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 was a unique opportunity to examine relationships among substance use, depressive symptoms, and sex risk behavior.

Past 6-month substance use; substance use severity (Drug Abuse Screening Test - 10); depressive symptoms (Quick Inventory of Depressive Symptomatology); and three types of sex risk behavior (unprotected sex occasions [USOs] with primary partners; USOs with nonprimary partners; and USOs while high/drunk) were assessed. Zero-inflated negative binomial analyses 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% had 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 (eg, 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.

Sexual risk behavior is common among individuals in outpatient substance abuse treatment. Results highlight problem drinking (eg, up to three-fold) and cocaine (eg, up to twice) in increasing sex risk behavior. They 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.

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By: Tross S1, Feaster DJ, Thorens G, Duan R, Gomez Z, Pavlicova M, Hu MC, Kyle T, Erickson S, Spector A, Haynes L, Metsch LR.

• 1New York State Psychiatric Institute (S.T., M.C.H., A.S.), Columbia University Medical Center, New York, USA; Department of Biostatistics (D.J.F., R.D., Z.G.), Miller School of Medicine, University of Miami, Miami, Florida, USA; Department of Mental Health and Psychiatry (G.T.), University Hospital of Geneva, Geneva, Switzerland; Department of Biostatistics (M.P.), Mailman School of Public Health, Columbia University Medical Center, New York, USA; Center for Drug-Free Living (T.K.), Orlando, Florida, USA; Department of Psychology (S.E.), University of New Mexico, Albuquerque, New Mexico; Medical University of South Carolina (L.H.), Charleston, South Carolina, USA; and Department of Sociomedical Sciences (L.R.M.), Mailman School of Public Health, Columbia University Medical Center, New York, USA.  

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