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A cross-sectional study examining associations between substance use frequency, problematic use and STIs among youth living with HIV
  1. Kristi E Gamarel1,
  2. Sharon Nichols2,
  3. Christopher W Kahler3,
  4. Andrew O Westfall4,
  5. Michelle A Lally5,6,
  6. Craig M Wilson7
  7. the Adolescent Medicine Trials Network for HIV/AIDS Intervention
  1. 1 Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
  2. 2 Department of Neuroscience, University of California, San Diego, San Diego, CA, USA
  3. 3 Center for Alcohol & Addiction Studies and Department of Behavioral and Social Science, Brown University School of Public Health, Providence, Rhode Island, USA
  4. 4 Department of Medicine, University of Alabama at Birmingham USA, Birmingham, Alabama, USA
  5. 5 Lifespan Hospital System, Providence, Rhode Island, USA
  6. 6 Alpert Medical School, Brown University, Providence, Rhode Island, USA
  7. 7 Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
  1. Correspondence to Dr Kristi E Gamarel, Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan 48109, USA; kgamarel{at}


Objectives This study sought to examine the prevalence of STIs and whether substance use frequency and/or problematic use—specifically alcohol, marijuana and other drugs—was associated with having an STI diagnosis among youth living with HIV (YLWH)

Methods A sample of 823 YLWH were recruited at 14 adolescent HIV clinics through the Adolescent Medicine Trials Network for HIV Interventions. Study staff abstracted STI data from medical records for up to 26 weeks prior to participants’ completing a cross-sectional survey including the ASSIST (Alcohol, Smoking and Substance Involvement Screening Test), which measures substance use frequency and consequences.

Results Almost one-third of youth had been diagnosed with an STI (30.5%) at the time of their baseline assessment. In multivariable analyses, those who engaged in weekly or greater marijuana use (adjusted OR (AOR)=10.66, 95% CI: 4.39 to 25.87, P<0.001) had an increased odds of being diagnosed with an STI. Additionally, youth who met alcohol use criteria for moderate (AOR=5.23, 95% CI: 2.50 to 10.93, P<0.001) and high risk (AOR=6.53, 95% CI: 1.20 to 35.68, P<0.05) alcohol use had an increased odds of being diagnosed with an STI compared with low-risk alcohol users.

Conclusions Study findings underscore the need to investigate the role of greater frequency of marijuana use and problematic alcohol use in STI incidence among YLWH. Given the associations between both substance use frequency and problematic use in STI diagnoses among YLWH seen in HIV care settings, clinicians should use validated substance use screening tools which capture both frequencies and consequences in order to identify YLWH who may need further evaluation and treatment.

  • HIV
  • substance misuse
  • adolescent

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  • Handling editor Jackie A Cassell

  • Contributors KEG conceptualised the project, conducted all statistical analyses and wrote the first draft of the manuscript. SN, MAL, CWK and CMW reviewed manuscript drafts and provided feedback. AOW provided consultation on the analyses. All authors contributed to and have approved the final manuscript.

  • Funding This research was supported by The Adolescent Medicine Trials Network for HIV/AIDS Interventions (ATN) from the Eunice Kennedy Shriver National Institutes of Health (U01HD040533 and U01HD040474) through the National Institute of Child Health and Human Development (Kapogiannis, Lee), with supplemental funding from the National Institutes on Drug Abuse (Davenny, Kahana) and Mental Health (Brouwers, Allison). Support was also provided to the first and fifth author by the Providence/Boston Center for AIDS Research (P30AI042853, PI: Cu-Uvin). The study was scientifically reviewed by the ATN’s Behavioral Leadership Group. Network, scientific and logistical support was provided by the ATN Coordinating Center (Wilson, Partlow) at the University of Alabama at Birmingham. Network operations and data management support was provided by the ATN Data and Operations center at Westat (Korelitz, Driver).

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or National Research Committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The University of Alabama, Birmingham Institutional Review Board for Human Use approval number is X060303002.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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