The 130th Annual Meeting of APHA

Abstract #39444

Jo L. Sotheran, PhD, Gunjeong Lee, MPhil, and Angela Aidala, PhD. Mailman School of Public Health, Dept of Sociomedical Sciences, Columbia University, 722 W. 168 St., New York, NY 10032, (212) 305-1744, JSotheran@aol.com

INTRODUCTION: Patients with drug-using histories often enter HIV care later in the disease course than others, contributing to poorer outcomes. Understanding this pattern can help reduce this disadvantage. We examine associations of drug use patterns with HIV testing, HIV care entry, and services use. METHODS: 968 HIV+s recruited within and outside HIV medical and social-service agencies in 1994 and 1998 for the CHAIN longitudinal study, were given a structured questionnaire by trained interviewers. We classified them by patterns of drug (heroin, cocaine, or crack-cocaine) use reported at study intake: lifetime "Never" (N=247), "Past" (6 months or more preceding interview, N=473), currently active "Lower Frequency" (less than daily use, N=176) or "Higher Frequency" (daily or more use, N=72). RESULTS: Consistent, significant (p<.05) differences appeared at all stages of the HIV care-seeking process, forming a continuum of disadvantage from "Never" through "Past" and "Lower Frequency" to "Higher Frequency" users. Stages included: HIV testing in facilities providing referral (79%, 69%, 71%, 58%), receiving referrals for follow-up care (71%, 72%, 66%, 49%), entering care within 12 months of diagnosis (91%, 88%, 85%, 75%), and using HIV care (98%, 97%, 91%, 76%) or routine medical care (96%, 91%, 81%, 65%) at study intake. Other service barriers (unstable housing, heavy alcohol use, decreased mental health function) were also significantly (p<.05) related to drug use, along the same continuum. CONCLUSIONS: Active drug users face cumulative disadvantages in HIV care-seeking. We should explore "lower threshold" service models to reduce these barriers.

Learning Objectives:

(
• Identify major patterns of lifetime drug use as they affect use of services (
• Describe major components of the care-seeking process for HIV and how they relate to each other (
• Understand how major barriers to care differ by drug use pattern

Keywords: Drug Use Variation, Access and Services

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.