Sociodemographic and Substance Use Disorder Determinants of HIV Sexual Risk Behavior in Men and Women in Outpatient Drug Treatment in the NIDA National Drug Abuse Treatment Clinical Trials Network

Abstract

BACKGROUND Sexual risk behavior is now the primary vector of HIV transmission among substance users in the United States with gender as a crucial moderator of risk behavior. OBJECTIVES The purpose of this study was to examine gender differences in factors (age, race/ethnicity, education) that predict main-partner unprotected sexual occasions (USO) using the unique platform of two parallel NIDA National Drug Abuse Treatment Clinical Trials Network gender-specific safer sex intervention trials. METHODS Baseline assessments of male (N=430) and female (N=377) participants included demographic characteristics; past 3-month sexual activity; and a diagnostic assessment for alcohol, cocaine/stimulant, and opioid use disorders. Using mixed effects generalized linear modeling of the main outcome USO, two-way interactions of gender with age, race/ethnicity, and education were evaluated and adjusted by alcohol, cocaine/stimulant, or opioid use disorder. RESULTS When adjusted for alcohol use disorder, the interaction of education and gender was significant. For men, a high school or greater education was significantly associated with more USO compared to men with less than high school. For women, greater than high school education was significantly associated with less USO compared to women with a high school education. None of the other interactions were significant when adjusted for cocaine/stimulant or opioid use disorder. CONCLUSIONS/IMPORTANCE This study demonstrates gender differences in the relationship of education, alcohol use disorder, and main-partner USO in individuals in substance abuse treatment. This underscores the importance of considering demographic and substance use factors in HIV sexual risk behavior and in crafting prevention messages for this population.

Implementation and Evaluation of a Text Message–Based Addiction Counseling Program (Text4Hope-Addiction Support): Protocol for a Questionnaire Study

“…Familial studies have reported an increased risk of addiction in persons with a genetic predisposition [ 15 , 16 ], but this increased vulnerability is subject to the interplay between gene and environment. Sociodemographic factors such as peer pressure, unemployment, and geographical location can influence the onset and outcome of substance abuse [ 17 ]. Psychological factors predicting a person’s vulnerability to substance abuse include a history of trauma, high psychopathology of anxiety, and depression [ 18 , 19 ].…”

Donor-derived human herpesvirus 8 and development of Kaposi sarcoma among 6 recipients of organs from donors with high-risk sexual and substance use behavior

“…Four donors had known risk factors for HHV‐8 infection; MSM (Donors 2 and 6) or IDU (Donors 4 and 5). Donors 1 and 3 had probable risk factors for HHV‐8 infection as regular users of methamphetamine (also heroin and cocaine for Donor 3), which is associated with high‐risk sexual behaviors (trading sex for drugs and money) 14,15 and IDU 16 . Organs from 6 donors were transplanted into 22 recipients (Table 2).…”

“…However, donor history questionnaires can have incomplete information 25 . Donor 1 was noted to be sexually active with unknown gender preference, which may imply MSM behavior, and was a frequent user of methamphetamine, which is associated with high‐risk sexual behavior 14,15 and IDU 16 . Donor 3 was reported to inhale methamphetamine, cocaine, and heroin, which are associated with high‐risk sexual behavior 14,15 and IDU 16 .…”

“…Donor 1 was noted to be sexually active with unknown gender preference, which may imply MSM behavior, and was a frequent user of methamphetamine, which is associated with high‐risk sexual behavior 14,15 and IDU 16 . Donor 3 was reported to inhale methamphetamine, cocaine, and heroin, which are associated with high‐risk sexual behavior 14,15 and IDU 16 . Therefore, it is the hypothesis of the authors that inhalation drug use disorder is not a newly identified risk factor for HHV‐8 infection but rather is associated with behaviors that are HHV‐8 risk factors.…”

Drug use by men admitted to a psychiatric hospital*

“…Alcohol intoxication and drug use lead the user to increase the probability of doing or getting involved in something potentially harmful (19) , such as drunk driving, violent behaviors, and crimes (20) , or negligent behavior (sexual, for example) (21) . About activities, they can increase the probability of accidents (22) , leading to an increased risk of injuries and traumas (17) .…”