Substance use patterns among U.S. adults with HIV: identifying priorities for screening and interventions

Given the significant syndemic of HIV and substance use in the U.S., this study sought to examine substance use patterns (consistent user, former user, recent adopter, and abstainers) and identify sociodemographic disparities among people with HIV (PWH). Using 2015-2019 National Survey on Drug Use and Health data (<i>N</i> = 212,411), we estimated prevalence rates and conducted multinomial logistic regression to assess associations between HIV status and (1) substance use and (2) sociodemographic factors. Results show PWH have higher rates of consistent and former use of a range of substances, including inhalants, methamphetamine, cocaine, and heroin. Younger PWH are more likely to use cannabis and hallucinogens, while middle-aged PWH show elevated methamphetamine use. Male and urban-residing PWH face higher risks for inhalants and cocaine. These findings underscore the need for targeted interventions addressing substance use disparities among PWH, particularly for high-risk subgroups and substances. Integrated care models emphasizing harm reduction and relapse prevention are critical. Policy reforms should expand Medicaid and Ryan White Program coverage to include comprehensive substance use treatment for PWH. Future research should explore longitudinal patterns of substance use transitions and the impact of structural factors such as stigma on these disparities to inform effective prevention and treatment strategies.