Under-reporting of alcohol and substance use versus other psychiatric symptoms in individuals living with HIV.

Substance use is known to negatively impact outcomes in patients living with HIV by decreasing adherence to and effectiveness of antiretroviral therapies. Alcohol and other drug abuse and dependence are widespread among HIV-positive individuals, though reported rates vary greatly by study, suggesting the possibility of under-reporting. The extent to which patients minimize symptoms and the factors that influence reporting remain to be determined. The present study sought to gauge the degree to which substance use is under-reported in a primary care HIV clinic by evaluating the influence of anonymity versus confidentiality of self-report on endorsement rates. Patients (n = 55) currently receiving medical treatment completed a confidential questionnaire assessing the presence of alcohol abuse, other drug misuse, and Generalized Anxiety Disorder (GAD). Another group of 55 patients completed a comparable survey, but did so anonymously. The two groups were similar in terms of demographic characteristics, but self-report of substance use differed depending on how symptoms were assessed, with anonymous questionnaires yielding significantly (p<0.05) higher rates, compared to confidential surveys. Under-reporting appeared specific to alcohol and substance use, with no statistically significant differences between anonymous and confidential surveys in the proportion of patients endorsing symptoms of GAD. The fact that the screener specifically designed to identify patients in need of further evaluation produced lower rates of reported alcohol and drug use suggests that more work is needed to identify appropriate tools for accurately assessing substance use in HIV-positive patients so that adequate referrals and services can be offered to those in need.