Substance use, depression and sociodemographic determinants of HIV sexual risk behavior in outpatient substance abuse treatment patients.
The NIDA Clinical Trials Network trial of rapid HIV testing/counseling in 1281 patients (protocol CTN-0032) was a unique opportunity to examine relationships among substance use, depressive symptoms, and sex risk behavior. In this ancillary examination of the study data, past 6-month substance use, substance use severity, depressive symptoms, and three types of sex risk behavior (unprotected sex occasions [USOs] with primary partners, with nonprimary partners, and while high/drunk) were assessed. Zero-inflated negative binomial analyses were provided: probability and rate of sex risk behavior (in risk behavior subsample). Levels of sexual risk behavior were high, while variable across the three types of sex risk behaviors. Among the patients, 50.4% has engaged in USOs with primary partners, 42% in sex while drunk or high, and 23.8% in USOs with nonprimary partners. Similar factors were significantly associated with all three types of sex risk behaviors. For all types, problem drinking, cocaine use, and substance use severity had an exacerbating effect. Older age was associated with lower risk behavior, other relationship categories (e.g., married, separated/divorced, cohabitating) were associated with greater risk behavior than was single status. Depressive symptoms were associated with decreased likelihood of USOs with a primary partner.
Conclusions: Sexual risk behavior is common among individuals in outpatient substance abuse treatment. Results highlight the roles of problem drinking (e.g., up to three-fold) and cocaine (e.g., up to twice) in increasing sex risk behavior. They also demonstrate the utility of distinguishing between partner types and presence/absence of alcohol/drugs during sex. Findings argue for the need to integrate sex risk reduction into drug treatment, in both the assessment and counseling process. Addressing sexual risk behavior may enhance relapse prevention in this vulnerable population.
Related protocols: CTN-0032