title: Gender differences in factors associated with adherence to antiretroviral therapy.
abstract: OBJECTIVE
  To identify gender differences in social and behavioral factors associated with antiretroviral adherence.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  Methadone maintenance program.
  
  
  METHODS
  One hundred thirteen HIV-seropositive current or former opioid users.
  
  
  RESULTS
  Participants were surveyed at baseline about social and behavioral characteristics and at monthly research visits about drug and alcohol use and medication side effects. Electronic monitors (MEMS) were used to measure antiretroviral adherence. Median adherence among women was 27% lower than among men (46% vs. 73%; P < .05). In gender-stratified multivariate models, factors associated with worse adherence in men included not belonging to an HIV support group (P < .0001), crack/cocaine use (P < .005), and medication side effects (P = .01). Among women, alcohol use (P = .005), heroin use (P < .05), and significant medication side effects (P < .005) were independently associated with worse adherence. In a model including both men and women, worse adherence was associated with lack of long-term housing (P < .005), not belonging to any HIV support groups (P < .0005), crack or cocaine use (P < .01), and medication side effects (P < .0005). In addition, worse adherence was associated with the interaction between female gender and alcohol use (P < or = .05).
  
  
  CONCLUSIONS
  In this cohort of current and former opioid users, gender-stratified analysis demonstrated that different social and behavioral factors are associated with adherence in men and women. Among both men and women, worse adherence was associated with lack of long-term housing, not belonging to an HIV support group, crack/cocaine use, and medication side effects. Among women only, alcohol use was associated with worse adherence.
authors.affiliation: Division of Substance Abuse, Department of Psychiatry and Behavioral Sciences, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10467, USA. kberg@montefiore.org
authors.forename: Karina M
authors.initials: KM
authors.lastname: Berg
authors.forename: Penelope A
authors.initials: PA
authors.lastname: Demas
authors.forename: Andrea A
authors.initials: AA
authors.lastname: Howard
authors.forename: Ellie E
authors.initials: EE
authors.lastname: Schoenbaum
authors.forename: Marc N
authors.initials: MN
authors.lastname: Gourevitch
authors.forename: Julia H
authors.initials: JH
authors.lastname: Arnsten
mesh_terms: D000328:Adult; D000428:Alcohol Drinking; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D015986:Confounding Factors, Epidemiologic; D005260:Female; D006679:HIV Seropositivity / Q000188:drug therapy*; D006798:Housing; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010349:Patient Compliance / Q000706:statistics & numerical data*; D011446:Prospective Studies
chemical_list: D044966:Anti-Retroviral Agents