Substance Use Patterns and Treatment Access in Reproductive-Age Women With and Without HIV

Overview

Among 891 reproductive-age women in the Southern US, substance use was common, with stimulant use predominating alongside high rates of tobacco and cannabis use. Women with HIV reported lower rates of drug and hazardous alcohol use compared to women without HIV, but treatment access remained low across groups.

Background

Women with HIV (WWH) face poorer health outcomes, exacerbated by comorbid substance use disorders (SUDs), which impair HIV care engagement and viral suppression. Substance use patterns fluctuate across reproductive life stages, with pregnancy often associated with reduced use but increased risk postpartum. Drug overdose mortality has risen sharply, particularly involving synthetic opioids and stimulants, affecting pregnant and postpartum women. Despite these risks, reproductive-age WWH remain underrepresented in research, limiting understanding of substance use and treatment access in this population.

Data Highlights

Key Findings

• 12% of reproductive-age women reported past-year drug use, with lower rates among WWH (9%) compared to WWoH (15%).
• Hazardous alcohol use was reported by 15% overall, significantly lower in WWH (11%) than WWoH (20%).
• Tobacco and cannabis use were common, reported by 37% and 45% respectively, with cannabis use significantly higher in WWoH.
• Crack/cocaine was the most frequently used drug (61% among drug users).
• Among pregnant women, substance use rates were lower but still notable, with 7% reporting drug use and 39% cannabis use.
• Only 23% of women with past-year drug use accessed any drug treatment program, with no significant differences by HIV or pregnancy status.

Clinical Implications

Substance use is prevalent among reproductive-age women with and without HIV in the Southern US, highlighting the need for integrated substance use disorder care within HIV and women's health services. Given the low treatment engagement despite significant overdose risk, clinicians should prioritize screening and tailored interventions, especially addressing stimulant, tobacco, and cannabis use. Pregnancy and postpartum periods represent critical windows for intervention to reduce substance-related harms.

Conclusion

Substance use, particularly stimulant and co-occurring tobacco and cannabis use, is common among reproductive-age women regardless of HIV status, with low treatment uptake. Tailored implementation studies are needed to overcome barriers and integrate substance use disorder care into HIV and reproductive health settings.

References

1. Study of Treatment And Reproductive Outcomes (STAR) Cohort 2021-2024 -- Substance Use Patterns and Treatment Access in Reproductive-Age Women With and Without HIV in the Southern United States