Desire for Substance Use Disorder Treatment Among HIV-infected Substance Users in Two U.S. Southern Cities

Background:  Interventions addressing factors affecting desire and/or readiness for substance use disorder (SUD) treatment for HIV-infected substance users are needed.  We examined the relationship between desire for SUD treatment and perceived HIV stigma, medical mistrust, and the Alcohol Composite Index (ACI) from the Addiction Severity Index.     

Methods:  We used the baseline behavioral risk assessment from a randomized clinical trial evaluating the effectiveness of an integrated “Retention Clinic” in achieving virologic suppression among HIV-infected cocaine users. Multiple variable logistic regression was used to examine the relationship between desire for SUD treatment and perceived HIV stigma, medical mistrust and the ACI. Predictors are scaled to have a standard deviation of 1.

Results:  Two-hundred-nineteen participants have been randomized into the trial; 60% are male, 82% are Black, and the mean age is 46.  At baseline, all participants had a detectable viral load and reported substance use in the past year, 54.2% had moderate or greater substance use severity, and 41.3% had a desire for SUD treatment, which was associated with higher perceived HIV stigma (aOR 1.68, 95% CI (1.19, 2.36)), lower medical mistrust (aOR 0.61, 95% CI (0.43, 0.88)) and higher ACI (aOR 1.50, 95% CI (1.10, 2.05)).

Discussion:  Perceived HIV stigma, medical mistrust and the ACI were associated with desire for SUD treatment.  Although all participants self-reported substance use, less than half had a desire for SUD treatment.  Further research should be conducted to assess the relationship between desire for and attendance at SUD treatment.