Background
Women with HIV (WWH) who engage in substance use (SU) have poor HIV-related outcomes. Additionally, mortality associated with overdose has recently increased among pregnant and postpartum persons. We characterized SU and treatment among cisgender, reproductive age WWH and women without HIV (WWoH) enrolled in the Study of Treatment And Reproductive Outcomes (STAR).
Methods
Baseline data from participants enrolled in STAR 2021-2023 were analyzed to determine current SU (illicit drug use in past year) and accidental overdose in the past year. Tobacco, hazardous alcohol use (Alcohol Use Disorders Identification Test score ≥8), and marijuana use were assessed separately. SU treatment utilization was self-reported use of any drug treatment program in the past year among those with current SU. We assessed the proportion of SU and treatment stratified by pregnancy status, and compared treatment by HIV status using Fisher’s exact test. Postpartum was defined as having had a pregnancy outcome in the past year.
Results
Among 759 women (473 WWH, 286 WWoH), median age was 36 years, 75% identified as non-Hispanic Black, 11% were currently pregnant, 6% postpartum, and 62% ≥1 year postpartum. Overall, 84 (11%) reported current SU (9% WWH, 15% WWoH). Current SU was 14% among women who had never been pregnant, 9% among pregnant women, 4% among postpartum women, and 11% among women ≥1 year postpartum. Among women who reported SU, 62% reported crack/cocaine use, 30% benzodiazepines/barbiturates, 13% methamphetamines, 7% opioids, and 8% reported injecting drugs; 70% smoked cigarettes, 41% had hazardous alcohol use, and 61% used marijuana in the past year. Among 667 women without current SU, 25% smoked cigarettes, 10% had hazardous alcohol use, and 43% had used marijuana in the past year. Of the 61 reporting current SU who answered overdose questions, 8 (13%) reported accidental overdose in the past year. Among women with current SU, 18 (21%) utilized treatment (26% WWH, 17% WWoH; p=0.34), including 2/21 who were nulliparous, 2/9 who were pregnant/postpartum, and 14/53 who were ≥1 year postpartum (p=0.28).
Conclusions
In this cohort of reproductive age women in the Southern US, SU was common overall but fluctuated across reproductive life stages. One in five utilized SU treatment, irrespective of HIV status, lower than previously reported from demographically similar women >50 years. SU treatment strategies and overdose prevention targeted towards women in their reproductive years are needed.