Previous Intravenous Drug Use May Impact Women’s Comfort With Injectable HIV Medications

A recent study found that women had varying levels of willingness to use long-acting injectable HIV medications, based on their history with intravenous drug use.

Women who have different histories with injectable medications had different views on their level of comfort with long-acting injectable (LAI) HIV medications, according to a recent study published in AIDS Patient Care and STDs.

The researchers said that differences of opinion, especially for patients with a history of illegal drug use, highlight that physicians should take into account patient history with injection drug use prior to making a decision on prescribing an LAI or an oral medication for preexposure prophylaxis (PrEP) or antiretroviral therapy (ART).

Daily administration of oral PrEP and ART can present barriers to adherence to HIV medicines, especially for female patients, on individual, clinical, and sociostructual levels. Women make up 5% of PrEP users in the United States and discontinue treatment quicker than their male counterparts. In addition, only 60% of women living with HIV (WLWH) who take daily oral treatments are suppressed at 12 months, suggesting they are in need of alternatives.

Monthly use of LAI ART and PrEP is currently under FDA review. Presently, there is minimal research on how LAIs affect women. Findings from one study suggest LAIs can increase adherence to HIV medications, while additional research has raised concerns that LAIs could trigger recurrence for people with a history of injectable drug abuse.

To better understand how LAI ART and PrEP therapies can be used by women with a history of injectable medication use, researchers conducted 89 in-depth interviews across 6 Women’s Interagency HIV Study sites across the United States, of which 59 were with WLWH. The in-person interviews were conducted from November 2017 to October 2018.

Participants had a median age of 51 years, and 96% were women of color. Most women were unemployed (66%), had a yearly salary below $12,000 (59%), and said they would prefer to take LAI PrEP (50%) or ART (56%) instead of daily medication.

More than two-thirds of the women had a history of using injectables, consisting of substance use, having physical comorbidities that require injectable treatments, using birth control, or receiving vaccines.

The researchers developed 4 categories based on the women’s history and perceptions of how others would react based on their experiences:

  • Episodic injections and had few concerns about LAIs
  • Frequent injections and would refuse additional ones
  • History of illegal drug use with differing opinions on whether LAIs might trigger a recurrence
  • Currently using injectable drugs and had few concerns about LAIs

The most polarizing answers stemmed from the group with a history of drug use who worried LAIs could trigger a relapse. Some participants stressed that needles, and needle-like objects such as mechanical pencils, could be triggers for recovering addicts. Others felt that LAIs were no big deal, because of their experience with needles, especially with self-administering.

“This highlights the importance of patient–provider communication to identify unique needs among women with injection drug use histories,” wrote the authors.

Women who have received episodic injections showed few concerns, because their experience with shots may increase their comfort level with LAIs. Several women commented that LAIs reminded them of birth control options and felt that the injection would take away feelings of panic associated with having to keep track of pills.

Women who receive frequent injections, such as women who have diabetes or hepatitis C, expressed that LAIs would add excessive injections to their regimen. One participant noted that even though she is very tolerant to injections, she doesn’t particularly like or want more of them. Some women who receive frequent injections also have aversions to needles, placing a larger burden on caregivers who would have to administer them.

Women who were current users of injectable medicines and had few concerns felt indifferent to LAI therapy and said that appointments every 1 to 2 months felt manageable.

“Rather than a matter of preference for or aversion to needles based on histories of drug use, this response considers how LAIs might fit more seamlessly into the challenging realities of daily life for those who inject drugs,” noted the authors, adding that HIV status did not impact whether women would anticipate someone being wary of LAIs.

The researchers noted that their results are limited in reliability because the data stem from people’s opinions based on personal experiences.


Philbin MM, Parish C, Bergen S, et al. A qualitative exploration of women’s interest in long-acting injectable antiretroviral therapy across six cities in the Women’s Interagency HIV Study: intersections with current and past injectable medication and substance use. AIDS Patient Care STDS. 2021;35(1):23-30. doi:10.1089/apc.2020.0164