Gender differences in rates and correlates of HIV risk behaviors among drug dependent individuals.

This ancillary investigation by the CTN Gender Special Interests Group (SIG) examined gender differences in the rates and correlates of HIV sexual and drug risk behaviors in a sample of clients participating in five multi-site trials of the National Drug Abuse Treatment Clinical Trials Network (CTN). HIV sexual risk behaviors and drug risk behaviors in the past 30 days were assessed at treatment entry. Measures of recent substance use, psychiatric severity, abuse history, social relations, legal involvement, and housing stability were examined in models predicting sex and drug risk behaviors. In the sample of 1429 individuals, 39% had used both opioids and stimulants in the last 30 days, 21% had used stimulants only, and 17% used opioids only. Men were more likely to report injection drug use, but no other differences in drug risk behaviors were found. Women were more likely to report multiple partners, unprotected sex with regular partners, and greater engagement in high risk sexual behaviors overall. Women with greater alcohol use engaged in higher drug risk behaviors, while impairment in social relations was related to less engagement in sex risk behaviors for men. Stimulant use, sexual abuse history, drug use severity, and legal involvement were all associated with engagement in higher risk sexual behaviors for both women and men.

In conclusion, rising rates of HIV in women highlight the need to identify factors associated with risk behaviors in women. Women were less likely to report condom use with a regular partner, suggesting that condom use in an ongoing relationship may be discouraged by the male partner and reflect poorer negotiation skills. The association of alcohol use and psychiatric symptoms with risk behaviors may be the result of inferior negotiation skills or reflect social affiliation needs of vulnerable women.

Related protocols: CTN-0039-S