• Jeffrey T Parsons, Tyrel J Starks, Brett M Millar, Kailip Boonrai, and David Marcotte.
• Department of Psychology, Hunter College of the City University of New York (CUNY), 695 Park Avenue, New York, NY 10065, USA; Center for HIV/AIDS Educational Studies and Training (CHEST), New York, NY, USA; Doctoral Program in Health Psychology and Clinical Science, The Graduate Center of CUNY, New York, NY, USA; CUNY School of Public Health at Hunter College, New York, NY, USA. Electronic address: Jeffrey.parsons@hunter.cuny.edu.
• Drug Alcohol Depend. 2014 Jun 1; 139: 33-40.

BackgroundThe population of older adults living with HIV is increasing in the United States. Despite an increased focus on the health of HIV-positive older adults, knowledge about their substance use, a primary risk factor for HIV medication non-adherence, and the association between use, problems associated with use, and adherence behavior, is limited.MethodsData were collected from 557 HIV-positive adults aged 50 and older in the New York City area via telephone interview. Participants reported the number of days in the past month on which they missed any doses of HIV medication as well as the number of days they used alcohol, marijuana, cocaine/crack, opiates, amyl nitrite (poppers), and other drugs. The severity of substance use associated problems was assessed using the DAST-10 and AUDIT-C.ResultsThe sample included gay/bisexual (40.4%) and heterosexual (28.1%) men as well as lesbian/bisexual (4.9%) and heterosexual (26.7%) women. Latent class analyses identified four distinct patterns of substance use: Exclusive Alcohol Use; Alcohol and Marijuana; Alcohol and Cocaine/Crack; and Multiple-Substance Use. Variability in the number of missed HIV medication days and perceptions of substance use associated problems were observed across classes, with poorest adherence reported in the Alcohol and Marijuana class, the Alcohol and Cocaine/Crack class, and the Multiple-Substance Use class. The latter two classes also reported the greatest perceived impairment from substance use.ConclusionsPatterns of recent substance use were associated with varying levels of HIV medication adherence and perceived substance use impairment, indicating that substance type matters when considering the health of older adults living with HIV, and that multiple-substance use needs to be addressed by interventions aimed at improving medication adherence.Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

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