AIDS and Behavior

, Volume 22, Issue 3, pp 971–985 | Cite as

Substance Use, Violence, and Antiretroviral Adherence: A Latent Class Analysis of Women Living with HIV in Canada

  • Allison Carter
  • Eric Abella Roth
  • Erin Ding
  • M-J Milloy
  • Mary Kestler
  • Shahab Jabbari
  • Kath Webster
  • Alexandra de Pokomandy
  • Mona Loutfy
  • Angela KaidaEmail author
  • Behalf of the CHIWOS Research Team
Original Paper


We used latent class analysis to identify substance use patterns for 1363 women living with HIV in Canada and assessed associations with socio-economic marginalization, violence, and sub-optimal adherence to combination antiretroviral therapy (cART). A six-class model was identified consisting of: abstainers (26.3%), Tobacco Users (8.81%), Alcohol Users (31.9%), ‘Socially Acceptable’ Poly-substance Users (13.9%), Illicit Poly-substance Users (9.81%) and Illicit Poly-substance Users of All Types (9.27%). Multinomial logistic regression showed that women experiencing recent violence had significantly higher odds of membership in all substance use latent classes, relative to Abstainers, while those reporting sub-optimal cART adherence had higher odds of being members of the poly-substance use classes only. Factors significantly associated with Illicit Poly-substance Users of All Types were sexual minority status, lower income, and lower resiliency. Findings underline a need for increased social and structural supports for women who use substances to support them in leading safe and healthy lives with HIV.


Substance use Violence Antiretroviral adherence HIV/AIDS Women 



The Canadian HIV Women’s Sexual and Reproductive Health Cohort Study (CHIWOS) Research Team would like to especially thank all of the women living with HIV who participate in this research. We also thank the entire national team of Co-Investigators, Collaborators, and Peer Research Associates. We would like to acknowledge the national Steering Committee, the three provincial Community Advisory Boards, the national CHIWOS Aboriginal Advisory Board, and our partnering organizations for supporting the study, especially those who provide interview space and support to our Peer Research Associates.


CHIWOS is funded by the Canadian Institutes of Health Research (CIHR, MOP111041); the CIHR Canadian HIV Trials Network (CTN 262); the Ontario HIV Treatment Network (OHTN); and the Academic Health Science Centres (AHSC) Alternative Funding Plans (AFP) Innovation Fund. AC received support from a CIHR Doctoral Award. AdP received support from Fonds de Recherche du Quebéc – Santé (FRQS) (Chercheur-boursier clinicien – Junior 1). AK received salary support through a Tier 2 Canada Research Chair in Global Perspectives on HIV and Sexual and Reproductive Health. M-JM is supported in part by the United States National Institutes of Health (R01-DA0251525), a Scholar Award from the Michael Smith Foundation for Health Research and a New Investigator Award from CIHR. His institution has received unstructured funding to support his research from NG Biomed, Ltd.

Compliance with Ethical Standards

Conflict of interest

All authors declare that they have no conflicts of interest.

Ethical 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.

Informed Consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  • Allison Carter
    • 1
    • 2
  • Eric Abella Roth
    • 3
    • 4
  • Erin Ding
    • 2
  • M-J Milloy
    • 2
    • 5
    • 6
  • Mary Kestler
    • 7
    • 8
  • Shahab Jabbari
    • 2
  • Kath Webster
    • 1
  • Alexandra de Pokomandy
    • 9
    • 10
  • Mona Loutfy
    • 11
  • Angela Kaida
    • 1
    • 12
    Email author
  • Behalf of the CHIWOS Research Team
  1. 1.Faculty of Health SciencesSimon Fraser UniversityBurnabyCanada
  2. 2.British Columbia Centre for Excellence in HIV/AIDSVancouverCanada
  3. 3.Centre for Addictions Research of British ColumbiaUniversity of VictoriaVictoriaCanada
  4. 4.Department of AnthropologyUniversity of VictoriaVictoriaCanada
  5. 5.Division of AIDS, Department of MedicineUniversity of British ColumbiaVancouverCanada
  6. 6.British Columbia Centre on Substance UseVancouverCanada
  7. 7.Oak Tree ClinicBC Women’s Health CentreVancouverCanada
  8. 8.Division of Infectious Diseases, Department of MedicineUniversity of British ColumbiaVancouverCanada
  9. 9.McGill University Health CentreMontrealCanada
  10. 10.Department of Family MedicineMcGill UniversityMontrealCanada
  11. 11.Women’s College Research InstituteWomen’s College HospitalTorontoCanada
  12. 12.Faculty of Health SciencesSimon Fraser UniversityBurnabyCanada

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