Drug and alcohol use among people living with HIV in care in the United States by geographic region

Heidi M. Crane, Robin M. Nance, Bridget M. Whitney, Stephanie Ruderman, Judith I. Tsui, Geetanjali Chander, Mary E. McCaul, Bryan Lau, Kenneth H. Mayer, D. Scott Batey, Steven A. Safren, Richard D. Moore, Joseph J. Eron, Sonia Napravnik, W. Chris Mathews, Rob J. Fredericksen, Andrew W. Hahn, Michael J. Mugavero, William B. Lober, Michael S. SaagMari M. Kitahata, Joseph A.C. Delaney

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Substance use in the U.S. varies by geographic region. Opioid prescribing practices and marijuana, heroin, and methamphetamine availability are evolving differently across regions. We examined self-reported substance use among people living with HIV (PLWH) in care at seven sites from 2017–2019 to understand current regional substance use patterns. We calculated the percentage and standardized percentage of PLWH reporting current drug use and at-risk and binge alcohol use by U.S. Census Bureau geographic region and examined associations in adjusted logistic regression analyses. Among 7,686 PLWH, marijuana use was the most prevalent drug (30%), followed by methamphetamine/crystal (8%), cocaine/crack (7%), and illicit opioids (3%). One-third reported binge alcohol use (32%). Differences in percent of current use by region were seen for marijuana (24–41%) and methamphetamine/crystal (2–15%), with more use in the West and Northeast, and binge alcohol use (26–40%). In adjusted analyses, PLWH in the Midwest were significantly less likely to use methamphetamine/crystal (aOR: 0.13;0.06–0.25) or illicit opioids (aOR:0.16;0.05–0.53), and PLWH in the Northeast were more likely to use cocaine/crack (aOR:1.59;1.16–2.17), compared to PLWH in the West. Understanding differences in substance use patterns in the current era, as policies continue to evolve, will enable more targeted interventions in clinical settings among PLWH.

Original languageEnglish (US)
Pages (from-to)1569-1576
Number of pages8
JournalAIDS Care - Psychological and Socio-Medical Aspects of AIDS/HIV
Issue number12
StatePublished - 2021


  • Drug use
  • HIV
  • alcohol use
  • marijuana
  • methamphetamine

ASJC Scopus subject areas

  • Health(social science)
  • Social Psychology
  • Public Health, Environmental and Occupational Health


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