title: Patterns of substance use among HIV-positive adults over 50: implications for treatment and medication adherence.
abstract: BACKGROUND
  The population of older adults living with HIV is increasing in the United States. Despite an increased focus on the health of HIV-positive older adults, knowledge about their substance use, a primary risk factor for HIV medication non-adherence, and the association between use, problems associated with use, and adherence behavior, is limited.
  
  
  METHODS
  Data were collected from 557 HIV-positive adults aged 50 and older in the New York City area via telephone interview. Participants reported the number of days in the past month on which they missed any doses of HIV medication as well as the number of days they used alcohol, marijuana, cocaine/crack, opiates, amyl nitrite (poppers), and other drugs. The severity of substance use associated problems was assessed using the DAST-10 and AUDIT-C.
  
  
  RESULTS
  The sample included gay/bisexual (40.4%) and heterosexual (28.1%) men as well as lesbian/bisexual (4.9%) and heterosexual (26.7%) women. Latent class analyses identified four distinct patterns of substance use: Exclusive Alcohol Use; Alcohol and Marijuana; Alcohol and Cocaine/Crack; and Multiple-Substance Use. Variability in the number of missed HIV medication days and perceptions of substance use associated problems were observed across classes, with poorest adherence reported in the Alcohol and Marijuana class, the Alcohol and Cocaine/Crack class, and the Multiple-Substance Use class. The latter two classes also reported the greatest perceived impairment from substance use.
  
  
  CONCLUSIONS
  Patterns of recent substance use were associated with varying levels of HIV medication adherence and perceived substance use impairment, indicating that substance type matters when considering the health of older adults living with HIV, and that multiple-substance use needs to be addressed by interventions aimed at improving medication adherence.
authors.affiliation: Department of Psychology, Hunter College of the City University of New York (CUNY), 695 Park Avenue, New York, NY 10065, USA; Center for HIV/AIDS Educational Studies and Training (CHEST), New York, NY, USA; Doctoral Program in Health Psychology and Clinical Science, The Graduate Center of CUNY, New York, NY, USA; CUNY School of Public Health at Hunter College, New York, NY, USA. Electronic address: Jeffrey.parsons@hunter.cuny.edu.
authors.forename: Jeffrey T
authors.initials: JT
authors.lastname: Parsons
authors.affiliation: Department of Psychology, Hunter College of the City University of New York (CUNY), 695 Park Avenue, New York, NY 10065, USA; Department of Psychology, Pace University, New York, NY, USA.
authors.forename: Tyrel J
authors.initials: TJ
authors.lastname: Starks
authors.affiliation: Center for HIV/AIDS Educational Studies and Training (CHEST), New York, NY, USA; Doctoral Program in Health Psychology and Clinical Science, The Graduate Center of CUNY, New York, NY, USA.
authors.forename: Brett M
authors.initials: BM
authors.lastname: Millar
authors.affiliation: Department of Psychology, Hunter College of the City University of New York (CUNY), 695 Park Avenue, New York, NY 10065, USA.
authors.forename: Kailip
authors.initials: K
authors.lastname: Boonrai
authors.affiliation: Department of Psychology, Fordham University, New York, NY, USA.
authors.forename: David
authors.initials: D
authors.lastname: Marcotte
mesh_terms: D000437:Alcoholism / Q000453:epidemiology / Q000523:psychology / Q000628:therapy; D019970:Cocaine-Related Disorders / Q000453:epidemiology / Q000523:psychology / Q000628:therapy; D005260:Female; D006679:HIV Seropositivity / Q000188:drug therapy / Q000523:psychology*; D006801:Humans; D008297:Male; D002189:Marijuana Abuse / Q000453:epidemiology / Q000523:psychology / Q000628:therapy; D055118:Medication Adherence / Q000523:psychology*; D008875:Middle Aged; D009519:New York City / Q000453:epidemiology; D012307:Risk Factors; D012720:Severity of Illness Index; D019966:Substance-Related Disorders / Q000453:epidemiology / Q000523:psychology* / Q000628:therapy; D016903:Drug Monitoring
keywords: HIV and aging; Medication adherence; Older adults; Substance use
references.citation: AIDS Care. 2003 Dec;15(6):775-85
references.pmid: 14617499
references.citation: J Acquir Immune Defic Syndr. 2009 Jan 1;50(1):93-9
references.pmid: 19295339
references.citation: Addiction. 2003 Jan;98(1):7-22
references.pmid: 12492751
references.citation: AIDS. 2004 Jan 1;18 Suppl 1:S43-8
references.pmid: 15075497
references.citation: AIDS Behav. 2008 Nov;12(6):943-56
references.pmid: 18389361
references.citation: AIDS Educ Prev. 2007 Aug;19(4):321-33
references.pmid: 17685845
references.citation: AIDS Care. 2000 Aug;12(4):405-8
references.pmid: 11091773
references.citation: Arch Fam Med. 1996 May;5(5):297-300
references.pmid: 8620270
references.citation: Neuropsychol Rev. 2009 Jun;19(2):263-72
references.pmid: 19247836
references.citation: Psychol Addict Behav. 2013 Dec;27(4):1050-1058
references.pmid: 23438250
references.citation: JAMA. 2013 Apr 3;309(13):1397-405
references.pmid: 23549585
references.citation: Health Psychol. 2007 Jan;26(1):40-9
references.pmid: 17209696
references.citation: Arch Intern Med. 1998 Sep 14;158(16):1789-95
references.pmid: 9738608
references.citation: AIDS Patient Care STDS. 2013 Jan;27(1):5-16
references.pmid: 23305257
references.citation: Addiction. 2008 Aug;103(8):1242-57
references.pmid: 18855813
references.citation: Subst Abuse Treat Prev Policy. 2007 Nov 08;2:33
references.pmid: 17996066
references.citation: Gerontologist. 2006 Dec;46(6):781-90
references.pmid: 17169933
references.citation: AIDS Care. 2010 May;22(5):630-9
references.pmid: 20401765
references.citation: Drug Alcohol Depend. 2007 Apr 17;88(1):1-8
references.pmid: 17049753
references.citation: Curr HIV/AIDS Rep. 2010 May;7(2):69-76
references.pmid: 20425560
references.citation: Ann Intern Med. 2001 May 15;134(10):968-77
references.pmid: 11352698
references.citation: AIDS Behav. 2007 Mar;11(2):185-94
references.pmid: 16897351
references.citation: Sex Transm Dis. 2010 Oct;37(10):615-20
references.pmid: 21305717
references.citation: J Gen Psychol. 2006 Oct;133(4):453-67
references.pmid: 17128962
references.citation: Aging Ment Health. 2002 May;6(2):121-8
references.pmid: 12028880
references.citation: AIDS Care. 2011 Jun;23(6):775-85
references.pmid: 21293986
references.citation: AIDS. 2001 Jun 15;15(9):1181-3
references.pmid: 11416722
references.citation: Addict Behav. 1982;7(4):363-71
references.pmid: 7183189
references.citation: Alcohol Clin Exp Res. 2000 Jun;24(6):882-91
references.pmid: 10888079
references.citation: AIDS Care. 2013;25(4):451-8
references.pmid: 22894702
references.citation: Pharmacoeconomics. 2010;28(12):1097-107
references.pmid: 21080735
references.citation: AIDS Behav. 2006 May;10(3):227-45
references.pmid: 16783535
references.citation: Drug Alcohol Depend. 2011 Jul 1;116(1-3):177-87
references.pmid: 21306837
references.citation: AIDS Patient Care STDS. 2006 Nov;20(11):782-91
references.pmid: 17134352
references.citation: Psychiatry Res. 1988 Mar;23(3):335-44
references.pmid: 3387505
references.citation: Curr HIV/AIDS Rep. 2011 Dec;8(4):223-34
references.pmid: 21858414
references.citation: Ann Intern Med. 2000 Jul 4;133(1):21-30
references.pmid: 10877736
references.citation: J Gen Intern Med. 2002 May;17(5):377-81
references.pmid: 12047736
references.citation: AIDS Behav. 2013 Jan;17(1):168-73
references.pmid: 23008124
references.citation: Antivir Ther. 2004 Jun;9(3):407-14
references.pmid: 15259903
references.citation: Drug Alcohol Depend. 2010 Aug 1;110(3):208-20
references.pmid: 20395074
references.citation: Sex Health. 2011 Dec;8(4):551-9
references.pmid: 22127042
references.citation: AIDS Behav. 2013 May;17(4):1478-87
references.pmid: 23553345
references.citation: J Clin Epidemiol. 2001 Dec;54 Suppl 1:S44-52
references.pmid: 11750209
references.citation: Drug Alcohol Depend. 2007 Sep 6;90(1):72-80
references.pmid: 17446013
references.citation: AIDS Care. 2009 May;21(5):541-51
references.pmid: 19444661