Who is not using condoms among HIV-positive patients in treatment in the largest city in Brazil?

Data on risky sexual behaviors in people living with HIV/AIDS (PLWHA) is still scarce in some populations around the world. The purpose of this study was to assess the factors associated with the use of condoms in a representative sample of PLWHA in outpatient treatment in the city of São Paulo. Six hundred and sixty-seven HIV-positive patients (383 men and 284 women) who were being treated at eight centers participated in this study. Data were collected using a sociodemographic survey, the Beck depression and anxiety inventories, a survey of alcohol and other drugs use, the Alcohol Use Disorders Identification Test, a sexual behavior survey, and the Sexual Risk Behavior Assessment Schedule. The majority of study participants were sexually active (almost 62% of the sample had at least one sexual partner in the last three months), and at least one-fourth engaged in unsafe sex (25.3% did not use condoms during at least one instance of anal and/or vaginal intercourse in the past three months). Multivariate logistic regression showed that engaging in unprotected sex was more likely among females (p < .001), persons with an HIV-positive partner (p < .001), and people using cannabis before sex (p = .002). These findings should stimulate health-care workers to create specific groups for women, seroconcordant couples, and cannabis users to discuss condom use, as they seem to be vulnerable groups.     

Substance Use and High Risk Sexual Behaviors among Women in Psychosocial Outpatient and Methadone Maintenance Treatment Programs

Objectives: The purpose of the present study was to assess the association between substance use/diagnosis and sexual risk behaviors among women enrolled in both psychosocial outpatient (PS) and methadone maintenance (MM) treatment and involved in a HIV prevention intervention study within the National Institute for Drug Abuse Clinical Trials Network. Methods: 515 sexually active women reported on unprotected sexual occasions (USO), anal sex, sex trading, sex with drug occasions, and multiple male sex partners at the baseline assessment. Results: Within the PS sample, cocaine use diagnosis was associated with more than twice the risk of having multiple partners, trading sex for drugs, having anal sex, or having sex with drugs; alcohol or opioid use diagnosis was associated with fewer risk behaviors. Within the MM sample, cocaine use, alcohol use and opiate use diagnoses were each associated with one to two risk behaviors. Associations between sexual risk and substance using days were less frequent in both samples. Conclusions: These findings highlight the need for integration of HIV sexual prevention interventions that address the relationship between sexual risk behavior and substance use diagnoses into substance abuse treatment programs.     

Substance Use and HIV-Risk Behaviors Among Young Men Involved in the Criminal Justice System

Objectives: We examined the relationship between substance use and sexual HIV-risk behaviors among young men who have been incarcerated, in order to understand how HIV risks develop for this vulnerable population. Methods: A sample of 552 young men in a New York City jail was interviewed at the time of incarceration. Bivariate analyses were performed to examine demographic and sexual HIV-risk behavior differences between men with and without recent alcohol and marijuana use. Logistic regression was used to examine associations between alcohol and marijuana use and sexual HIV-risk behaviors in the 90 days prior to incarceration. Results: Respondents were predominantly Black (57%) or Latino (37%), with a mean age of 17.4 years. The most common substances used were marijuana (82%) and alcohol (65%). Alcohol use prior to incarceration was significantly associated with having three or more sexual partners in the same time period (OR = 2.40, p < .001), as well as with having unprotected sex with a long-term partner (OR = 1.72, p < .01). Marijuana use was significantly associated with having multiple sex partners (OR = 1.55, p < .01). Heavy alcohol and marijuana use did not result in an increased likelihood of sexual HIV-risk behaviors. Conclusions: High rates of substance use and unprotected sex may have unintended health consequences for incarcerated young men. Severity of substance use is not a significant predictor of risk behaviors, suggesting the importance of contextual and social factors. Results highlight the need for HIV prevention efforts for this population that take into account contextual and social factors.     

Sexual Health Risks Among Young Thai Women: Implications for HIV/STD Prevention and Contraception

This paper examines factors that may place female Thai adolescents and young adults at risk for HIV, sexually transmitted diseases (STDs), and unintended pregnancies. A total of 832 female vocational students participated in a cross-sectional audio-computer-assisted self-interview (ACASI) survey after providing informed consent. The questionnaire covered: sociodemographic characteristics; knowledge, attitudes, and beliefs related to HIV and STDs; contraceptive practices; sexual experiences and behaviors; and drug use. Oral fluid was tested for HIV antibodies and urine was tested for illicit drugs and for the presence of gonococcal or chlamydial nucleic acids. A total of 359 women (43.1%) reported sexual intercourse history, with an average age at first sex of 17.6 years, and a 2.6 mean number of lifetime sex partners. Twenty-one percent of the entire sample reported coerced sexual contact or intercourse. Among those with sexual intercourse experience, 27.3% (n = 98) had been pregnant and the majority of their most recent pregnancies were terminated. Three tested positive for HIV antibodies. Sexually active young Thai women report behaviors or experiences that may expose them to HIV/STD infection and unintended pregnancy in the future. These include unprotected intercourse, sexual coercion, low levels of contraceptive use, and drug and alcohol use. Culturally appropriate interventions that increase their awareness of and ability to respond to these sexual health risks are needed.     

HIV-Related Risk Factors in a Population-Based Probability Sample of North and Central Trinidad: The Voluntary HIV-1 Counseling and Testing Efficacy Study

A population-based probability sample of North and Central Trinidad collected information on 860 respondents' demographic characteristics, as well as the prevalence of sexual risk behaviors and precursors to sexual risk taking in the 2 months preceding interview. Precursors of sexual risk behavior included HIV transmission knowledge, condom possession, and alcohol and drug use prior to sexual intercourse. A 91% response rate was achieved. Overall, approximately 51% of respondents reported unprotected sexual intercourse with a primary sex partner (i.e., spouse or steady partner), and 4% reported unprotected sexual intercourse with a nonprimary partner (i.e., casual or commercial partner) during the 2 months prior to interview. Substantial variability on these risk behaviors was noted across demographic strata. Alcohol and drug use prior to intercourse was associated with reports of unprotected intercourse with primary and nonprimary partners. Those who kept condoms at home were less likely to report having unprotected sexual intercourse with both primary and nonprimary partners. The demographic indicators of marital status and respondent gender had indirect (i.e., mediated) effects, through one or more of the risk precursors, on sexual risk behaviors. Implications for the design and targeting of HIV-related interventions and services are discussed.     

Patterns of substance use and correlates of lifetime and active injection drug use among women in Malaysia

ABSTRACT

Background: While drug use is associated with HIV risk in Southeast Asia, little is known about substance use behaviors among women, including drug injection. Objectives: To describe patterns of substance use among women using alcohol and drugs in Malaysia and identify correlates of lifetime and active drug injection, a risk factor for HIV transmission. Methods: A survey of 103 women who used drugs in the last 12 months assessed drug use history and frequency, including drug injection and drug use during pregnancy, self-reported HIV-status, childhood and adulthood physical and sexual abuse, and access to and utilization of harm reduction services, including needle-syringe exchange programs (NSEP) and opioid agonist maintenance therapy (OAT). Principal component analyses (PCA) were conducted to assess drug use grouping. Results: Amphetamine-type substances (ATS; 82.5%), alcohol (75.7%) and heroin (71.8%) were the most commonly used drugs across the lifetime. Drug injection was reported by 32.0% (n = 33) of participants with 21.4% (n = 22) having injected in the last 30 days. PCA identified two groups of drug users: opioids/benzodiazepines and club drugs. Lifetime drug injection was significantly associated with lower education, homelessness, prior criminal justice involvement, opioid use, polysubstance use, childhood physical and sexual abuse, and being HIV-infected, but not with prior OAT. Conclusion: Women who use drugs in Malaysia report high levels of polysubstance use and injection-related risk behaviors, including sharing of injection equipment and being injected by others. Low OAT utilization suggests the need for improved access to OAT services and other harm reduction measures that prioritize women.     

Alcohol Use, Intimate Partner Violence, Sexual Coercion and HIV among Women Aged 15–24 in Rakai, Uganda

Disinhibition due to alcohol may induce intimate partner violence and sexual coercion and increased risk of HIV infection. In a sample of 3,422 women aged 15–24 from the Rakai cohort, Uganda, we examined the association between self-reported alcohol use before sex, physical violence/sexual coercion in the past and prevalent HIV, using adjusted odds ratios (Adj OR) and 95% confidence intervals (95% CI). During the previous year, physical violence (26.9%) and sexual coercion (13.4%) were common, and alcohol use before sex was associated with a higher risk of physical violence/sexual coercion. HIV prevalence was significantly higher with alcohol consumption before sex (Adj OR = 1.45, 95% CI: 1.06–1.98) and especially when women reported both prior sexual coercion and alcohol use before sex (Adj OR = 1.79, 95% CI: 1.25–2.56). Alcohol use before sex was associated with physical violence and sexual coercion, and both are jointly associated with HIV infection risk in young women.     

Patterns of simultaneous and concurrent alcohol and marijuana use among adolescents

Background: Alcohol and marijuana are the most commonly used substances among adolescents but little is known about patterns of co-use. Objectives: This study examined patterns of concurrent (not overlapping) and simultaneous (overlapping) use of alcohol and marijuana among adolescents. Methods: Data from US-national samples of 12th graders (N = 84,805, 48.4% female) who participated in the Monitoring the Future study from 1976 to 2016 and who used alcohol and/or marijuana in the past 12 months were used to identify latent classes of alcohol use, marijuana use, and simultaneous alcohol and marijuana (SAM) use. Results: A four-class solution indicated four patterns of use among adolescents: (1) Simultaneous alcohol and marijuana (SAM) use with binge drinking and recent marijuana use (SAM-Heavier Use; 11.2%); (2) SAM use without binge drinking and with recent marijuana use (SAM-Lighter Use; 21.6%); (3) Marijuana use and alcohol use but no SAM use (Concurrent Use; 10.7%); and (4) Alcohol use but no marijuana or SAM use (Alcohol-Only Use; 56.4%). Membership in either SAM use class was associated with a higher likelihood of truancy, evenings out, and use of illicit drugs other than marijuana. SAM-Heavier Use, compared to SAM-Lighter Use, class members were more likely to report these behaviors and be male, and less likely to have college plans. Conclusions: Among 12th graders who use both alcohol and marijuana, the majority use simultaneously, although not all use heavily. Given the recognized increased public health risks associated with simultaneous use, adolescent prevention programming should include focus on particular risks of simultaneous use.     

The relationship between recent alcohol use and sexual behaviors: gender differences among sexually transmitted disease clinic patients

Background: Binge drinking is associated with risky sexual behaviors and sexually transmitted diseases (STDs). Few studies have investigated this by gender or in an STD clinic. This cross‐sectional study examined the association between binge drinking and risky sexual behaviors/STDs among patients attending an urban STD clinic. Method: A total of 671 STD clinic patients were tested for STDs, and queried about recent alcohol/drug use and risky sexual behaviors using audio computer‐assisted‐self‐interview. The association between binge drinking and sexual behaviors/STDs was analyzed using logistic regression adjusting for age, employment, and drug use. Results: Binge drinking was reported by 30% of women and 42% of men. Gender differences were found in rates of receptive anal sex which increased linearly with increased alcohol use among women but did not differ among men. Within gender analyses showed that women binge drinkers engaged in anal sex at more than twice the rate of women who drank alcohol without binges (33.3% vs. 15.9%; p < 0.05) and 3 times the rate of women who abstained from alcohol (11.1%; p < 0.05). Having multiple sex partners was more than twice as common among women binge drinkers than women abstainers (40.5% vs. 16.8%; p < 0.05). Gonorrhea was nearly 5 times higher among women binge drinkers compared to women abstainers (10.6% vs. 2.2%; p < 0.05). The association between binge drinking and sexual behaviors/gonorrhea remained after controlling for drug use. Among men, rates of risky sexual behaviors/STDs were high, but did not differ by alcohol use. Conclusion: Rates of binge drinking among STD clinic patients were high. Among women, binge drinking was uniquely associated with risky sexual behaviors and an STD diagnosis. Our findings support the need to routinely screen for binge drinking as part of clinical care in STD clinics. Women binge drinkers, in particular, may benefit from interventions that jointly address binge drinking and risky sexual behaviors. Developing gender‐specific interventions could improve overall health outcomes in this population.     

Differences in Sexual Risk Behaviors among Male and Female HIV-Seronegative Heterosexual Methamphetamine Users

Background: Despite increased awareness and attention towards methamphetamine (MA) use among men who have sex with men (MSM), few studies have examined behaviors and effects of MA use among heterosexual populations. Objective: To learn whether behaviors and effects of MA use among heterosexuals differ according to gender. Methods: We examined gender differences in sociodemographic characteristics, drug use practices, sexual behaviors, and consequences and motivations for MA use among 452 HIV-negative MA users (306 men, 146 women) who had engaged in unprotected sex and used MA in the previous two months. Results: Females in the sample were younger and more likely to be married, to have been diagnosed with an STI in the last two months, and to report having been introduced to MA by a sexual partner. Women were also more likely to experience depressive symptoms and to report using MA “to lose weight.” Men were more likely to engage in sex marathons while high on MA and to use MA “to enhance sexual pleasure.” Conclusion: These differences suggest the importance of crafting gender-specific intervention messages, and they may contribute to identifying individuals at risk for initiating MA use. Scientific Significance: Our findings contribute to our knowledge of gender differences in behaviors and effects of MA use among heterosexuals. Future studies would benefit from collection of longitudinal data (to assess causal relationships) and use of a control group (to distinguish correlates of MA use from those of drug use in general).     

Sex-Specific Differences in Circumstances of Initiation into Injecting-Drug Use Among Young Adult Latinos in Harlem, New York City

Background: Data are limited that examine circumstances of initiation and risk for HIV infection among Latino injecting-drug users (IDUs) in the United States. Methods: Baseline data were obtained from a cohort study of young (aged 18–29 years) IDUs residing in Harlem, New York City, conducted during 1997–1999. Participants were administered standardized face-to-face interviews. Data collected included demographics, age and circumstances surrounding initiation of injecting-drug use, and lifetime and recent risk behaviors. Results: Of the 156 participants who self-identified as Latino, 145 (94%) were Puerto Rican, 112 (72%) were male, and 44 (28%) were female. The median number of years of injecting drug use was 3 for women and 5 for men (Wilcoxon ranks sums test p = .007). Significantly (p < .05) more women than men reported that at the first injection episode, they were injected by a sexual partner (26% versus 4%), were provided the syringe by their sexual partner (24% versus 4%), had sex with the initiator after being injected the first time (23% versus 5%), and were injected by a person 5 years older than themselves (50% versus 32%). Women were more likely than men to report having ever had unprotected sex with a person known to be HIV-positive (18% versus 4%, respectively; p = .006); however, women were just as likely as men to report having ever injected drugs with a person known to be HIV-positive (11% versus 10%). Conclusions: Latinas were more likely than their male counterparts to be initiated either directly (being injected) or indirectly (being provided a syringe) into injecting-drug use by their sexual partner. HIV and drug use prevention programs for Latinas in Harlem must address the interrelationship between drug use and sexual relations.     

Characteristic substance misuse profiles among youth entering an urban emergency department: neighborhood correlates and behavioral comorbidities

Background: Little is known about characteristic profiles of substance use – and their individual- and neighborhood-level correlates – among high-risk youth. Objectives: To identify characteristic substance misuse profiles among youth entering an urban emergency department (ED) and explore how those profiles relate to individual- and community-level factors. Methods: Individual-level measures came from screening surveys administered to youth aged 14–24 at an ED in Flint, Michigan (n = 878); alcohol outlet and crime data came from public sources. Binary misuse indicators were generated by using previously established cut-points on scores of alcohol and drug use severity. Latent class analysis (LCA) identified classes of substance use; univariate tests and multinomial models identified correlates of class membership. Results: Excluding non-misusers (51.5%), LCA identified three classes: marijuana-only (27.9%), alcohol/marijuana (16.1%), and multiple substances (polysubstance) (4.6%). Moving from non-misusers to polysubstance misusers, there was an increasing trend in rates of: unprotected sex, motor vehicle crash, serious violence, weapon aggression, and victimization (all p < .001). Controlling for individual-level variables, polysubstance misusers lived near more on-premises alcohol outlets than non-misusers (RRR = 1.42, p = .01) and marijuana-only misusers (RRR = 1.31, p = .03). Alcohol/marijuana misusers were more likely to live near high violent crime density areas than non-misusers (RRR = 1.83, p = .01), and were also more likely than marijuana-only misusers to live in areas of high drug crime density (RRR = 1.98, p = .03). No other relationships were significant. Conclusion: Substance-misusing youth seeking ED care have higher risk for other problem behaviors and neighborhood-level features display potential for distinguishing between use classes. Additional research to elucidate at-risk sub-populations/locales has potential to improve interventions for substance misuse by incorporating geographic information.     

Alcohol Use and Associated Sexual and Substance Use Behaviors Among Men Who Have Sex with Men in Moscow,Russia

Alcohol use is a public health problem in the Russian Federation. This study explored relationships between alcohol use and behavioral risks for HIV transmission among men who have sex with men (MSM) in Moscow, Russia. Alcohol use disorder identification test (AUDIT) scores for 1367 MSM participating in a cross-sectional survey and HIV testing were categorized to: “abstinence/low use”, “hazardous use”, “harmful use/dependency”. Multiple logistic regression models compared dependent variables for sexual and drug use behaviors across alcohol use strata. Hazardous and harmful/dependent alcohol use were significantly associated with high-risk sexual behaviors and drug use. Harmful use/dependency was associated with an increased odds of having more than five male sex partners (last 12 months; adjusted odds ratios—AOR 1.69; 95 % CI 1.25–2.27), inconsistent condom use during anal intercourse (AOR 2.19; 95 % CI 1.61–2.96) and, among those using recreational drugs, injection drug use (last month; AOR 4.38: 95 % CI 1.13–17.07) compared to abstinent/low-level users. Harmful/dependent use was marginally associated with HIV infection (AOR 1.48; 95 % CI 0.97–2.25). HIV prevention efforts for MSM in Moscow may benefit from addressing problem alcohol use to mitigate high-risk behaviors.     

An empirical study of alcohol consumption by patients considering HCV treatment

Background: Alcohol accelerates the course of hepatitis C (HCV) infection and liver damage. Little is known about recency of alcohol use among patients with HCV. Objectives: Alcohol consumption recency was compared among HCV patients with and without alcohol use disorders and current and lifetime alcohol use histories. Methods: Patients considering antiviral treatment for HCV (n?=?309) recruited from university-affiliated and VA liver and infectious disease clinics were assessed for lifetime and current-year psychiatric disorders and alcohol-use patterns. Full diagnostic interviews, self-report surveys, medical record review, and urine screening for recent alcohol and drug use were conducted. Results: 60% used alcohol in the last year. Besides alcohol history, those who stopped using alcohol in the past year differed from those with no lifetime use only in gender (60% vs. 22%); however, patients no longer using alcohol in the last year were less likely than those still using to have a current drug use disorder (16% vs. 3%) or last-month drug use (52% vs. 30%), and had fewer current risky behaviors (1.3 vs. 0.6). Among patients with last-year alcohol use, those with past alcohol use disorders differed from those without only by higher prevalence of drug use disorder (84% vs. 47%) and drug use after HCV diagnosis (67% vs. 43%). Conclusions: Patients who had stopped using alcohol for at least a year were much like those who never used alcohol in regard to other drug use, psychiatric history, smoking, and risky behaviors. These findings indicate that HCV patients with at least a year of abstinence from alcohol, including those with a history of alcohol use disorder, should be considered HCV treatment candidates.     

Longitudinal sexual behavior changes in injecting drug users.

OBJECTIVE: To determine whether injection drug users (IDU) maintained sexual behavior risk reduction over an 18-month period that had been noted previously over a 4-month period. DESIGN: A repeated measures design was utilized with IDU assessed initially at study enrollment and again 18 months later. METHODS: Sexual behaviors of a group of 220 IDU (148 men and 72 women) were assessed by a structured interview at the start of an AIDS prevention project and again 18 months later. RESULTS: Having multiple sex partners during the 12 months before initial assessment was reported by 42.6% of the men and 35.7% of the women. Significantly fewer had multiple sex partners during the 10 months before follow-up assessment (men, 20.9%; women, 14.3%). Condom use for vaginal intercourse increased from a mean of 11.9% initially to 27.8% at follow-up for men. The increase in condom use was greater for those with multiple sex partners. Women did not report significant increases in condom use. Continued involvement in unsafe sexual behaviors was associated with exchanging sex for money or drugs, using drugs to help meet sexual needs, alcohol use and drug use. CONCLUSIONS: Risk reductions noted previously were maintained over 18 months for the majority of the sample. Drug-use treatment and interventions that closely examine the interplay between drug use and sexuality for individual IDU are recommended as strategies to further reduce the sexual risk of HIV transmission among IDU.     

Substance-use and sexual harm reduction strategies of methamphetamine-using men who have sex with men and inject drugs

Research indicates that men who have sex with men (MSM), use methamphetamine, and inject drugs are at high risk of HIV infection and they employ multiple harm reduction strategies simultaneously to reduce that risk. In this study, we identified substances most commonly injected and harm reduction strategies most often employed by methamphetamine-using MSM, used latent class analysis (LCA) to identify patterns of harm reduction strategies, and differentiated MSM within each class by individual characteristics. We analyzed data from 284 participants who completed an online cross-sectional survey. Commonly injected substances were methamphetamine (93.70%), gamma-hydroxybutyrate/gamma-butyrolactone (41.55%), flunitrazepam (40.49%), and cocaine (35.56%). The substance-use strategies most often used were avoidance of sharing needles (85.92%) and use of bleach to clean drug paraphernalia (64.08%). The sexual strategy most often used was avoidance of condomless anal intercourse (CAS) while using drugs (77.11%). Using an LCA approach, we identified three classes distinguishable by age, race/ethnicity, and outness. One class (19%) employed lay strategies to reduce harm: they avoided sharing drug preparation equipment, serosorted when sharing needles and equipment or having CAS, and practiced withdrawal when having CAS. The largest class (53%) combined sexual and substance-use strategies: they avoided sharing needles, used bleach to clean needles and equipment, avoided CAS when using drugs, and used extra lubricant when having CAS. The remaining class (28%) employed only substance-use rather than sexual strategies. More MSM of color were in the substance-use class, and more young, non-Hispanic White men were in the lay class. The low utilization of sexual strategies by younger, non-Hispanic White men in the lay class is concerning as they are just as likely as older, non-Hispanic White men in the combined class to have CAS with multiple male partners. Interventionists should consider these differences when developing interventions tailored to methamphetamine-using MSM.     

Timeline: A web application for assessing the timing and details of health behaviors

Background: Timeline Followback (TLFB) interview methods are used to assess a variety of health behaviors, including alcohol use, drug use, and sexual behavior. While several online TLFBs have been developed, most focus on single behaviors, and few studies have explored their validity in assessing multiple risk behaviors using a single online TLFB. Objective: To examine the validity of a customizable web application (Timeline) for assessing alcohol use, drug use, and sexual behavior among high-risk men who have sex with men. Methods: Participants (N = 15 men) completed standardized survey instruments before undergoing a 30-day daily diary procedure where they submitted daily reports of health risk behaviors via smartphone. They then completed a Timeline at the end of the 30-day period covering the same time interval. Results: Comparing a baseline administration of Timeline with popular surveys of health risk behaviors supported Timeline’s validity (r = 0.41–0.59 for alcohol use, r = 0.83 for drug use, and r = 0.34–0.52) for sexual behaviors. While participants reported similar amounts of each behavior via daily diary as they did on a follow-up Timeline (r = 0.55–0.88 for alcohol use, r = 0.69 for drug use, and r = 0.87–0.92 for sexual behaviors), results provided evidence of underreporting on the Timeline. Timing of behaviors also frequently disagreed across these methods. Conclusions: Timeline is valid for assessing overall engagement in alcohol use, drug use, and sexual behavior over a 30-day window. However, researchers interested in the specific timing of behaviors within assessment intervals should use smaller follow-up intervals (e.g., 7 days, 14 days) or more intensive reporting methods (e.g., daily diary).     

Childhood Sexual Abuse and Its Relationship to High-Risk Behavior in Women Volunteering for an HIV and STD Prevention Intervention

This study examines the extent of childhood sexual abuse and its relationship to risky sexual and drug-using behaviors, condom use, and lifetime sexually transmitted diseases (STDs) in women volunteering for the WINGS intervention in New York City, Baltimore, and Seattle. Responses to structured interviews from 825 eligible women recruited from the community, clinics, and drug programs in 1995 and 1996 were analyzed. Thirty-eight percent to 66% of women across sites reported childhood sexual abuse before age 18. Q statistics and t tests measured the bivariate relationships between sexual abuse and outcomes. Then regression analysis was used to control for ethnicity and race, age, age at first intercourse, and site in predicting the adjusted effects of sexual abuse. Compared to nonabused women, abused women reported more lifetime partners, more episodes of different STDs, lower odds of using condoms at most recent sexual intercourse with main partners, and increased odds of using drugs or alcohol before sex. Researchers need to develop and test STD and HIV interventions tailored for victims of early sexual abuse and compare them with more general interventions for at-risk women.Correspondence should be addressed to Judith Greenberg, Centers for Disease Control and Prevention, 1600 Clifton Rd., N.E. (E44), Atlanta, Georgia 30333