One in Four People With HIV Were High Cannabis Users Over a Decade, Linked to Depression and Tobacco | Research

The takeaway

A 10-year study of 3,299 people with HIV identified four cannabis use trajectories: Low/No Use (67%), High Use (26%), Increased (4%), and Decreased (2%), with high use associated with older age, university education, tobacco smoking, and significant depression.

HIV clinicians, mental health providers working with PWH, and cannabis-HIV researchers.

26% of people with HIV were in the High Use trajectory

What the researchers found

Four trajectories: Low/No Use (67%), Increased Use (4%), Decreased Use (2%), High Use (26%). High Use group predictors: older age, university education, tobacco smoking, significant depressive symptoms. The majority (67%) had consistently low or no cannabis use over the decade.

Why it matters

Cannabis use is common among people with HIV, often for symptom management. Understanding long-term use patterns and their correlates helps clinicians identify who may need intervention and who is using cannabis stably.

The numbers in context

3,299 participants; 81% male; 57% gay; 58% current/former smokers; 43% significant depression; 26% high use trajectory; 67% low/no use.

How the study worked

Latent class growth analysis of the Ontario HIV Treatment Network Cohort Study (2008-2017). 3,299 participants with interview data over up to 10 years. Chi-square tests for trajectory group predictors.

What this study cannot tell us

Pre-legalization data (2008-2017) may not reflect current patterns. Self-reported cannabis use. Observational design cannot determine depression-cannabis directionality. Ontario cohort may not generalize.

How to read the evidence

Large cohort with decade-long follow-up and sophisticated trajectory analysis. Pre-legalization timeframe may limit current relevance.

When this study was published

2025 publication analyzing 2008-2017 pre-legalization data from Ontario.

The bigger picture

The association between high cannabis use and depressive symptoms raises the question of whether cannabis is being used to self-medicate depression or whether heavy use contributes to depressive symptoms. This pre-legalization dataset provides a baseline for tracking post-legalization changes.

Questions still open

Did cannabis legalization in 2018 change use trajectories among PWH?
Is the depression-cannabis association causal in either direction?

Common questions

How common is cannabis use among people with HIV?

In this Ontario cohort, 26% were consistently high users over a decade, while 67% had consistently low or no use.

Why do people with HIV use cannabis?

This study found high use was linked to depressive symptoms, suggesting self-medication may play a role, though the direction of causation is unclear.

Read the original research

Cannabis Use Trajectories Among People Living With HIV in the Decade Prior to Recreational Legalization in Ontario, Canada (2008-2017).

AIDS education and prevention : official publication of the International Society for AIDS Education, 37(2), 142-159

View on PubMed ↗Publisher’s paper ↗

Citation

Lazor, Tanya; Sanches, Marcos; Wardell, Jeffrey D; Wang, Wei; Burchell, Ann N; Margolese, Shari; Bekele, Tsegaye; Kroch, Abigail E; Rueda, Sergio. (2025). Cannabis Use Trajectories Among People Living With HIV in the Decade Prior to Recreational Legalization in Ontario, Canada (2008-2017).. AIDS education and prevention : official publication of the International Society for AIDS Education, 37(2), 142-159. https://doi.org/10.1521/aeap.2025.37.2.142