Psychological and Clinical Risk Factors for Substance Use in People With and Without HIV

Background Despite growing concerns, limited research has demonstrated how psychological factors influence substance use in people with HIV (PWH). Therefore, we examined the association between heightened vigilance and substance use outcomes in people with (PWH) and without HIV (PWoH), while accounting for key risk factors. Methods Participants (n = 138) were recruited from an HIV clinic and the surrounding community, completing a urine drug screener (UDS) and questionnaires. Results PWH reported greater insomnia ( P < .001), self-reported substance use ( P < .001), and tested positive for more substances ( P < .001) compared to PWoH. Self-reported use was associated with identifying as a man ( P = .04) and higher vigilance ( P = .02). Furthermore, having HIV ( P < .001), being African American ( P = .03), and greater depressive symptoms ( P = .04) predicted greater UDS substance use. Discussion Future research should center stress-induced vigilance, mental health, and substance use among PWH.