BOSTON — HIV prevalence, which was elevated in all substance-use disorder patients at the VHA, was highest among veterans with alcohol- and opioid-use disorders (AUD/OUD), with disparities by race/ethnicity and age, according to a new study.
Researchers from Boston University Chobanian & Avedisian School of Medicine and the VA Boston Healthcare System pointed out that veterans face a high risk for HIV and substance use, “and thus could be disproportionately impacted by the HIV and substance use disorder (SUD) ‘syndemic.”
The study team sought to project HIV prevalence and lifetime HIV screening history among U.S. veterans with alcohol-use disorder (AUD), opioid-use disorder (OUD) or both. Results were published in the Journal of General Internal Medicine.1
To do that, the researchers conducted a retrospective cohort analysis using national VHA data. Three cohorts of veterans with SUD—AUD, OUD and AUD/OUD—were included in the 2016-2022. Ultimately, the sample included 669,595 veterans with AUD, 63,787 with OUD and 57,015 with AUD/OUD.
HIV prevalence was estimated by dividing the number of veterans who met two out of three criteria (codes for HIV diagnosis, antiretroviral therapy or HIV screening/monitoring) by the total number of veterans in each cohort. The study team also estimated lifetime HIV screening history (as documented in VHA data) by cohort, reporting HIV prevalence and screening history by cohort and across demographic/clinical subgroups.
The results indicated that HIV prevalence was highest in the AUD/OUD cohort (3.9%), followed by the OUD (2.1%) and AUD (1.1%) cohorts. “Veterans of Black race and Hispanic/Latinx ethnicity, with HCV diagnoses, and aged 50-64 had the highest HIV prevalence in all cohorts,” the authors wrote. “Overall, 12.8%, 29.1%, and 33.1% of the AUD/OUD, OUD, and AUD cohorts did not have a history of HIV screening, respectively.”
Noting that a substantial portion of veterans had not received HIV screening in the VHA, the researchers concluded, “the Findings highlight room for improvement in HIV prevention and screening services for veterans with SUD.”
- McCann NC, Davenport MJ, Mandavia AD, Stein MD, Livingston NA. HIV Prevalence and HIV Screening History Among a Veterans Association Cohort of People with Opioid and Alcohol Use Disorders. J Gen Intern Med. 2023 Oct 17. doi: 10.1007/s11606-023-08452-5. Epub ahead of print. PMID: 37848765.
