, Volume 19, Issue 11, pp 1111-1117

Gender differences in factors associated with adherence to antiretroviral therapy

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OBJECTIVE: To identify gender differences in social and behavioral factors associated with antiretroviral adherence.

DESIGN: Prospective cohort study.

SETTING: Methadone maintenance program.

PARTICIPANTS: One hundred thirteen HIV-seropositive current or former opioid users.

MEASUREMENTS AND MAIN RESULTS: Participants were surveyed at baseline about social and behavioral characteristics and at monthly research visits about drug and alcohol use and medication side effects. Electronic monitors (MEMS) were used to measure antiretroviral adherence. Median adherence among women was 27% lower than among men (46% vs. 73%; P<.05). In gender-stratified multivariate models, factors associated with worse adherence in men included not belonging to an HIV support group (P<.0001), crack/cocaine use (P<.005), and medication side effects (P=.01). Among women, alcohol use (P=.005), heroin use (P<.05), and significant medication side effects (P<.005) were independently associated with worse adherence. In a model including both men and women, worse adherence was associated with lack of long-term housing (P<.005), not belonging to any HIV support groups (P<.0005), crack or cocaine use (P<.01), and medication side effects (P<.0005). In addition, worse adherence was associated with the interaction between female gender and alcohol use (P ≤ .05).

CONCLUSIONS: In this cohort of current and former opioid users, gender-stratified analysis demonstrated that different social and behavioral factors are associated with adherence in men and women. Among both men and women, worse adherence was associated with lack of long-term housing, not belonging to an HIV support group, crack/cocaine use, and medication side effects. Among women only, alcohol use was associated with worse adherence.

This study was supported by NIH R01 DA1 1869 (NIDA, PI: J. Arnsten). Dr. Berg was funded by NIH R25 DA 14551 (NIDA, PI: J. Arnsten). Dr. Arnsten was also supported by a Robert Wood Johnson Generalist Physician Faculty Scholar Award.