Current substance use behavior among severely mentally ill individuals diagnosed with HIV and HCV

BACKGROUND: Infection with HIV and HCV is higher among severely mentally ill (SMI) individuals than the general population. The literature addressing prevention focuses primarily on sexual risk, though substance-related risk is significant. Insufficient data is available about substance use behavior in this population to formulate effective secondary prevention interventions. METHODS: This cross-sectional study was a secondary analysis of a RCT. Subjects reporting a diagnosis of HIV/HCV (reporters) were compared to non-reporters. Data were extracted from interviews that included the Addiction Severity Index (ASI). Data were analyzed using logistic regression. RESULTS: Of 275 subjects, 64(23.3%) reported a HIV/HCV diagnosis. Compared to non-reporters, reporters were more likely to use amphetamines (OR=2.60, p=.05) and to use more types of drugs over the lifetime (OR=1.67, p<.0001). HIV/HCV reporters were more likely to be older (OR=1.04, p=.04) and to use injection drugs (OR=4.18, p=.001). The most commonly used substances were alcohol to intoxication (n=86, 100% oral), cocaine/crack (n=65, 69.2% smoked), marijuana (n=52, 100% smoked), and amphetamines (n=34, 52.9% injected). CONCLUSIONS: The results indicate that despite knowledge of HIV/HCV diagnosis, substance-related risk remains high and transmission risk is great for individuals associating with the infected. Recommendations to mitigate risk include: 1) routine screening and prevention education for SMI annually 2) harm reduction including providing safe crack smoking implements and counseling to prevent initiation and transition to injection use, 3) outreach to SMI injection amphetamine users who are unlikely to utilize needle exchange programs, and 4) training of mental health providers about infectious disease prevention education.