Associations Between Alcohol,Heroin, and Cocaine Use and High Risk Sexual Behaviors Among Detoxification Patients

The purpose of this study was to assess associations between substance use (alcohol to intoxication, heroin, and cocaine) and sexual activity, high risk sexual behaviors, and STD among detoxification inpatients (n = 470). Participants were surveyed on past 30 day substance use, past 6 month sexual behaviors, and STD in the past 6 months and/or over 24 months of follow-up. Logistic regression models adjusted for demographics found that cocaine use was significantly associated with being sexually active (OR_adj = 2.3, 95% CI = 1.1–4.8) and selling sex (OR_adj = 2.6, 95% CI = 1.3–5.3). Alcohol and heroin were not significantly associated with sexual activity, high risk sexual behaviors or STD in this sample.     

Partner Violence and Sexual HIV Risk Behaviors Among Women in Methadone Treatment

To examine associations between recent partner violence and sexual HIV risk behaviors and their implications for HIV prevention among women in methadone treatment, we conducted structured interviews covering demographics, drug use, trauma history, partner violence, and sexual risk behavior with 147 sexually active women who were at risk of HIV infection. Almost one third (30.5%) of the women reported that they had been physically or sexually abused by a spouse or boyfriend during the previous year. Multiple logistic regression analysis indicated that after adjusting for potential confounders, recently abused women were less likely to report using condoms (OR = 0.41, CI = 0.17, 0.99) and more likely than non-recently abused women to report having contracted a sexually transmitted disease (STD) (OR = 3.6, CI = 1.6, 8.5), exchanged sex for money (OR = 2.4, CI = 1.1, 5.4), and having had sex with an HIV-infected partner (OR = 2.5, CI = 1.0, 6.1). The study findings underscore the importance of developing HIV-risk reduction strategies that target the specific needs of abused women in drug treatment.     

Sexual Risk Behaviors in Late Middle Age and Older HIV Seropositive Adults

Little is known about the sexual behaviors of older adults, although the prevalence of HIV/AIDS is rapidly increasing in this population. As part of a larger multi-site study examining secondary HIV prevention, we recruited from an HIV primary care clinic 210 sexually active HIV positive individuals aged 45 and over (125 men, 85 women) who had engaged in vaginal or anal sex within the past six months. Twenty percent of the participants reported inconsistent use of condoms and 33% had multiple sexual partners during the previous six months. Negative mood and perceived HIV stigma were associated with inconsistent condom use. In addition, multiple sex partners and higher level of education were related to inconsistent condom use during sex with partners of negative or unknown serostatus. These findings indicate that contrary to current beliefs, sexually active older adults, similar to younger ones, may be engaging in high risk transmission behaviors.     

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.     

Predictors of HIV Sexual Risk Behaviors in a Community Sample of Injection Drug-Using Men and Women

Injection risk practices and unprotected sex between injection drug users (IDUs) and their sexual partners are responsible for a high proportion of AIDS cases and new HIV infections in the United States. The purpose of this study was to investigate the links between drug use behaviors and psychosocial factors with high-risk sexual behaviors among male and female IDUs. Understanding the determinants of sexual risk practices among drug users can lead to the development of more effective programs to prevent sexual HIV and STD transmission. This study enrolled a community sample of 101 IDUs (males = 65, females = 36), primarily African American and unemployed, who injected drugs and had unprotected sex in the past 3 months. The sample was categorized into highest sexual risk (multiple partners and intercourse without condoms) and lower sexual risk subgroups. Univariate analyses showed that IDUs at highest sexual risk had lower sexual risk reduction self-efficacy (p =.01) and were more likely to be African American (p =.02). Drug users at highest sexual risk also used noninjected cocaine and crack more frequently (p =.05), were less likely to inject heroin (p =.04), and tended to more often inject cocaine (p =.05). IDUs at highest sexual risk also tended to more often use crack and methamphetamines. Logistic regression analyses showed that injecting cocaine or crack, sexual risk reduction self-efficacy, and race were independent predictors of sexual risk behavior levels. Sexual risk reduction programs for this population are needed, with HIV prevention programs tailored to specific IDU risk reduction needs.     

Risk Perception and Sexual Risk Behaviors Among HIV-Positive Men on Antiretroviral Therapy

There are reports of increased sexual risk behavior among people on highly active antiretroviral therapy (HAART) due to beliefs about risk of HIV transmission when on HAART. In a cross-sectional study (Seropositive Urban Mens Study), we examined the relationship between risk perception and sexual risk behavior among sexually active, culturally diverse HIV positive men who have sex with men (N = 456). Less than twenty-five percent engaged in unprotected anal sex (either with an HIV negative, or unknown-status partner, or an HIV positive partner) within the past 3 months. Most men believed there was significant health risk (to partner or self) associated with unprotected sex when on HAART. There was no increased risk behavior associated with being on HAART, although the perception of negative health consequences, including HIV transmission, when on HAART was significantly lower for the relatively small subset of men who reported unprotected sex. Prevention strategies need to be tailored to address risk perception associated with HAART.     

Influences of Survey Instrument Format and Social Desirability on the Reliability of Self-Reported High Risk Sexual Behavior

This study examined instrument-related and respondent-related self-presentation effects on the reliability of HTV sexual risk self-reports. Sixty-five men who have sex with men (MSM) were randomly assigned to assessment conditions differing only on the format for questions about their sexual behavior. For Group 1, the instrument tested responses to items directly addressing the issue of unsafe sex; men reported absolute frequencies of sexual activities engaged in with and without a condom. For Group 2, questions were framed more positively with respect to condom use; participants were instructed to report total number of intercourse occasions, and then indicate on a scale the relative frequency (percentage) of times condoms were used. It was anticipated that Group 1 participants would feel more inhibited about reporting episodes of unprotected sex, particularly unprotected anal intercourse (UAI). The Marlowe–Crowne scale was used to control for general tendencies toward socially desirable responding within the sample. Results confirmed that men in Group 1 tended to report lower rates (percents) of UAI, and that, among participants with higher frequencies of anal intercourse, this difference was statistically significant. Weighted least squares regression analysis showed that hypothesized indicators of measurement error—assessment group and social desirability—together accounted for more than half of the explained variance in percent UAI. The findings suggest that HIV prevention researchers need to give higher priority to methodological issues involved in the data collection process. Also, more research is needed on the implications of socially desirable responding for the reliability of self-reports of HIV sexual risk behavior.     

Associations between Political/Civic Participation and HIV Drug Injection Risk

Background: Participating in civic activities has been found to be related to positive health outcomes. Objective: This study examines associations between injection drug use health variables (sharing paraphernalia, using shooting galleries) and political/civic engagement (identifying with any political party, attention paid to politics and being registered to vote). Methods: Participants (N = 162) were recruited at 6 New York City (NYC) methadone programs as part of an HIV intervention (86% male). Results: In the bivariate analysis, being registered to vote and political party identification were related to lower paraphernalia sharing; higher levels of attention paid to politics were associated with lower shooting gallery use. In the multivariate analysis, political party identification was associated with lower paraphernalia sharing and higher levels of attention paid to politics was related to lower shooting gallery use. Conclusions: Findings suggest that maintaining connections with mainstream civic activities can be related to reduced health risks, including HIV risk behaviors. Scientific Significance: This study contributes to understanding the relationships between involvement in civic/political participation and health, an area in which few studies have been conducted.     

Prevalence and Correlates of HIV-Related Risk Behaviors Among Adolescents at Public Schools in Brasilia

This cross-sectional study examined prevalence and correlates of HIV risk behaviors among a random sample of 431 adolescents (aged 12–21 years) attending schools in the Brasilia Federal District. The results showed that 43% of the students were sexually experienced. Condoms were consistently used by 43% of the sexually active students during vaginal intercourse and by 27% during anal intercourse. About 32% and 16% of the participants reported current consumption of alcohol and illegal substances, respectively, with 17% and 4% reporting having sex under their influence. Having stable partners was the main reason for not using condoms. Other high-risk correlates included male gender, older age, having repeated a school year, alcohol consumption, sex under the influence of alcohol, heavier alcohol consumption, and illegal substance use. Access to condoms was not reported to be a problem. These data are useful for designing health education interventions in schools and for behavioral surveillance of adolescents.     

Mental Health Problems and Sexual Abuse Among Adolescents in Foster Care: Relationship to HIV Risk Behaviors and Intentions

Adolescents in foster care present with multiple psychosocial and mental health problems that individually are associated with increased risk for HIV infection. However, few studies have examined empirically the interrelationships among these problems and HIV risk behaviors in this population. This study examined the sexual abuse histories and mental health problems among 343 youths in foster care to determine their association with HIV-risk behaviors and behavioral intentions. Results indicated that 25% reported internalizing behaviors (withdrawn, somatic complaints, depressed) and 28.3% reported externalizing behaviors (delinquent and aggressive behaviors). Of the sample, 37% reported some form of prior sexual abuse. Multivariate analyses using simultaneous entry of variables indicated that controlling for demographic variables and behavioral intentions, externalizing behaviors showed the strongest relationship with HIV-risk behaviors. Likewise, in the multivariate model, it was most strongly associated with behavioral intentions. Moreover, there was a significant race-by-gender interaction, with White females engaging in more risky behaviors than their male counterparts and youths of color.     

Sexual Harassment, Sexual Coercion, and HIV Risk Among U.S. Adults 18-49 Years

Sexual harassment and sexual coercion have received considerable public attention. However, the extent of these problems nationally and the breadth of their health consequences are not fully understood. We estimated the national prevalence of sexual harassment and sexual coercion, and examined their relationship to HIV risk in the general U.S. population. Data came from a 1992 telephone survey of a random probability sample of 2,030 U.S. adults aged 18–49 years. Nationally, 16% of men and 33% of women reported having been sexually harassed, and 4% of men and 16% of women reported having been sexually coerced. Significantly higher HIV risk was observed among male victims of sexual harassment compared to nonvictims (32% vs. 22%), but not among women (17% vs. 14%). HIV risk for men did not differ by having experienced sexual coercion (31% vs. 23%), but female victims reported more risk behavior than nonvictims (26% vs. 13%). Greater HIV risk found among victims argues for prevention efforts that focus on their particular needs.     

Pathways to Sexual Risk Reduction: Gender Differences and Strategies for Intervention

Using the AIDS risk reduction model as our conceptual framework and structural equation modeling as our analytic tool, we tested psychosocial antecedents of sexual risk reduction among heterosexually active men and women who use illegal drugs. With baseline sexual risk behavior controlled, stronger commitment to safer sex predicted less sexual risk behavior for both men and women. For men but not women, greater AIDS knowledge predicted safer sex commitment. For women but not men, higher self-efficacy predicted stronger commitment to safer sex, and peer norms favoring sexual risk reduction predicted higher self-efficacy. Intervention for men should focus on increasing safer sex commitment and AIDS knowledge. Intervention for women should promote safer sex commitment by raising self-efficacy for sexual risk reduction.     

Sexual Behaviors and Risks Among Bisexually- and Gay-Identified Young Latino Men

This research compares patterns of sexual behavior and sexual risk of bisexually- and gay-identified Latino young men who have sex with men (YMSM). Four hundred forty-one Latino YMSM were surveyed at community venues in New York City. Twenty-two percent of the sample identified as bisexual, and 78% identified as gay. Bisexually-identified men were more likely to report having had multiple male sex partners in the last 3 months and less likely to report being exclusively involved with a main male partner. They were also approximately 3 1/2 times more likely to report unprotected insertive anal intercourse at last sexual contact with a nonmain male partner and more likely to report being high at last contact with both main and nonmain male partners. Findings suggest that prevention programs need to address the particular sexual risk patterns of bisexually-identified Latino YMSM that place them at risk of both HIV infection and transmission.     

Severity of Child Sexual Abuse, Post- Traumatic Stress and Risky Sexual Behaviors Among HIV-Positive Women

Child sexual abuse (CSA) has been shown to enhance risk for HIV infection and other adverse outcomes. However, most studies examine the effects of a single incident of CSA rather than the full burden of abuse over the life span in predicting these adverse outcomes. A multi-dimensional approach was used in this study to examine the severity of abuse as a predictor of post-traumatic stress, depression, sexual symptoms, and risky sexual behaviors in a multi-ethnic sample of 147 HIV-positive women. Multivariate models indicated that experiencing both intrafamilial and extrafamilial CSA, adult sexual abuse (ASA) and Latina ethnicity predicted PTSD symptoms. ASA also predicted sexual trauma symptoms. Also, CSA and adult re-victimization contributed independently to risk for PTSD and sexual trauma symptoms, but not for risky sexual behaviors. The results support the need for interventions for HIV-positive women that address the full burden of abuse experienced and its sequelae.     

Sexual Networks and HIV Risk of People with Severe Mental Illness in Institutional and Community-Based Care

This study examines the sexual networks and HIV risk of clients with severe mental illness in treatment in institutional and community care settings. Data were gathered through structured interviews with 401 clients at three community mental health centers and two state psychiatric hospitals. Results indicate that community clients are more likely than hospital patients to be currently sexually active and to engage in high-risk sexual behavior whereas hospitalized patients tend to have more transient sexual relationships with partners who also have a mental illness. These findings suggest that mental health treatment settings may be shaping the HIV epidemic among psychiatric patients because of the impact they have on the structure of clients’ sexual networks.     

HIV Knowledge and Sexual Risk Behaviors of Street Children in Takoradi, Ghana

A pilot survey was conducted among 100 street children aged 11–19 years and data collected regarding HIV knowledge, risk behaviors, home and sexual experiences, and factors that contributed to their relocation to the street environment. Data indicated that 80% of the street children had at least minimal knowledge of HIV and 54% perceived themselves to be at risk for contracting HIV. More than three-fourths of the females, and over half of the boys reported ever having sex. There were significant differences between males and females for sexual activity, physical and sexual abuse, and prostitution, as girls were more likely to be sexually active, physically abused, and involved in prostitution.     

Alcohol Use and Sexual Risk Behavior among College Students: Understanding Gender and Ethnic Differences

Objectives: The purpose of the current study was to assess the role of gender and ethnicity in the relationship between alcohol use and risky sexual behavior. Method: Sexually active college students (n = 425) reported on alcohol expectancies, perceived risk of HIV, and drinking and sexual behavior in the context of a larger health behavior survey. Results: Approximately one-third of participants reported binge drinking 3 or more times in the past two weeks. African-American women reported less drinking and less positive alcohol expectancies than other women. Older men engaged more often than younger men in binge drinking and reported more sexual partners in the past year. Younger age and greater perceived risk for HIV were positively associated with condom use for both women and men. Conclusion: Collectively, these findings suggest that alcohol abuse and HIV prevention efforts among young adults need to consider gender, ethnicity, and age.     

Drug-Using Women's Sexual Risk: An Event Analysis

Using event analysis, this study describes the most recent sexual events of drug-using women and their male partners and identifies relationship-specific and event-specific determinants of condom use. Women drug users (n = 320) were recruited from the streets of East Harlem. After validation of drug use, they participated in structured interviews and were offered HIV testing and counseling. Interview topics included the following: (1) demographic characteristics of respondents, (2) relationship factors, including age difference, race/ethnicity concordance, and HIV serostatus of partners, and (3) event-specific factors, including sexual repertoire, communication about condom use, and perception of HIV risk. Univariate and multivariate analyses identified five major variables associated with event-specific condom use: (1) closeness to partner, (2) perceived dyadic serostatus, (3) sexual repertoire, (4) communication about condoms, and (5) perceived control of condom use. Behavioral interventions to reduce sexual risk should target dyads with long-standing sexual relationships and focus on the dynamics of the relationship, especially the issues of dyadic serostatus, intimacy, communication, and control.     

Association Between Cannabis Use and Sexual Risk Behavior Among Young Heterosexual Adults

To study the association between cannabis use and frequent sexual risk behavior, we tested the hypothesis of a situational influence of cannabis use in sexual encounters using a combination of global association study and event-level analysis and examined possible mediator variables, including the personality trait of hedonism/risk preference, psychosocial stress, and HIV-related beliefs, using mediation models. The results of a computer-assisted telephone interview of a random sample of 2790 heterosexual men and women aged 16–24 years showed that risky sexual behavior was more frequent in cannabis-using men and women than in non-using persons. The results did not support a situational effect of cannabis intoxication on sexual risk behavior. The more frequent sexual risk behavior among cannabis users was mediated by decreased intentions to use HIV protection, by lower HIV-self-efficacy, and higher risk preference/hedonism. Only among women psychosocial stress was a partial mediator. The findings show that HIV prevention programs for cannabis-using young adults should emphasize the role of person variables instead of situation variables.