title: Racial and Ethnic Differences in Substance Use Diagnoses, Comorbid Psychiatric Disorders, and Treatment Initiation among HIV-Positive and HIV-Negative Women in an Integrated Health Plan.
abstract: Access to substance use disorder (SUD) treatment is a critical issue for women with HIV. This study examined differences in SUD diagnoses, comorbid psychiatric diagnoses, and predictors of SUD treatment initiation among a diverse sample of HIV-positive women (n = 228) and a demographically similar cohort of HIV-negative women (n = 693). Diagnoses and service utilization data were obtained from electronic health records of members of a large integrated healthcare system in Northern California. HIV-positive women were less likely to initiate SUD treatment. Significant racial/ethnic differences were found among both HIV-positive and HIV-negative women with respect to SUD diagnosis type and diagnosis of comorbid psychiatric disorders. Among the HIV-negative women, rates of SUD treatment initiation were lower for black women than for white or Latina women. Multivariable logistic regression models showed that alcohol, cannabis, and opiate diagnoses were predictive of SUD treatment initiation for both cohorts, while amphetamine diagnoses, comorbid depressive disorder, and being white or Latina were predictive of SUD treatment initiation for HIV-negative, but not HIV-positive, women. Findings suggest that clinicians need to be aware of differences in substances of abuse, comorbid psychiatric disorders, and to consider the demographic and social factors that may contribute to differences in SUD treatment initiation among HIV-positive and HIV-negative women.
authors: a Associate Behavioral Scientist, RAND Corporation , Santa Monica , CA , USA.
authors: Erik David
authors: ED
authors: Storholm
authors: b Research Scientist, Kaiser Permanente Northern California Division of Research , Oakland , CA , USA.
authors: Michael J
authors: MJ
authors: Silverberg
authors: c Associate Professor, Department of Psychiatry , University of California at San Francisco , San Francisco , CA , USA.
authors: Derek D
authors: DD
authors: Satre
mesh_terms: D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D002140:California; D015331:Cohort Studies; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration*; D017831:Diagnosis, Dual (Psychiatry); D015658:HIV Infections / Q000453:epidemiology* / Q000208:ethnology / Q000628:therapy; D006297:Health Services Accessibility; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D016015:Logistic Models; D001523:Mental Disorders / Q000453:epidemiology / Q000523:psychology / Q000628:therapy*; D008875:Middle Aged; D012189:Retrospective Studies; D019966:Substance-Related Disorders / Q000208:ethnology / Q000523:psychology / Q000534:rehabilitation*; D044465:White People / Q000706:statistics & numerical data
keywords: Disparities; HIV; race/ethnicity; substance use; substance use treatment; women