When does an HIV diagnosis precede substance use initiation? Capturing the interactions of substance use and HIV milestones for people living with HIV/AIDS

Background: To identify needs of HIV positive consumers regarding substance use prevention, the Seattle HIV/AIDS Planning Council conducted an assessment looking at the relationship of substance use initiation and HIV diagnosis. The assessment focused on whether people living with HIV/AIDS were initiating substance use after diagnosis, and examined predictive factors of drug use initiation and interventions for providers. The substances addressed include methamphetamine, crack/cocaine, and heavy alcohol use.

Methods: Along with a survey, an innovative visual tool was developed to capture a timeline of major events and patterns for each respondent. This timeline was used to track substance use patterns against HIV milestones such as HIV diagnosis, AIDS diagnosis, initiation of HAART, disclosure of status, and adherence to HIV treatment. The timeline added value to the assessment and offered a unique perspective on the interactions of substance use and HIV milestones throughout the adolescent and adult life of respondents.

Results: The assessment showed complex patterns of multiple drug use and a higher proportion of substance use initiation pre-HIV diagnosis. Data analysis suggested post-diagnosis initiation was most often associated with methamphetamine use. Family history of substance use and mental illness were characteristics associated with the majority of the post-diagnosis initiators, regardless of substance.

Conclusions: The assessment offers information about the complicated circumstances impacting initiation of substance use. Data collection through the timeline allowed individual experiences to be understood in a holistic context, and provides an important example of how socioeconomic and external influences can be applied to public health practice.