Prevalence of substance use problems in HIV-positive patients attending comprehensive care clinics in NYC

Background: Substance use among HIV-positive persons exacerbates health problems. This study sought to estimate the prevalence of alcohol and drug-use problems among HIV-positive patients in NYC.

Methods: This retrospective cohort study includes electronic medical records (EMRs) of 5,584 HIV-positive patients who attended comprehensive care clinics in NYC in 2012.  EMRs were used to obtain estimates of the prevalence of alcohol and drug-use problems based on ICD-9/10 diagnoses of abuse/dependence.

Results: In the prior year, 11% of patients had an alcohol-use problem (no racial/ethnic differences were found). More Black patients (33.6%) had a drug-use problem, followed by Latino (30.7%) and White (30.0%) patients, with fewer “other” race patients having a problem (23.6%, p<.01). Gender comparisons revealed that a smaller proportion (2.7%) of transgender patients (74) had an alcohol-use problem than both cisgender males (11.6%) and females (11.0%, p=.05); females (37.0%) had significantly higher rates of drug problems than males (30.2%) and transgender patients (27.0%, p<.001). A significantly smaller proportion of MSM (10.5%) had an alcohol or drug-related problem (10.5% and 26.6%, respectively) than non-MSM (12.4% and 37.8%, respectively, p < .01). Three-quarters of patients with an alcohol problem also had a co-morbid drug problem and compared with patients with no alcohol problem, had nearly 9 times the odds of having a drug problem. 

Conclusions: Contrary to previous studies showing higher rates of substance use among HIV-positive MSM and transgender populations, our results found these groups had lower rates.  Further examination of the extent of such comorbidity is instrumental for intervention efforts.