Effects of behavioral intervention on substance use among people living with HIV: the Healthy Living Project randomized controlled study

Abstract

Reductions in substance use were examined in response to an intensive intervention with people living with human immunodeficiency virus (HIV) (PLH). A randomized controlled trial was conducted with 936 PLH who had recently engaged in unprotected sexual risk acts recruited from four US cities: Milwaukee, San Francisco, New York and Los Angeles. Substance use was assessed as the number of days of use of 19 substances recently (over the last 90 days), evaluated at 5-month intervals over 25 months. A 15-session case management intervention was delivered to PLH in the intervention condition; the control condition received usual care. An intention-to-treat analysis was conducted examining reductions on multiple indices of recent substance use calculated as the number of days of use. Reductions in recent substance use were significantly greater for intervention PLH compared to control PLH: alcohol and/or marijuana use, any substance use, hard drug use and a weighted index adjusting for seriousness of the drug. While the intervention-related reductions in substance use were larger among women than men, men also reduced their use. Compared to controls, gay and heterosexual men in the intervention reduced significantly their use of alcohol and marijuana, any substance, stimulants and the drug severity-weighted frequency of use index. Gay men also reduced their hard drug use significantly in the intervention compared to the control condition. A case management intervention model, delivered individually, is likely to result in significant and sustained reductions in substance use among PLH.