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.

KEYWORDS:

• Disparities
• HIV
• race/ethnicity
• substance use
• substance use treatment
• women

Funding

This study is supported in part by a research grant from Pfizer, with additional funding for Dr. Storholm provided by a National Institute on Drug Abuse training grant T32DA007250 and center grant P50DA009253. Additional funding for Drs. Silverberg and Satre was provided by a research grant from the National Institute on Alcohol Abuse and Alcoholism U01AA021997.

Additional information

Funding

This study is supported in part by a research grant from Pfizer, with additional funding for Dr. Storholm provided by a National Institute on Drug Abuse training grant T32DA007250 and center grant P50DA009253. Additional funding for Drs. Silverberg and Satre was provided by a research grant from the National Institute on Alcohol Abuse and Alcoholism U01AA021997.