Search the Library

Abstract: This study, ancillary investigation CTN-0039-S, examined gender differences in the rates and correlates of HIV risk behaviors among 1429 clients participating in five multi-site clinical trials throughout the United States between 2001 and 2005 as part of the National Drug Abuse Treatment Clinical Trials Network (protocols CTN-0001, CTN-0002, CTN-0005, CTN-0006, and CTN-0007). Analyses found that women engaged in higher risk sexual behaviors. Greater alcohol use and psychiatric severity were associated with higher risk behaviors for women, while impaired social relations were associated with decreased risk for men. Specific risk factors were differentially predictive of HIV risk behaviors for women and men, highlighting the need for gender-specific risk-reduction interventions. The findings suggest that there is a context or culture in which HIV risk behaviors occur as well as individual differences in the presence of risk factors associated with engaging in HIV risk behaviors. HIV risk-reduction efforts therefore need to expand beyond condom distribution, needle exchange programs, and basic HIV education in treatment programs to include comprehensive risk assessment and targeted interventions for sub-groups of women and men most vulnerable to HIV infection. Limitations of this study are also discussed. Related protocols: CTN-0039-S

Abstract:

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