Collaboration in Civic Spheres

Risky Biz: Seattle HIV Patients May Be Hurting Care

by June 24th, 2013

HIV-infected patients getting primary treatment at University of Washington Harborview Medical Center in Seattle along with counterparts being treated in San Diego and Boston are at significant risk of undermining their care and treatment because of drug use, risky sex, non-adherence to medication regimes and other factors, according to a new study published in the American Journal of Public Health by doctors from UW, Harvard, University of California-San Diego and the University of Alabama.

Surveys of a total of 3,413 mostly male HIV-positive patients at clinics in Seattle, Boston, San Diego and the control group of Birmingham showed that only 7 of 10 stuck fully to the medication routines key to their treatment and that a fairly significant number had unprotected anal sex – more than half of the 38 percent who had any anal sex at all within the survey period.

On drug use, Seattle UW-Harborview HIV patients were especially prone to using injection drugs, amphetamine, and opiates compared to the Birmingham control group, according to the study. Seattle patients were also more prone than the control group to use crack cocaine, marijuana and engage in “polydrug” use.

Across the study and its four geographical patient groups, the risk for unprotected anal sex and a higher number of related partners were seen by researchers as particularly tied to use of injection drugs and also marijuana.

The Seattle patient group’s proclivity for use of injection drugs, amphetamine, opiates and also crack and “polydrug” use were “significantly” tied to increased risk of non-adherence to medication schedules.

Compared to the other two groups of patients, from Boston and San Diego, the Seattle cohort in the study ranked notably higher than the Birmingham control group in 6 out of 6 types of drug use, versus 4 of 6 for Boston and 5 of 6 for San Diego.

The authors write that a limitation on the study’s findings was that it did not factor in the percentage of sex between “sero-concordant” partners, meaning where both participants were HIV-positive. Where this might have actually occurred it would have reduced HIV-transmission risks.

Currently, more than one million U.S. residents live with HIV and among them, “high rates of substance use have been observed,” according to the study.

According to the study’s key conclusions, there was heightened prevalence of depression and mental illness plus risky sexual acts among HIV-positive patients in primary care which put them – including those assessed in Seattle – at greater risk for diminishment of the positive effects of “test, treat and link to care” therapies and efforts to reduce overall “community viral load” of HIV.

The needed response, the authors, said, is “to continue to develop and implement prevention programs that address substance abuse, medication non-adherence, and unprotected sex among patients in primary care” to improve their health and that of their partners.

Authors of the study include Heidi M. Crane and Mari M. Kitahata of the University of Washington School of Medicine Division of Infectious Diseases. It was based on self-reports from patients who are getting primary care through the Centers For AIDS Research Network of Integrated Clinical Systems (CNICS) as part of an ongoing study started in 1995 at clinics across the U.S.


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