Substance Abuse Research Development Program for Underserved Populations
"Service Utilization Patterns among HIV+ Drug Users:
Investigators: Dorie Gilbert, Ph.D., Elizabeth Abel, Ph.D.
Current Project Status and Findings
Compared to other HIV-positive groups, drug users tend to have poorer outcomes with utilization of AIDS services, including successful retention in antiretroviral therapy (ART) services and are susceptible to continued drug use without effective treatment. This is of great concern because inconsistent use of ART medications and continued drug use may lead to rapid progression of HIV disease, reduced life expectancy, and potentially to the development and transmission of resistant strains of HIV. Given that an estimated 50% of HIV-positive drug users are receiving ART with various levels of success, the above statistics underscore the importance of: (1) linking HIV-positive drug users to a range of health and social services to improve HIV-therapy outcomes, and (2) assessing a person's readiness for ART medical services. It is particularly important to improve retention among African American and Mexican American populations, who are disproportionately impacted by the AIDS pandemic.
The Transtheoretical Model ([TTM], helps to explain the cognitive and behavioral processes individuals experience while changing their behavior, and presents a useful model for assessing a person's readiness for ART adherence. The Specific Aims of this research are to:
1) To explore what factors influence decisions for taking or not taking HIV medications among HIV-positive individuals with histories of substance abuse, with emphasis on uncovering any ethnic/racial differences
2) Develop and test and a measure of Decisional Balance for HIV-meds compliance based on items generated in Aim #1
3) Collect data and analyze relationships among background variables hypothesized to be related to stages-of-change: service utilization, ethnicity, gender, cultural mistrust, continued drug use, hepatitis C co-infection, and psychopathology
Thus far, project activities involved in the Elicitation Phase of the study (Aim 1) have been completed. Focus groups have been conducted with 85 HIV+ adults (aged 18+) in the Austin area. All participants had a history of alcohol or drug use and had taken HIV medications. The ethnic distribution of respondents is displayed below:
Concept mapping procedures involved the following. Three focus groups were conducted to elicit an exhaustive list of reasons associated with taking or not taking HIV meds as reported by the participants. A total of 100 statements were generated by over 80 participants. 50 participants then sorted the 100 statements (based on their perception of similarity of concepts). 80 participants rated the 100 statements (identified statements as being either a pro or con and important (yes or no) to their lives.
Preliminary analysis using multidimensional scaling and cluster analysis revealed 8 themes related to the pros and cons of taking HIV meds:
• Maintaining a sense of empowerment
• Fears about meds & side effects
• Trust issues with doctors/government
• Friends and Family (supportive or non-supportive)
• Lack of information or hope about meds and illness
Substance abuse (to use or not to use while on
• Reframing the illness as a blessing
Tentatively speaking, it appears that two concepts related to ethnicity and mistrust are emerging as unique themes identified by African American/Black and Latino/Hispanic participants as pros and cons to taking HIV meds.
Project activities related to the quantitative phases of the study (Aims 2 – 3) are planned for Spring – Summer of 2003.
Funded by: NIDA Social Work Research Development Program R24-DA13579
Publications and Presentations: