The Role of Drinking Severity on Sex Risk Behavior and HIV Exposure among Illicit Drug Users

Abstract

Objectives-The current study examined how drinking severity among injection and noninjection drug users is associated with sex risk behaviors and risk of HIV exposure.Methods-The study is a secondary analysis of an investigation of risk factors among drug users in Baltimore known as the NEURO-HIV Epidemiologic Study. Participants (N = 557) completed an interview, self-reported 30-day alcohol use, lifetime injection and non-injection drug use, and provided blood samples to screen for HIV. Participants were grouped into one of three drinking severity conditions: Abstinent (no reported alcohol use in prior 30-days), Moderate Alcohol Use (≤30 drinks for females, or ≤ 60 drinks for males), or Problematic Alcohol Use (>30 drinks for females, or >60 drinks for males). Drinking severity groups were significantly different on lifetime injection drug use, heroin injection, snorting/sniffing cocaine, and smoking crack.Results-Logistic regression analyses found problematic alcohol users to be more likely than alcohol abstainers to inject drugs before or during sex (AOR = 5.78; 95% CI = 2.07-16.10), and more likely than moderate alcohol users to use alcohol before/during sex (AOR = 4.96; 95% CI = 2.09-11.81), inject drugs before/during sex (AOR = 2.96; 95% CI = 1.29-6.80) and to be HIV+ among Black participants (AOR = 2.72; 95% CI = 1.14-6.49).Conclusions-These results outline the necessity for research and clinical intervention among this population to reduce sex risk behaviors and potential HIV exposure, while highlighting the need to examine drinking severity as a predictor of sex risk behaviors.Sex risk behaviors increase the risk of sexually transmitted diseases (STDs) including the human immunodeficiency virus (HIV). 1, 2 However, of individuals currently living with HIV, approximately two thirds of them (64.44%) report non-injection drug use (NIDU) in their lifetime, 3 indicating that both IDU and NIDU are prevalent substance using categories to consider within this population. IDU is believed to be associated with infectious diseases due to sharing of needles, but multiple pathways have been suggested for how NIDU may Address correspondence to Dr. Scherer, Johns Hopkins University, Bloomberg School of Public Health, Department of Mental Health, 624 N. Broadway, 8 th floor, 895, Baltimore, MD 21205. mscherer@jhsph.edu.. Declaration of Interest:The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this paper. 4 This issue is somewhat exacerbated by the prevalence of polysubstance use among individuals who engage in high risk sex behaviors and, subsequently, are at particularly high risk for contracting HIV. In fact, sex with multiple partners, sex while under the influence of alcohol or other drugs, and unprotected sex are the three most prevalent sex-related HIV risk factors. 1,5 Of particular importance is the critical role of alcohol use in engaging in risky behaviors generally, sex risk behaviors specifically, and the subsequent increased risk of cont...