COVID-19 pandemic-related stress and substance use behaviors among people with HIV – a mixed method analysis

Background: Stress and financial concerns due to the COVID-19 pandemic are well documented, with mixed evidence regarding their relationship with substance use. This mixed-methods study describes the prevalence of pandemic-related stress and financial worry, and their association with changes in substance use among people with HIV with a history of injection drug use in Russia. Methods: We conducted a secondary analysis of survey and qualitative data collected from two trials between May 2020 and July 2021. We used multivariable logistic regression to assess associations between pandemic-related stress and financial worry, and reported changes in illicit opioids (primary), cigarettes (secondary), and alcohol (exploratory) use. The outcome was defined as any change (increase, decrease, or stopping) in substance use. A thematic analysis of semi-structured interviews explored experiences of stress and substance use during the pandemic. Results and conclusions: Among 132 survey participants, 52% reported high pandemic financial worry and 31% reported high pandemic stress. Overall, 22% reported changes in opioid use (20% decrease, 2% increase), 21% in cigarette smoking (18% decrease, 3% increase), and 15% in alcohol use (9% decrease, 6% increase). High stress was associated with reporting any change in opioid use due to the pandemic (AOR 2.98; 95%CI: 1.20, 7.40; p = 0.02). Financial worry showed a similar but imprecise association (AOR 2.45; 95%CI: 0.96, 6.21; p = 0.06). No associations were observed for cigarette or alcohol use. Qualitative findings indicated that pandemic-related stressors and disruptions in drug access may have been linked to substance use patterns for some participants, although changes in use were not a dominant theme. Most participants did not report changes in substance use; among those who did, changes were primarily decreases. Pandemic-related stress was associated with opioid use change, though direction varied. These findings suggest that stress-related responses are context-specific and may not uniformly lead to increased substance use among PWH.