Impact of drug treatment on subsequent sexual risk behavior in a multisite cohort of drug-using women

Latka, Mary H.; Wilson, Tracey E.; Cook, Judith Α.; Bacon, Melanie C.; Richardson, Jean L.; Sohler, Nancy; Cohen, Mardge H.; Greenblatt, Ruth M.; Andreopoulis, Evie; Vlahov, David

doi:10.1016/j.jsat.2005.08.008

Cited by 12 publications

(8 citation statements)

References 35 publications

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“…A similar return to risk-taking behavior was reported during the Vax004 trial among women participants[1]. Frequent visits and contact with study staff, regular risk-reduction counseling, and referral to services such as drug treatment were all thought to influence behavior change in the study, as has been reported elsewhere[19, 20]. Repeated screening for HIV has been reported to have little impact on change in risk behavior, and it is unclear if it contributed to the observed change in this study[21].…”

Section: Discussionsupporting

confidence: 64%

Risk behavior among women enrolled in a randomized controlled efficacy trial of an adenoviral vector vaccine to prevent HIV acquisition

Novak¹,

Metch

Buchbinder

et al. 2013

Aids

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Objectives Report of risk behavior, HIV incidence, and pregnancy rates among women participating in the Step Study, a phase IIB trial of MRKAd5 HIV-1 gag/pol/nef vaccine in HIV-negative individuals who were at high risk of HIV-1. Design Prospective multicenter, double-blinded, placebo-controlled trial Methods Women were from North American (NA) and Caribbean and South America (CSA) sites. Risk behavior was collected at screening and 6-month intervals. Differences in characteristics between groups were tested with Chi-square, two-sided Fisher’s exact tests, and Wilcoxon rank sum tests. Generalized estimating equation models were used to assess behavioral change. Results Among 1134 enrolled women, the median number of male partners was 18; 73.8% reported unprotected vaginal sex, 15.9% unprotected anal sex and 10.8% evidence of a sexually transmitted infection in the 6 months prior to baseline. With 3344 person-years (p–y) of follow up, there were 15 incident HIV infections: incidence rate was 0.45 per 100/p-y (95% CI 0.25, 0.74). Crack cocaine use in both regions (relative risk [RR]=2.4 [1.7,3.3]) and in CSA, unprotected anal sex (RR=6.4 [3.8. 10.7]) and drug use (RR=4.1 [2.1, 8.0]) were baseline risk behaviors associated with HIV acquisition. There was a marked reduction in risk behaviors after study enrollment with some recurrence in unprotected vaginal sex. Of 963 non-sterilized women, 304 (31.6%) became pregnant. Conclusions Crack cocaine use and unprotected anal sex are important risk criteria to identify high-risk women for HIV efficacy trials. Pregnancy during the trial was a common occurrence and needs to be considered in trial planning for prevention trials in women.

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Section: Discussionsupporting

confidence: 64%

Risk behavior among women enrolled in a randomized controlled efficacy trial of an adenoviral vector vaccine to prevent HIV acquisition

Novak¹,

Metch

Buchbinder

et al. 2013

Aids

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“…For example, because women are typically incarcerated in jails for a short period of time compared to prison or community custody settings, there may be a critical window for screening/assessment for substance use and co-occurring mental health issues in jail settings. Because studies have shown that women's participation in drug treatment can also have a positive impact on their risky sexual behavior (Latka et al, 2005), this study also has policy implications of expansion of substance abuse treatment in jail settings. Having a better understanding of co-occurring substance use, mental health, and other health risk behavior, as well as the complexity of HIV risk, also has important implications for re-entry to the community and for making appropriate treatment referrals.…”

Section: Discussionmentioning

confidence: 99%

An exploratory study of mental health and HIV risk behavior among drug-using rural women in jail.

Staton‐Tindall¹,

Harp²,

Minieri³

et al. 2015

Psychiatric Rehabilitation Journal

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Objective Rural women, particularly those involved in the criminal justice system, are at risk for HIV due to the increasing prevalence of injection drug use, as well as limited services. Research on HIV risk correlates, including drug use and mental health, has primarily focused on urban women incarcerated in prisons. The purpose of this exploratory study is to examine dual HIV risk behavior by three different mental health problems (depression, anxiety, and PTSD) among drug-using women in rural jails. Methods This study involved random selection, screening, and face-to-face interviews with 136 women from rural jails in one Appalachian state. Analyses focused on the relationship between mental health and HIV risk among this sample of drug-using women. Findings Nearly 80% of women self-reported symptoms of depression, and more than 60% endorsed symptoms consistent with anxiety and PTSD symptoms. Mental health was significantly correlated with severity of certain types of drug use, as well as risky sexual activity. In addition, for women experiencing anxiety and PTSD, injection drug use moderated the relationship between mental health and risky sexual activity. Implications Based on these rates of drug use, mental health problems, and the emergence of injection drug use in rural Appalachia, the need to explore the relationships between these issues among vulnerable and understudied populations, such as rural women, is critical. Due to service limitations in rural communities, criminal justice venues such as jails provide opportune settings for screening, assessment, and intervention for drug use, mental health, and HIV education and prevention.

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“…Among DATOS clients, short-term reduction (from intake to 3 or 6 months post treatment) of sex and needle-risk behaviors were found for individuals treated in outpatient methadone treatment and outpatient drug-free settings (Broome, Joe, and Simpson 1999). On the other hand, Latka et al (2005) found that while women in drug treatment were less likely to become sexually active, except for those involved in three or more programs, drug treatment did not impact the consistent use of condoms among sexually active women. Hoffman et al (1998) found that entry into drug treatment was associated with reduction in risky sexual behavior, but the reductions were less substantial and less consistent than those noted for drug use and injection risk behaviors.…”

mentioning

confidence: 83%

Longitudinal HIV Risk Behavior Among the Drug Abuse Treatment Outcome Studies (DATOS) Adult Sample

et al. 2008

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Longitudinal trajectories for HIV risk were examined over five years following treatment among 1,393 patients who participated in the nationwide Drug Abuse Treatment Outcome studies (DATOS). Both injection drug use and sexual risk behavior declined over time, with most of the decline occurring between intake and the first year follow-up. However, results of the application of growth mixture models for both sets of trajectories indicated a subgroup of individuals reverted to a highrisk behavior over time, with a higher level of risk at the 5-year follow-up than their original risk level at intake. Of clients who were engaged in regular injection drug use at intake, 76% continued to inject drug at a Moderate/stable or Increased rate over the 5-year follow-up. KeywordsHIV; Risk Behavior; Injection Drug Use; Sexual Risk Behavior In the U.S., the majority of individuals infected with HIV contracted the virus by engaging in either sexual behavior or drug use. Among drug injectors, failing to utilize hygienic needle use behaviors (such as cleaning with bleach before reuse and not sharing cookers or needles) is associated with HIV infection (Dasgupta et al. 1995;Neaigus et al. 1994). In addition, use of alcohol or drugs before sex is significantly related to unprotected sex (Hou and Basen-Engquist 1997), leaving substance abusers at high risk for HIV infection. Longitudinal studies of HIV risk behaviors can contribute to a better understanding of change or continuity over time and identification of contributing factors. Such knowledge may have implications for developing improved intervention strategies. Taking advantage of the nationwide Drug Abuse Treatment Outcome studies (DATOS), we examine trajectories over five years following treatment among a large sample of drug-abusing patients, focusing on their injection and sexual risks-the two major HIV risk behaviors among this population. We are particularly interested in identifying distinctive patterns of risk trajectories so that timing and/or individuals at greater risk can be targeted for intervention. Below we provide a brief literature review to provide the relevant context of our study.Correspondence: Debra A. Murphy, Ph.D., Health Risk Reduction Projects, Department of Psychiatry, UCLA, 11075 Santa Monica Blvd., Suite 200, Los Angeles, Phone: (310) Drug Treatment and Injection Drug UseAs far back as the early years of the HIV epidemic, injection drug users (IDUs) were identified as a group at risk for HIV infection through the sharing of needles and other drug paraphernalia (Marmor et al. 1984). Approximately 300,000 IDUs in the U.S. have been diagnosed with acquired immunodeficiency syndrome since 1980 (Centers for Disease Control and Prevention 2003). While treatment is not typically considered prevention, it has been proposed that the close association between injection drug use and HIV transmission suggests that drug treatment can be considered primary HIV prevention (e.g., Metzger, Navaline, and Woody 1998). In the past 20 years, several studi...

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Impact of drug treatment on subsequent sexual risk behavior in a multisite cohort of drug-using women

Cited by 12 publications

References 35 publications

Risk behavior among women enrolled in a randomized controlled efficacy trial of an adenoviral vector vaccine to prevent HIV acquisition

Risk behavior among women enrolled in a randomized controlled efficacy trial of an adenoviral vector vaccine to prevent HIV acquisition

An exploratory study of mental health and HIV risk behavior among drug-using rural women in jail.

Longitudinal HIV Risk Behavior Among the Drug Abuse Treatment Outcome Studies (DATOS) Adult Sample

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