Substance Use Among Older People Living With HIV: Challenges for Health Care Providers

Abstract

Older people living with HIV (OPLWH) have higher rates of substance use (tobacco, alcohol, and other drugs) than their HIV-negative peers. Addressing health care needs of OPLWH who use substances is more challenging than for those who do not: they are highly impacted by comorbid conditions, substance use can interact with other medications (including antiretroviral therapy-ART) and reduce their effectiveness, and substance use has been associated with reduced adherence to ART and increased risky behaviors (including sexual risks). People who use substances also suffer disparities along the HIV continuum of care, resulting in lower viral suppression rates and poorer health outcomes. They are especially impacted by stigma and stress, which have implications for HIV treatment and care. Recommendations for health care providers working with OPLWH who use substances include: (1) the need to screen and refer for multiple associated conditions, and (2) training/continuing education to enhance care management and maximize health outcomes.

Research on alcohol and other drug (AOD) use among sexual minority women: A global scoping review

“…Our exclusion of HIV/STI-focused research was intentional. Studies of AOD use among HIV/STI-defined populations constitute a substantial portion of AOD-related research among SMs, and several reviews of this literature have been conducted [178,179]. We also excluded studies about tobacco use.…”

Addressing treatment and care needs of older adults living with HIV who use drugs

“…For example some nursing homes in the US do not admit patients who are on treatment for opioid use disorder [38]. Existing literature on healthcare services delivery suggests that integrating harm reduction improves access to and engagement with care among PLHIV who use drugs, and emphasizes the need for providers in care facilities to expand their understanding of harm reduction and take anti-stigma trainings [6,39,40]. Harm reduction as an important underpinning approach goes beyond disease prevention and treatment to ending stigma and harm to people who use drugs.…”

“…Harm reduction as an important underpinning approach goes beyond disease prevention and treatment to ending stigma and harm to people who use drugs. It also involves care settings and providers facilitating access to harm reduction services in a non-judgemental fashion [6]. Previous research on an integrated HIV care facility with a supervised injection site in Canada has shown the positive effects of adopting harm reduction for OALHIV who use drugs, including reduced risk of overdose [41].…”

“…Finally, due to the complex challenges facing people who use drugs with co-morbidities, best practices suggest that facilities like long-term care adopt a "case manager" approach to delivering holistic healthcare, integrating medical and behavioural treatment from practitioners across disciplines as well as connecting clients to relevant social services within their communities [6]. Research is needed to examine the feasibility, acceptability and effectiveness of adopting case manager approaches in various forms of care settings accessed by OALHIV who use drugs.…”

“…OALHIV face myriad challenges that compromise their health and wellbeing, and these may be further magnified for those who use drugs [6]. At the same time, recent research on ageing has shown that, while ageing is associated with mortality, morbidity and decreased autonomy and functional independence, it is also associated with increased wellbeing and psychosocial functioning [7].…”