Anxiety and Tobacco Use Predict Cannabis Problems in People With HIV | Research

The takeaway

Among nearly 1,000 people with HIV who use cannabis, anxiety and concurrent tobacco use were the strongest predictors of higher-risk cannabis use.

HIV care providers, addiction medicine specialists, mental health clinicians

35.9% of HIV patients who use cannabis screened positive for higher CUD risk

What the researchers found

Of 973 people with HIV, 35.9% screened positive for higher risk of cannabis use disorder. In multivariable analysis, Black race (OR=1.90), anxiety (OR=1.91), and higher-risk tobacco use (OR=2.25) were independently associated with higher CUD risk.

Why it matters

Cannabis use is common among people with HIV, and identifying who is at highest risk for problematic use helps target screening and intervention efforts in a population already managing complex health needs.

The numbers in context

N=973, 94.1% male, 58.5% White, median age 54.5. 35.9% at higher CUD risk. Black race OR=1.90, anxiety OR=1.91, higher-risk tobacco use OR=2.25.

How the study worked

Cross-sectional analysis of TAPS screening data from 973 people with HIV across 3 primary care clinics in Kaiser Permanente Northern California.

What this study cannot tell us

Cross-sectional design cannot establish causation. Predominantly male sample from one healthcare system. TAPS screening is a brief tool that may not capture the full complexity of cannabis use patterns.

How to read the evidence

Moderate-sized clinical sample with multivariable analysis, but cross-sectional design and single healthcare system limit generalizability.

When this study was published

2025 study from Kaiser Permanente Northern California HIV clinics.

The bigger picture

Substance use, mental health, and HIV management are deeply interconnected. This study suggests that addressing anxiety and tobacco use could be entry points for preventing cannabis-related problems in this population.

Questions still open

Would treating anxiety reduce cannabis-related problems in people with HIV? Could integrated substance use interventions address tobacco and cannabis simultaneously?

Common questions

Is cannabis use common among people with HIV?

Yes. In this study of nearly 1,000 people with HIV who were screened for substance use, cannabis use was prevalent, and over a third showed signs of higher-risk use or cannabis use disorder.

What increases the risk of cannabis problems in people with HIV?

Anxiety and concurrent tobacco use were the strongest independent predictors of higher-risk cannabis use in this study, suggesting these could be targets for integrated prevention efforts.

Read the original research

Substance use and mental health factors associated with self-reported higher risk cannabis use among people with HIV screened in primary care.

BMC public health, 25(1), 2580

View on PubMed ↗Publisher’s paper ↗

Citation

Mian, Maha N; Sarovar, V; Levine, T; Lea, A; Leibowitz, A; Luu, M; Flamm, J; Hare, C B; Horberg, M; Young-Wolff, K C; Phillips, K T; Silverberg, M J; Satre, D D. (2025). Substance use and mental health factors associated with self-reported higher risk cannabis use among people with HIV screened in primary care.. BMC public health, 25(1), 2580. https://doi.org/10.1186/s12889-025-23735-8