Gender differences in alcohol, tobacco and drug use in HIV positive adults
Rational: Health promotion screening is an important practice for nurses who care for adults with chronic illnesses, including HIV disease. High rates of substance use are associated with both HIV risk acquisition and disparities in health outcomes among people living with HIV (PLWHIV). In PLWHIV cocaine use exacerbates disease progression compared to non-cocaine users. It is also linked to HIV-associated neurocognitive disorders. Amphetamine use is associated with primary drug resistance to non-nucleoside reverse transcriptase inhibitors and higher sexually transmitted infection rates. PLWHIV who use tobacco have higher rates of anal, cervical and lung cancer, chronic obstructive pulmonary disease, cardiovascular disease, and decreased virological response to antiretrovirals compared to non-smokers. Screening for substance use is an evidence-based approach to identify individuals whose substance use is causing harm and creates an opportunity to diminish harmful risk behavior. Further, an understanding of the differences and similarities between the genders with respect to drug, alcohol, and tobacco use may be useful in shaping health promotion messages and health screening guidelines for providers caring for PLWHIV.
Methods: We performed a secondary analysis of baseline data collected as part of a randomized controlled trial that compared substance use screening modalities. Participants were recruited from an urban HIV-primary care clinic. Substance use was determined by the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST). Participants completed the ASSIST measure to determine patterns of substance use over the prior three months. Specific substances measured were: tobacco, alcohol, cannabis, cocaine, amphetamines, opioids, sedatives or sleeping pills. Frequencies were: never, once or twice, monthly, weekly, daily or almost daily.
Results: A total of 210 participants (23% women) were enrolled. Women were African-American 61%, Caucasian 27%, Hispanic 4%. Men were Caucasian 36.4% African-American 33%, Hispanic 19%. Most (83%) reported their income as inadequate. Mean ages were: women, 49 years, (s.d. ±8.421); men, 45 years, (s.d. ±8.017). Daily cocaine use was significantly higher in women (66.0%) when compared to men (53.8%); p = 0.045). Although not statistically significant the following gender differences were observed: weekly alcohol use was higher in men than in women (21.3% vs 10.6%). Cannabis use was higher in men than in women, both daily (24.0% vs 11.0%) and weekly (18.9% vs 11.1%). Amphetamine use was higher in men weekly (11.9%), monthly (11.2%), and once or twice (17.2%), than in women who were less than 4% in all use frequencies. There were no significant gender differences for tobacco, or alcohol use.
Implications: These data demonstrate PLWHIV are continuing to use drugs, alcohol and tobacco leaving them at risk of multiple health deficits. Evidence based approaches for addressing harmful substance use as part of clinical care could be integrated into the care of PLWHIV similar to this sample. Nurses are positioned to administer clinic based screening utilizing evidence based interventions to tailor health promotion that addresses harmful substance use for PLWHIV.