title: Female gender predicts lower access and adherence to antiretroviral therapy in a setting of free healthcare.
abstract: BACKGROUND
  Barriers to HIV treatment among injection drug users (IDU) are a major public health concern. However, there remain few long-term studies investigating key demographic and behavioral factors--and gender differences in particular--that may pose barriers to antiretroviral therapy (ART), especially in settings with universal healthcare. We evaluated access and adherence to ART in a long-term cohort of HIV-positive IDU in a setting where medical care and antiretroviral therapy are provided free of charge through a universal healthcare system.
  
  
  METHODS
  We evaluated baseline antiretroviral use and subsequent adherence to ART among a Canadian cohort of HIV-positive IDU. We used generalized estimating equation logistic regression to evaluate factors associated with 95% adherence to antiretroviral therapy estimated based on prescription refill compliance.
  
  
  RESULTS
  Between May 1996 and April 2008, 545 IDU participants were followed for a median of 23.8 months (Inter-quartile range: 8.5-91.6), among whom 341 (63%) were male and 204 (37%) were female. Within the six-month period prior to the baseline interview, 133 (39%) men and 62 (30%) women were on ART (p=0.042). After adjusting for clinical characteristics as well as drug use patterns measured longitudinally throughout follow-up, female gender was independently associated with a lower likelihood of being 95% adherent to ART (Odds Ratio [OR]=0.70; 95% Confidence Interval: 0.53-0.93).
  
  
  CONCLUSIONS
  Despite universal access to free HIV treatment and medical care, female IDU were less likely to access and adhere to antiretroviral therapy, a finding that was independent of drug use and clinical characteristics. These data suggest that interventions to improve access to HIV treatment among IDU must be tailored to address unique barriers to antiretroviral therapy faced by female IDU.
authors.affiliation: British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, and Department of Medicine, University of British Columbia, Vancouver, Canada.
authors.forename: Christine
authors.initials: C
authors.lastname: Tapp
authors.forename: M-J
authors.initials: MJ
authors.lastname: Milloy
authors.forename: Thomas
authors.initials: T
authors.lastname: Kerr
authors.forename: Ruth
authors.initials: R
authors.lastname: Zhang
authors.forename: Silvia
authors.initials: S
authors.lastname: Guillemi
authors.forename: Robert S
authors.initials: RS
authors.lastname: Hogg
authors.forename: Julio
authors.initials: J
authors.lastname: Montaner
authors.forename: Evan
authors.initials: E
authors.lastname: Wood
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active; D001955:British Columbia; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D010349:Patient Compliance; D012737:Sex Factors; D015819:Substance Abuse, Intravenous / Q000150:complications; D019472:Universal Health Insurance; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents