutic purposes. Most women felt comfortable informing medical providers of cannabis use. Participants expressed distrust about cannabis legalization and product safety.

Findings highlight the complex and multifaceted influences shaping cannabis use. The application of the SEM underscores the need for a holistic approach in understanding cannabis use among older adult women with and without HIV. These insights point to the need for tailored clinical guidance and harm reduction strategies that acknowledge the unique health and social contexts of women living with HIV while addressing important policy considerations affecting this population.