Changes in Marijuana Use Frequency Among People with HIV During the COVID-19 Pandemic: A Multi-Methods Exploration

Background: People with HIV (PWH) report unique reasons for using marijuana. Similarly, they report unique concerns resulting from marijuana use. Assessing and understanding the reasons driving marijuana use among PWH could provide critical insights into how to help maximize the therapeutic benefits and minimize potential harms of marijuana use. The COVID-19 pandemic has impacted the access and use of substances globally. This study describes changes in patterns of marijuana use and reasons for those changes among PWH during the pandemic and implications for these findings in the future. The objectives of this study are to: 1) describe self-reported changes in marijuana use frequency during the COVID-19 pandemic among a cohort of PWH in Florida and 2) understand the reasons behind these changes through an analysis of open-ended qualitative questions. Methods: Data are cross-sectional and come from questions in a follow-up phone survey administered to a prospective cohort of PWH (75% current marijuana use) in Florida between May 2020-March 2021. Participants who used marijuana were asked about changes in their frequency of marijuana use due to the pandemic using a closed-ended quantitative survey and reasons for any reported changes in a qualitative open-ended question. Descriptive statistics and significance testing were completed in SAS 9.4. Qualitative data were analyzed using thematic analysis. Results: Among the total sample of 227 PWH (mean age 50, 50% men, 69% Black/African American, 14% Hispanic/Latino); 15% reported a decreased frequency of marijuana, 9% reported increased frequency, and 76% reported no change. The most common reason for increasing the frequency of marijuana use was to reduce the increased anxiety or stress experienced during the COVID-19 pandemic. Participants also reported that marijuana helped them cope with self-reported depression and other negative life events and helped reduce boredom while their regular activities were restricted. Concerns about the impacts of marijuana on COVID-19 risk, using the pandemic as an opportunity to reduce or quit marijuana use, and issues with obtaining marijuana were common reasons for decreased use. Additionally, some participants reported that a primary reason for using marijuana was the social aspect of using in a group, and without being able to gather they were less motivated to use, contributing to decreased use. Conclusions: Nearly one-quarter of the participants had changes in their marijuana use frequency during the pandemic, and most of the participants with a change decreased their frequency of use. The changes in the frequency of marijuana use experienced by PWH during the pandemic might continue and prevent a return to “normal,” so it is important to understand how to best address the new needs of PWH who use marijuana. Understanding the reasons behind changes in marijuana use patterns in this population—and what demographics, attitudes, and beliefs might differentiate those with increases, decreases, or no change in marijuana use—can allow researchers and providers to make greater connections between HIV-specific health outcomes and marijuana use. These findings provide specific targets for interventions to maintain or even improve health among PWH during public health emergencies and beyond.