Clinical Scorecard: Substance Use Patterns and Treatment Access in Reproductive-Age Women With and Without HIV in the Southern United States
At a Glance
Category
Detail
Condition
Substance use and HIV in reproductive-age women
Key Mechanisms
Substance use disorders worsen HIV-related outcomes including ART adherence, retention in care, and viral suppression; substance use patterns vary across reproductive life stages
Target Population
Reproductive-age cisgender women (18–45 years) with and without HIV in the Southern United States
Care Setting
HIV care settings, women's health clinics, and substance use disorder treatment programs
Key Highlights
Among 891 women studied, 12% reported past-year drug use, 15% hazardous alcohol use, 37% tobacco use, and 45% cannabis use, with crack/cocaine being the most frequently used drug (61%).
Substance use was common among pregnant women, with 7% reporting drug use and 12% hazardous alcohol use; 16% of women with past-year drug use experienced accidental overdose.
Only 23% of women with past-year drug use reported using any drug treatment program in the past year, with no significant differences by HIV or pregnancy status.
Guideline-Based Recommendations
Diagnosis
Screen reproductive-age women with and without HIV for substance use including tobacco, hazardous alcohol, cannabis, and nonmedical drug use.
Assess pregnancy and postpartum status to understand substance use patterns and risks.
Management
Integrate substance use disorder care into HIV and women's health settings tailored to reproductive-age women.
Address barriers such as stigma, fear of criminalization, and mistrust of health and child welfare systems to improve treatment access.
Monitoring & Follow-up
Monitor substance use patterns across reproductive life stages, including pregnancy and postpartum periods.
Track overdose risk, especially among women with past-year drug use.
Risks
High risk of poor HIV-related outcomes with comorbid substance use disorders.
Increased overdose mortality, particularly involving synthetic opioids and psychostimulants.
Potential avoidance of care due to stigma and fear of child custody loss.
Patient & Prescribing Data
Reproductive-age women with and without HIV in the Southern United States
Low utilization of drug treatment programs among women with past-year drug use (23%), indicating a need for improved access and integration of substance use care.
Clinical Best Practices
Conduct routine, comprehensive substance use screening in reproductive-age women with and without HIV.
Provide tailored substance use disorder interventions that consider reproductive life stage and pregnancy status.
Implement strategies to reduce stigma and build trust to enhance engagement in substance use treatment.
Coordinate care between HIV providers, obstetric care, and substance use treatment services.
by Ayako Wendy Fujita, C Christina Mehta, Qian Yang, Tina T Tisdale, Maria L Alcaide, Aadia Rana, Deborah J Konkle-Parker, Daniel Westreich, Seble G Kassaye, Elizabeth F Topper, Anandi N Sheth
