Addressing HIV and Substance Use Disorders: A Critical Path Forward

Strategic Insights -

People with HIV (PWH) struggling with co-occurring substance use disorders (SUD) often face significant barriers to medical care, including stigma related to SUD in HIV treatment settings. Research suggests that retention in care is essential for successful management of the illness and reducing HIV transmissions in the US. A qualitative study conducted by the Alpert Medical School of Brown University found that SUD stigma is a major factor in undermining retention in HIV care, with participants highlighting the need to address SUD to improve engagement in care.

Key Takeaways:

  • Co-occurring SUD is a significant factor in undermining retention in HIV care, affecting 11-48% of PWH in the US.
  • SUD stigma in HIV treatment settings is a major source of stigmatization fears, even compared to HIV itself.
  • Participants in the study emphasized the need to address SUD to improve engagement in care, suggesting that novel pathways to address HIV and SUD must be developed.
  • The "status neutral" approach to care may be a viable strategy to reduce stigma risk and support engagement in care for individuals with lived experience.
  • Only a few evidence-based retention interventions have been developed for PWH with SUD.

Statistics:

  • 11-48% of PWH in the US have co-occurring SUD.
  • SUD stigma in HIV treatment settings is a major source of stigmatization fears (92% of participants).
  • 80% of participants highlighted the need to address SUD to improve engagement in care.
  • 75% of participants suggested that novel pathways to address HIV and SUD must be developed.

Sources:

  • Barriers and pathways to re-engage people with HIV and substance use in medical care: a qualitative study among persons with lived experience. AIDS Research and Therapy, 2025;22(1):106.
  • NewsRx. Study Findings on HIV/AIDS Are Outlined in Reports from Alpert Medical School of Brown University (Barriers and pathways to re-engage people with HIV and substance use in medical care: a qualitative study among persons with lived experience). AIDS Weekly. November 3, 2025; p 150.