Differential gender effect of depression on use of HIV medications among HIV-positive drug users

Background: Many barriers to the use of HIV medications have been identified. Research findings have also shown a gender disparity in HIV care behaviors. However, interaction effects of gender with the potential barriers to use of HIV medications among minority drug users remain under-studied. This study examined interaction effects of gender with potential moderating factors (i.e., individual and network characteristics) on use of HIV medications.

Methods: Analyses were based on 260 HIV-positive Puerto Rican heroin and cocaine users, recruited in New York (N=178) and Puerto Rico (N=82) in 1998-2003. HIV status was assessed using OraSure, and heroin or cocaine use was verified by urinalysis. All participants were tested and interviewed at baseline and 6 month follow-up (183 males; 77 females). In predicting use of HIV medications at follow-up (HIVMEDF), use of HIV medications at baseline (HIVMED), individual characteristics (e.g., depression, injection drug use), network characteristics (e.g., having an IDU sex partner), recruitment site, and interaction effects of these variables with gender, were examined in multiple logistic regression analysis.

Results: Mean age 39; HIVMED 29%; HIVMEDF 40%; and had depressive symptoms 77%. HIVMED (AOR=4.7; p<.001) and depression (AOR=61.3; p<.01) had significant main effects on HIVMEDF. Depression also had a significant interaction effect with gender on HIVMEDF. Unlike men, women with depression were less likely than women without depression to use the medications.

Discussion: The findings indicate that gender-specific issues should be addressed by treatment programs for HIV-positive drug users, with particular efforts needed to enhance use of medications for depressed women.