1
|
Merghati Khoei E, Mohraz M, Mohammadi S, Brady KT, Killeen T, Korte JE, Rezaei Z. Gender differences in sexual risk behaviors among population with substance use disorders, Iran. JOURNAL OF SUBSTANCE USE 2022. [DOI: 10.1080/14659891.2022.2098843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Effat Merghati Khoei
- Iranian National Center for Addiction Studies, Tehran University of Medical Sciences, Tehran, Iran
| | - Minoo Mohraz
- Iranian Research Center for HIV/AIDS, Iranian Institute for Reduction of High-Risk Behaviors, Tehran University of Medical Sciences, Tehran, Iran
| | - Samira Mohammadi
- Health Metrics Research Center, Iranian Institute for Health Sciences Research, ACECR, Tehran, Iran
| | - Kathleen T. Brady
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Therese Killeen
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Jeffrey E. Korte
- Department of Public Health Sciences, School of Medicine, Medical University of South Carolina, South Carolina, USA
| | - Zahed Rezaei
- Social Determinants of Health Research Center, Gonabad University of Medical Science, Gonabad, Iran
| |
Collapse
|
2
|
Latent Classes of Sexual Risk Behavior and Engagement in Outreach, Intervention and Prevention Services Among Women Who Inject Drugs Across 20 US Cities. J Acquir Immune Defic Syndr 2019; 79:305-314. [PMID: 30044301 DOI: 10.1097/qai.0000000000001816] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Monitoring the effects of HIV prevention efforts among persons who inject drugs is key to informing prevention programs and policy. METHODS Data for this study came from the 2012 National HIV Behavioral Surveillance interviews with persons who inject drugs across 20 US cities. The present analyses include those who identified as female, ever had sex with a man, and were at risk of HIV infection (did not report a previous positive HIV test result) (n = 2624). We conducted latent class analysis to identify sexual risk classes, and modeled associations with engagement in HIV prevention services and HIV test results. RESULTS We identified 6 classes of sexual risk behavior: (1) low risk, (2) monogamous, (3) casual partner, (4) multiple partners, (5) exchange sex, and (6) exchange plus main partner. The class distribution was similar across the mainland regions. Bisexual orientation and homelessness were significant predictors of higher-risk class. HIV prevalence and participation in behavioral interventions did not vary significantly by risk class, while obtaining and using free condoms did. Independent of risk class, women in cities in the South were significantly less likely to use free condoms, and HIV prevalence was higher among non-Hispanic black women and women aged 40-49 years. CONCLUSIONS Bisexual orientation and homelessness were predictors of higher risk. Condom distribution programs reached fewer women in cities in the South. Race and age disparities in HIV-positive rates persisted after adjusting for sexual risk class.
Collapse
|
3
|
Noska AJ, Roberts MB, Sufrin C, Stein LAR, Beckwith CG, Rich JD, Dauria EF, Clarke JG. History of Sex Exchange in Women with a History of Incarceration. J Health Care Poor Underserved 2018; 27:149-62. [PMID: 27133516 DOI: 10.1353/hpu.2016.0054] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Sex exchange among incarcerated women is not well-described in the literature. Sex exchange can lead to numerous adverse health outcomes, especially when combined with individual factors (e.g., depression and homelessness) and larger systemic inequalities. The purpose of this study was to explore factors associated with having a history of sex exchange among a sample of incarcerated women. Of 257 women surveyed in this study, 68 women (26.5%) reported a history of sex exchange. In multivariate logistic regression analysis, physical abuse history (p=.05, OR 2.20), history of two or more sexually transmitted infections (p=.01, OR 2.90), injection drug use (p=.04, OR 2.46) and crack-cocaine use (p<.01, OR 3.42) were associated with prior sex exchange. This is one of only two studies to examine factors associated with prior sex exchange among incarcerated women. Our study has important implications for corrections providers to provide more comprehensive care, directly addressing the unique needs of this population.
Collapse
|
4
|
Guimarães RA, de Oliveira Landgraf de Castro V, do Valle Leone de Oliveira SM, Stabile AC, Motta-Castro ARC, dos Santos Carneiro MA, Araujo LA, Caetano KAA, de Matos MA, Teles SA. Gender differences in patterns of drug use and sexual risky behaviour among crack cocaine users in Central Brazil. BMC Psychiatry 2017; 17:412. [PMID: 29282091 PMCID: PMC5745789 DOI: 10.1186/s12888-017-1569-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 12/05/2017] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The aim of this study was to compare sociodemographic characteristics, patterns of drug use, and risky sexual behaviour among female and male users of crack cocaine. METHODS Between 2012 and 2013, we conducted a cross-sectional study of 919 crack cocaine users (783 men and 136 women) in Central Brazil using face-to-face interviews. Blood samples were collected to test for syphilis. The Chi-Square Automatic Interaction Detector (CHAID) was used to explore the differences between genders. We implemented two models: the first model included previous incarceration and variables related to patterns of drug use, and the second model included variables related to sexual risky behaviours and syphilis exposure. RESULTS Women consumed more crack cocaine than men on a regular basis; however, poly-drug use was more common among men. More women than men reported exchanging sex for money and/or drugs and inconsistent condom use during sexual intercourse; women also reported more sexual partners. In addition, the frequency of sexual violence was higher for women than men. A higher proportion of women than men were positive for syphilis (27.2% vs. 9.2%; p < 0.001). The CHAID decision tree analysis identified seven variables that differentiated the genders: previous incarceration, marijuana use, daily crack cocaine consumption, age at first illicit drug use, sexual violence, exchange of sex for money and/or drugs, and syphilis exposure. CONCLUSION Our findings demonstrate a difference in patterns of crack cocaine consumption and sexual risky behaviours between genders, thus indicating a need for gender-specific interventions in this population.
Collapse
Affiliation(s)
- Rafael Alves Guimarães
- 0000 0001 2192 5801grid.411195.9Institute of Tropical Pathology and Public Health, Federal University of Goiás, Goiânia, Goiás Brazil ,0000 0001 2192 5801grid.411195.9Faculty of Nursing, Federal University of Goiás, Goiânia, Goiás Brazil
| | | | | | - Andréa Cristina Stabile
- 0000 0001 2163 5978grid.412352.3Federal University of Mato Grosso do Sul, Campo Grande, Mato Grosso do Sul Brazil
| | - Ana Rita Coimbra Motta-Castro
- 0000 0001 2163 5978grid.412352.3Federal University of Mato Grosso do Sul, Campo Grande, Mato Grosso do Sul Brazil ,0000 0001 0723 0931grid.418068.3Oswaldo Cruz Foundation, Campo Grande, Mato Grosso do Sul Brazil
| | | | - Lyriane Apolinário Araujo
- 0000 0001 2192 5801grid.411195.9Institute of Tropical Pathology and Public Health, Federal University of Goiás, Goiânia, Goiás Brazil
| | | | - Marcos André de Matos
- 0000 0001 2192 5801grid.411195.9Faculty of Nursing, Federal University of Goiás, Goiânia, Goiás Brazil
| | | |
Collapse
|
5
|
Pan Y, Metsch LR, Wang W, Wang KS, Duan R, Kyle TL, Gooden LK, Feaster DJ. Gender Differences in HIV Sexual Risk Behaviors Among Clients of Substance Use Disorder Treatment Programs in the U.S. ARCHIVES OF SEXUAL BEHAVIOR 2017; 46:1151-1158. [PMID: 26892100 PMCID: PMC6261376 DOI: 10.1007/s10508-015-0686-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Revised: 12/15/2015] [Accepted: 12/23/2015] [Indexed: 06/05/2023]
Abstract
This study examined differences in sexual risk behaviors by gender and over time among 1281 patients (777 males and 504 females) from 12 community-based substance use disorder treatment programs throughout the United States participating in CTN-0032, a randomized control trial conducted within the National Drug Abuse Treatment Clinical Trials Network. Zero-inflated negative binomial and negative binomial models were used in the statistical analysis. Results indicated significant reductions in most types of sexual risk behaviors among substance users regardless of the intervention arms. There were also significant gender differences in sexual risk behaviors. Men (compared with women) reported more condomless sex acts with their non-primary partners (IRR = 1.80, 95 % CI 1.21-2.69) and condomless anal sex acts (IRR = 1.74, 95 % CI 1.11-2.72), but fewer condomless sex partners (IRR = 0.87, 95 % CI 0.77-0.99), condomless vaginal sex acts (IRR = 0.83, 95 % CI 0.69-1.00), and condomless sex acts within 2 h of using drugs or alcohol (IRR = 0.70, 95 % CI 0.53-0.90). Gender-specific intervention approaches are called for in substance use disorder treatment.
Collapse
Affiliation(s)
- Yue Pan
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Clinical Research Building, Room 1066, 1120 N.W. 14th St., Miami, FL, 33136, USA.
| | - Lisa R Metsch
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Weize Wang
- Department of Biostatistics, Robert Stempel College of Public Health & Social Work at Florida International University, Miami, FL, USA
| | - Ke-Sheng Wang
- Department of Biostatistics and Epidemiology, College of Public Health, East Tennessee State University, Johnson City, TN, USA
| | - Rui Duan
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Clinical Research Building, Room 1066, 1120 N.W. 14th St., Miami, FL, 33136, USA
| | | | - Lauren K Gooden
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Daniel J Feaster
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Clinical Research Building, Room 1066, 1120 N.W. 14th St., Miami, FL, 33136, USA
| |
Collapse
|
6
|
Saw YM, Saw TN, Wai KM, Poudel KC, Win HH. Correlates of sex trading among male non-injecting drug users in Myanmar: a cross-sectional study. Harm Reduct J 2016; 13:34. [PMID: 27919289 PMCID: PMC5139087 DOI: 10.1186/s12954-016-0123-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Accepted: 11/26/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Sex trading is a recognized risk factor for human immune deficiency virus infection and other sexually transmitted infections among non-injecting drug users (NIDUs). However, very little research has addressed the factors associated with sex trading among male NIDUs in Myanmar. METHODS A cross-sectional study was conducted from January to February 2010 using the respondent-driven sampling method. In total, 210 NIDUs aged between 18 and 49 years, with no history of injecting drug use, and who used non-injected illicit drugs in the last 6 months were recruited. Face-to-face interviews were conducted using a structured questionnaire to collect information on participants' sexual and drug use behaviors. Binary and multivariate logistic regressions were applied to analyze the resulting data. RESULTS Of 210 NIDUs, 84 (40%) reported involvement in the sex trade during the last 3 months. In the adjusted model, factors associated with sex trade involvement included homosexual preference (adjusted odds ratio [AOR] 4.90; 95% confidence interval [CI] 1.61-14.95), having more than two partners (AOR = 3.88; 95% CI 1.55-9.72), had a regular job (AOR = 5.10; 95% CI 1.65-15.72), use of stimulant drugs rather than opiate (AOR = 2.38; 95% CI 1.10-5.15), and who used drugs more than twice per day. CONCLUSIONS More than one third of NIDUs were involved in sex trading. This study suggested that further comprehensive intervention programs that aim to reduce risk factors of trading sex among NIDUs may consider including NIDUs who used stimulant drugs, had regular/full-time jobs, used drugs more than twice per day, and had homosexual preferences.
Collapse
Affiliation(s)
- Yu Mon Saw
- Department of Healthcare Administration, Graduate School of Medicine, Nagoya University, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan. .,Nagoya University Asian Satellite Campuses Institute, Nagoya, Japan.
| | - Thu Nandar Saw
- Myanma Perfect Research, Yangon, Myanmar.,Department of Community and Global Health, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan
| | - Kyi Mar Wai
- Department of Human Ecology, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan
| | - Krishna C Poudel
- Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, MA, USA
| | - Hla Hla Win
- Department of Preventive and Social Medicine, University of Medicine 1, Yangon, Myanmar
| |
Collapse
|
7
|
Feaster DJ, Parish CL, Gooden L, Matheson T, Castellon PC, Duan R, Pan Y, Haynes LF, Schackman BR, Malotte CK, Mandler RN, Colfax GN, Metsch LR. Substance use and STI acquisition: Secondary analysis from the AWARE study. Drug Alcohol Depend 2016; 169:171-179. [PMID: 27837708 PMCID: PMC5140686 DOI: 10.1016/j.drugalcdep.2016.10.027] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 10/17/2016] [Accepted: 10/23/2016] [Indexed: 01/02/2023]
Abstract
OBJECTIVES Sexually transmitted infections (STIs) are significant public health and financial burdens in the United States. This manuscript examines the relationship between substance use and prevalent and incident STIs in HIV-negative adult patients at STI clinics. METHODS A secondary analysis of Project AWARE was performed based on 5012 patients from 9 STI clinics. STIs were assessed by laboratory assay and substance use by self-report. Patterns of substance use were assessed using latent class analysis. The relationship of latent class to STI rates was investigated using Poisson regression by population groups at high risk for STIs defined by participant's and partner's gender. RESULTS Drug use patterns differed by risk group and substance use was related to STI rates with the relationships varying by risk behavior group. Substance use treatment participation was associated with increased STI rates. CONCLUSIONS Substance use focused interventions may be useful in STI clinics to reduce morbidity associated with substance use. Conversely, gender-specific sexual health interventions may be useful in substance use treatment.
Collapse
Affiliation(s)
- Daniel J Feaster
- University of Miami Miller School of Medicine, Department of Public Health Sciences, 1120 NW 14th St., Miami, FL 33136, USA.
| | - Carrigan L Parish
- Columbia University Mailman School of Public Health, Department of Sociomedical Sciences, Miami Research Center, 1120 NW 14th St., Miami, FL 33136, USA.
| | - Lauren Gooden
- Columbia University Mailman School of Public Health, Department of Sociomedical Sciences, Miami Research Center, 1120 NW 14th St., Miami, FL 33136, USA.
| | - Tim Matheson
- San Francisco Department of Public Health, HIV Prevention Section, 25 Van Ness Avenue, San Francisco, CA 94102, USA.
| | - Pedro C Castellon
- Columbia University Mailman School of Public Health, Department of Sociomedical Sciences, Miami Research Center, 1120 NW 14th St., Miami, FL 33136, USA.
| | - Rui Duan
- University of Miami Miller School of Medicine, Department of Public Health Sciences, 1120 NW 14th St., Miami, FL 33136, USA.
| | - Yue Pan
- University of Miami Miller School of Medicine, Department of Public Health Sciences, 1120 NW 14th St., Miami, FL 33136, USA.
| | - Louise F Haynes
- Medical University of South Carolina, Addiction Sciences Division, 67 President Street, Charleston, SC 29425, USA.
| | - Bruce R Schackman
- Weill Cornell Medical College, Department of Healthcare Policy and Research, 425 East 61st St., New York, NY, USA.
| | - C Kevin Malotte
- California State University, Long Beach, Department of Health Sciences, Center for Health Care Innovation, 5500 Atherton St., Long Beach, CA, USA.
| | - Raul N Mandler
- National Institute of Health, National Institute on Drug Abuse, 6000 Executive Boulevard, Rockville, MD 20852, USA.
| | - Grant N Colfax
- San Francisco Department of Public Health, HIV Prevention Section, 25 Van Ness Avenue, San Francisco, CA 94102, USA.
| | - Lisa R Metsch
- Columbia University Mailman School of Public Health, Department of Sociomedical Sciences, 722 W 168th St., 9th Floor, New York, NY 10032, USA.
| |
Collapse
|
8
|
Understanding the effects of different HIV transmission models in individual-based microsimulation of HIV epidemic dynamics in people who inject drugs. Epidemiol Infect 2016; 144:1683-700. [PMID: 26753627 DOI: 10.1017/s0950268815003180] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We investigated how different models of HIV transmission, and assumptions regarding the distribution of unprotected sex and syringe-sharing events ('risk acts'), affect quantitative understanding of HIV transmission process in people who inject drugs (PWID). The individual-based model simulated HIV transmission in a dynamic sexual and injecting network representing New York City. We constructed four HIV transmission models: model 1, constant probabilities; model 2, random number of sexual and parenteral acts; model 3, viral load individual assigned; and model 4, two groups of partnerships (low and high risk). Overall, models with less heterogeneity were more sensitive to changes in numbers risk acts, producing HIV incidence up to four times higher than that empirically observed. Although all models overestimated HIV incidence, micro-simulations with greater heterogeneity in the HIV transmission modelling process produced more robust results and better reproduced empirical epidemic dynamics.
Collapse
|
9
|
Alcohol Use Predicts Number of Sexual Partners for Female but not Male STI Clinic Patients. AIDS Behav 2016; 20 Suppl 1:S52-9. [PMID: 26310596 DOI: 10.1007/s10461-015-1177-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
This study tested the hypothesis that greater alcohol involvement will predict number of sexual partners to a greater extent for women than for men, and that the hypothesized sex-specific, alcohol-sexual partner associations will hold when controlling for alternative sex-linked explanations (i.e., depression and drug use). We recruited 508 patients (46 % female, 67 % African American) from a public sexually transmitted infections (STI) clinic. Participants reported number of sexual partners, drinks per week, maximum drinks per day, frequency of heavy drinking; they also completed the AUDIT-C and a measure of alcohol problems. As expected, men reported more drinking and sexual partners. Also as expected, the association between alcohol use and number of partners was significant for women but not for men, and these associations were not explained by drug use or depression. A comprehensive prevention strategy for women attending STI clinics might include alcohol use reduction.
Collapse
|
10
|
Lewis CF, Rivera AV, Crawford ND, Gordon K, White K, Vlahov D, Galea S. Individual and Neighborhood Characteristics Associated with HIV Among Black and Latino Adults Who Use Drugs and Unaware of Their HIV-Positive Status, New York City, 2000-2004. J Racial Ethn Health Disparities 2015; 3:573-581. [PMID: 27294761 DOI: 10.1007/s40615-015-0176-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 10/05/2015] [Accepted: 10/07/2015] [Indexed: 11/24/2022]
Abstract
With mounting evidence of how neighborhood socioeconomic context influences individual behavior, investigation of neighborhood social context and sex/drug use risk behavior could help explain and provide insight into solutions to solve persistent racial disparities in HIV. Interviewer-administered surveys and HIV testing among street-recruited individuals who reported illicit drug use in New York City were conducted from 2000 to 2004. Individuals were geocoded to census tracts, and generalized estimating equations were used to determine correlates of being newly diagnosed with HIV at study enrollment. Analyses were completed in 2014. Of the 920 participants, 10.5 % were HIV-positive, and among those, 45 % were diagnosed at study enrollment. After restricting the sample to those who self-reported negative HIV status (n = 867), 72 % were male, 65 % Latino, and 5.1 % tested HIV-positive. After adjustment, those testing HIV-positive were more likely to report male same-sex partnership (p < 0.01) and less likely to be homeless compared with those confirmed HIV-negative (p < 0.01). Neighborhood-adjusted models indicated those from neighborhoods with less deprivation (p < 0.05), and a higher proportion of owner-occupied homes (p < 0.01) were more likely to test HIV-positive. Additionally, Black individuals who used drugs and were from neighborhoods with a higher proportion of Black residents were more likely to be newly diagnosed compared to Latino individuals who used drugs and were from neighborhoods with lower proportions of Black residents (p < 0.05). These data suggest that HIV prevention and treatment efforts should continue widening its reach to those unaware of their HIV infection, namely men who have sex with men, heavy, drug-involved Black communities, and both Black and Latino communities from relatively less disadvantaged neighborhoods.
Collapse
Affiliation(s)
- Crystal Fuller Lewis
- Division of Social Solutions and Services Research, Nathan Kline Institute for Psychiatric Research, State of New York Office of Mental Health, 140 Orangeburg Road, Bldg. #35, N202, Orangeburg, NY, 10962, USA. .,Department of Psychiatry, New York University School of Medicine, New York, NY, USA.
| | - Alexis V Rivera
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Natalie D Crawford
- Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Kirsha Gordon
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Kellee White
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - David Vlahov
- School of Nursing, University of California, San Francisco, CA, USA
| | - Sandro Galea
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| |
Collapse
|
11
|
Iversen J, Dolan K, Ezard N, Maher L. HIV and Hepatitis C Virus Infection and Risk Behaviors Among Heterosexual, Bisexual, and Lesbian Women Who Inject Drugs in Australia. LGBT Health 2015; 2:127-34. [PMID: 26790118 DOI: 10.1089/lgbt.2014.0116] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
PURPOSE Women who inject drugs (WWID) are vulnerable to a range of harms, including exposure to sexually transmitted and blood-borne infections, abusive relationships, physical and sexual violence and mental health issues. Lesbians and bisexual women are at greater risk than heterosexual women for substance use disorders. This study aimed to compare a large sample of heterosexual, bisexual, and lesbian WWID and to identify correlates of sexual orientation. METHODS The Australian Needle and Syringe Program (NSP) Survey is an annual cross-sectional survey. People who inject drugs (PWID) who attend NSP services are invited to complete a brief self-administered questionnaire and provide a capillary dried blood spot. Of 22,791 survey respondents between 2004-2013, one third were women (n=7,604). Analyses were restricted to the first participation record for each respondent. RESULTS Of the 5,378 individual women, 4,073 (76%) identified as heterosexual, 1,007 (19%) identified as bisexual, and 298 (6%) identified as lesbian. HIV prevalence was low (<1.0%). More than half (56%) had been exposed to hepatitis C virus (HCV), with prevalence highest among bisexual women (59%). In adjusted analysis, bisexual women had significantly greater odds of initiating injection at a younger age (AOR 1.44, 95% CI 1.19-1.73), and reporting public injection (AOR 1.44, 95% CI 1.21-1.73) and receptive sharing of drug preparation equipment (AOR 1.20, 95% CI 1.00-1.44). Bisexual women (AOR 1.42, 95% CI 1.07-1.88) and lesbians (AOR 1.63, 95% CI 1.10-2.44) had significantly greater odds of reporting sex work than their heterosexual counterparts. CONCLUSION Results contribute to the literature on HIV and HCV transmission risk among WWID. Analysis of the relationship between sexual orientation and risk behavior identified bisexual orientation as independently associated with increased risk. Services that target PWID need to recognise and address a broad range of sexual identities and behaviors. Future research should explore reasons for increased risk in sexual minority women.
Collapse
Affiliation(s)
- Jenny Iversen
- 1 Viral Hepatitis Epidemiology and Prevention Program, The Kirby Institute, Faculty of Medicine, University of New South Wales Australia , Sydney, Australia
| | - Kate Dolan
- 2 Program of International Research and Training, National Drug and Alcohol Research Centre, University of New South Wales Australia , Sydney, Australia
| | - Nadine Ezard
- 3 Alcohol and Drug Service, St. Vincent's Hospital , Sydney, Australia .,4 Faculty of Medicine, University of New South Wales Australia , Sydney, Australia
| | - Lisa Maher
- 1 Viral Hepatitis Epidemiology and Prevention Program, The Kirby Institute, Faculty of Medicine, University of New South Wales Australia , Sydney, Australia
| |
Collapse
|
12
|
Calsyn DA, Peavy M, Wells EA, Campbell ANC, Hatch-Maillette MA, Greenfield SF, Tross S. Differences between men and women in condom use, attitudes, and skills in substance abuse treatment seekers. Am J Addict 2013; 22:150-7. [PMID: 23414501 DOI: 10.1111/j.1521-0391.2013.00312.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2012] [Revised: 03/05/2012] [Accepted: 03/12/2012] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND For substance abuse treatment-seekers engaging in high risk sexual behavior, their inconsistent condom use may be related to their condom use attitudes and skills. OBJECTIVE This study compared treatment-seeking male and female substance abusers in their reported barriers to condom use and condom use skills. METHODS Men and women (N = 1,105) enrolled in two multi-site HIV risk reduction studies were administered the Condom Barriers Scale, Condom Use Skills, and an audio computer-assisted structured interview assessing sexual risk behavior. RESULTS Men endorsed more barriers to condom use, especially on the Effects on Sexual Experience factor. For both men and women, stronger endorsement of barriers to condom use was associated with less use of condoms. However, the difference between condom users and non-users in endorsement of condom barriers in general is greater for men than women, especially for those who report having casual partners. CONCLUSIONS Findings support the need to focus on gender-specific barriers to condom use in HIV/STI prevention interventions, especially risk behavior intervention techniques that address sexual experience with condoms. SCIENTIFIC SIGNIFICANCE Results provide additional information about the treatment and prevention needs of treatment-seeking men and women.
Collapse
Affiliation(s)
- Donald A Calsyn
- Alcohol and Drug Abuse Institute, University of Washington, Seattle, WA 98105, USA.
| | | | | | | | | | | | | |
Collapse
|
13
|
Vasquez C, Lioznov D, Nikolaenko S, Yatsishin S, Lesnikova D, Cox D, Pankovich J, Rosenes R, Wobeser W, Cooper, on behalf of the St. Peters C. Gender disparities in HIV risk behavior and access to health care in St. Petersburg, Russia. AIDS Patient Care STDS 2013; 27:304-10. [PMID: 23651108 DOI: 10.1089/apc.2013.0019] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Over 40,000 HIV-infected individuals live in St Petersburg, Russia. Population characteristics and barriers to care are largely undefined. 152 consecutive patients receiving HIV care at two sites completed a questionnaire in Spring 2011. Rates of chronic hepatitis C virus (HCV) and hepatitis B virus (HBV) infection, alcohol use, and rates of antiretroviral uptake were similar by gender. Males reported a higher history of injection drug use (80.3% vs. 48.7%; p<0.01) and tuberculosis infection (18.8% vs. 1.6%; p<0.01). Females were more likely to have had a child (63.3% vs. 31.5%; p<0.01) and be currently raising that child within their residence (49.3% vs. 15.3%; p<0.01). Unprotected sex (60.5% vs. 17.8%; p<0.01) and a history of sexually transmitted infection (37.7% vs. 20.3%; p=0.03) were more common in females. Females utilized social services more frequently (34.2% vs. 11.9%; p<0.01). There is a heavy burden of concurrent infectious disease, substance use and abuse, mental health illness, and need for social service support in this population. Important differences exist between genders in service uptake and utilization. Further evaluation of these differences may help inform the allocation of limited resources in this high HIV prevalence region of Russia.
Collapse
Affiliation(s)
| | | | | | - Sergey Yatsishin
- St. Petersburg Branch of Russian Red Cross, St. Petersburg, Russia
| | - Darya Lesnikova
- St. Petersburg Branch of Russian Red Cross, St. Petersburg, Russia
| | - David Cox
- CIHR Canadian HIV Trials Network, Vancouver, British Columbia, Canada
| | - Jim Pankovich
- CIHR Canadian HIV Trials Network, Vancouver, British Columbia, Canada
| | - Ron Rosenes
- CIHR Canadian HIV Trials Network, Vancouver, British Columbia, Canada
- CTN Community Advisory Committee, Toronto, Ontario, Canada
| | - Wendy Wobeser
- CIHR Canadian HIV Trials Network, Vancouver, British Columbia, Canada
- Queen's University, Kingston, Ontario, Canada
| | | |
Collapse
|
14
|
Folch C, Casabona J, Espelt A, Majó X, Meroño M, Gonzalez V, Brugal MT. Gender differences in HIV risk behaviours among intravenous drug users in Catalonia, Spain. GACETA SANITARIA 2013; 27:338-43. [PMID: 23578527 DOI: 10.1016/j.gaceta.2013.02.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Revised: 02/14/2013] [Accepted: 02/20/2013] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To describe gender differences in injection and sexual risks behaviours, and human immunodeficiency virus (HIV) and hepatitis C (HCV) prevalence among injecting drug users (IDU) in Catalonia, Spain. METHODS Cross-sectional studies in 2008-2009 (n=748) and 2010-2011 (n=597) in the network of harm reduction centres. Face to face interviews were conducted and oral fluid samples were collected to estimate HIV/HCV prevalence. RESULTS Female were more likely than male IDU to have had a steady sexual partner (68.2% versus 44.9%), to have had an IDU steady sexual partner (46.6% versus 15.1%) and to have exchanged sex for money or drugs in the last 6 months (25.5% versus 2.3%). There were no gender differences in injecting risk behaviours. HIV prevalence was 38.7% (91/235) in women and 31.5% (347/1103) in men (p=0.031). HIV prevalence among female IDU who reported having exchange sex for money or drugs was 53.3% (32/60). The prevalence of HCV was 67.4% (159/236) and 73.6% (810/1101) in female and male IDU, respectively (p=0.053). After adjustment by immigrant status, age and years of injection, differences among HIV/HCV prevalence by gender were not significant. CONCLUSIONS This study demonstrated differences in sexual risk behaviours between male and female IDU, but failed to find gender differences in injecting risk behaviours. Apart from that, the higher prevalence of HIV among women than among men, together with a lower prevalence of HCV, provides evidence that sexual transmission of HIV is important among female IDU. Additional studies are needed to analyze in-depth these specific risk factors for women in order to develop appropriate prevention and health education programs.
Collapse
Affiliation(s)
- Cinta Folch
- Centre d'Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya CEEISCAT, Institut català d'Oncologia ICO, Agència de Salut Pública de Catalunya ASPC, Generalitat de Catalunya, Badalona, Barcelona, Spain.
| | | | | | | | | | | | | | | |
Collapse
|
15
|
Magnus M, Kuo I, Phillips G, Rawls A, Peterson J, Montanez L, West-Ojo T, Jia Y, Opoku J, Kamanu-Elias N, Hamilton F, Wood A, Greenberg AE. Differing HIV risks and prevention needs among men and women injection drug users (IDU) in the District of Columbia. J Urban Health 2013; 90:157-66. [PMID: 22692841 PMCID: PMC3579300 DOI: 10.1007/s11524-012-9687-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Washington, DC has among the highest HIV/AIDS rates in the US. Gender differences among injection drug users (IDUs) may be associated with adoption of prevention opportunities including needle exchange programs, HIV testing, psychosocial support, and prevention programming. National HIV Behavioral Surveillance data on current IDUs aged ≥18 were collected from 8/09 to 11/09 via respondent-driven sampling in Washington, DC. HIV status was assessed using oral OraQuick with Western Blot confirmation. Weighted estimates were derived using RDSAT. Stata was used to characterize the sample and differences between male and female IDU, using uni-, bi-, and multivariable methods. Factors associated with HIV risk differed between men and women. Men were more likely than women to have had a history of incarceration (86.6 % vs. 66.8 %, p < 0.01). Women were more likely than men to have depressive symptoms (73.9 % vs. 47.4 %, p < 0.01), to have been physically or emotionally abused (66.1 % vs. 16.1 %, p < 0.0001), to report childhood sexual abuse (42.7 % vs. 4.7 %, p < 0.0001), and pressured or forced to have sex (62.8 % vs. 4.0 %, p < 0.0001); each of these differences was significant in the multivariable analysis. Despite a decreasing HIV/AIDS epidemic among IDU, there remain significant gender differences with women experiencing multiple threats to psychosocial health, which may in turn affect HIV testing, access, care, and drug use. Diverging needs by gender are critical to consider when implementing HIV prevention strategies.
Collapse
Affiliation(s)
- Manya Magnus
- Department of Epidemiology and Biostatistics, The George Washington University School of Public Health and Health Services, Washington DC, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
16
|
Pinkham S, Stoicescu C, Myers B. Developing effective health interventions for women who inject drugs: key areas and recommendations for program development and policy. Adv Prev Med 2012; 2012:269123. [PMID: 23198158 PMCID: PMC3501794 DOI: 10.1155/2012/269123] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2012] [Accepted: 09/14/2012] [Indexed: 11/23/2022] Open
Abstract
Women who inject drugs face multiple gender-specific health risks and barriers to healthcare access. These gendered factors may contribute to elevated rates of HIV for this population. Though few countries systematically collect gender-disaggregated data related to injecting drug use, evidence indicates that there are large populations of women who inject drugs and who are in need of improved health services, including HIV prevention. Research on the effectiveness of interventions specifically tailored for women who inject drugs, along with the experience of programs working with this subpopulation, suggests that HIV risk practices need to be addressed within the larger context of women's lives. Multifaceted interventions that address relationship dynamics, housing, employment, and the needs of children may have more success in reducing risky practices than interventions that focus exclusively on injecting practices and condom use. Improved sexual and reproductive healthcare for women who use drugs is an area in need of development and should be better integrated into basic harm reduction programs.
Collapse
Affiliation(s)
- Sophie Pinkham
- Department of Slavic Languages, Columbia University, 1130 Amsterdam Avenue, Mail Code 2839, New York, NY 10027, USA
| | - Claudia Stoicescu
- Public Health Policy, Harm Reduction International, Unit 2D12 South Bank Technopark, 90 London Road, London SE1 6LN, UK
- Department of Social Policy and Intervention, University of Oxford, Barnett House, 32 Wellington Square, Oxford OX1 2ER, UK
| | - Bronwyn Myers
- Alcohol and Drug Abuse Research Unit, South African Medical Research Council, P.O. Box 19070, Tygerberg 7505, South Africa
- Department of Psychiatry and Mental Health, University of Cape Town, Faculty of Health Sciences Private Bag, Observatory, Cape Town 7935, South Africa
| |
Collapse
|
17
|
Marshall BDL, Paczkowski MM, Seemann L, Tempalski B, Pouget ER, Galea S, Friedman SR. A complex systems approach to evaluate HIV prevention in metropolitan areas: preliminary implications for combination intervention strategies. PLoS One 2012; 7:e44833. [PMID: 23028637 PMCID: PMC3441492 DOI: 10.1371/journal.pone.0044833] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2012] [Accepted: 08/09/2012] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND HIV transmission among injecting and non-injecting drug users (IDU, NIDU) is a significant public health problem. Continuing propagation in endemic settings and emerging regional outbreaks have indicated the need for comprehensive and coordinated HIV prevention. We describe the development of a conceptual framework and calibration of an agent-based model (ABM) to examine how combinations of interventions may reduce and potentially eliminate HIV transmission among drug-using populations. METHODOLOGY/PRINCIPAL FINDINGS A multidisciplinary team of researchers from epidemiology, sociology, geography, and mathematics developed a conceptual framework based on prior ethnographic and epidemiologic research. An ABM was constructed and calibrated through an iterative design and verification process. In the model, "agents" represent IDU, NIDU, and non-drug users who interact with each other and within risk networks, engaging in sexual and, for IDUs, injection-related risk behavior over time. Agents also interact with simulated HIV prevention interventions (e.g., syringe exchange programs, substance abuse treatment, HIV testing) and initiate antiretroviral treatment (ART) in a stochastic manner. The model was constructed to represent the New York metropolitan statistical area (MSA) population, and calibrated by comparing output trajectories for various outcomes (e.g., IDU/NIDU prevalence, HIV prevalence and incidence) against previously validated MSA-level data. The model closely approximated HIV trajectories in IDU and NIDU observed in New York City between 1992 and 2002, including a linear decrease in HIV prevalence among IDUs. Exploratory results are consistent with empirical studies demonstrating that the effectiveness of a combination of interventions, including syringe exchange expansion and ART provision, dramatically reduced HIV prevalence among IDUs during this time period. CONCLUSIONS/SIGNIFICANCE Complex systems models of adaptive HIV transmission dynamics can be used to identify potential collective benefits of hypothetical combination prevention interventions. Future work will seek to inform novel strategies that may lead to more effective and equitable HIV prevention strategies for drug-using populations.
Collapse
Affiliation(s)
- Brandon D L Marshall
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York, United States of America.
| | | | | | | | | | | | | |
Collapse
|
18
|
Kuo I, Greenberg AE, Magnus M, Phillips G, Rawls A, Peterson J, Hamilton F, West-Ojo T, Hader S. High prevalence of substance use among heterosexuals living in communities with high rates of AIDS and poverty in Washington, DC. Drug Alcohol Depend 2011; 117:139-44. [PMID: 21316871 DOI: 10.1016/j.drugalcdep.2011.01.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2010] [Revised: 01/13/2011] [Accepted: 01/15/2011] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To assess the prevalence and patterns of substance use, HIV prevalence, and sexual risk behaviors in a community-based sample of heterosexuals recruited from areas at high risk for HIV/AIDS and poverty in Washington, DC. METHODS Community-recruited heterosexuals aged 18-50 from areas of high AIDS and poverty rates in DC were analyzed. Based on past 12 months use, participants were hierarchically classified into five groups: (1) ever injection drug use (IDU); (2) non-injection crack; (3) non-injection heroin and cocaine; (4) marijuana; and (5) no drug use. Sexual behaviors and HIV serology were also assessed. RESULTS Of 862 participants, 40% were men, most were Black and unemployed, and more than half had ever been incarcerated. Prevalence of past year substance use was high: binge drinking (59%); marijuana (50%); non-injection crack (28%); heroin and/or cocaine injection (28%), non-injection cocaine (13%); and ecstasy (13%). In the hierarchical classification, 25% were ever IDU, 15% non-injection crack users, 2% non-injection heroin and/or cocaine users, 31% marijuana users, and 27% reported no drug use. Overall HIV seroprevalence was 5.7% and differed by drug use group-9.5%, 11.1%, 1.8%, 1.6%, and 3.2%, respectively. Nearly half reported having ≥3 sex partners in the past year; 20% reported exchange partners, and 69% had concurrent sex partners. CONCLUSION Estimated prevalence of substance use in this heterosexual population was high. HIV prevalence among IDUs and non-injection crack users was higher than the estimated population prevalence in Washington, DC. Sexual behaviors above and beyond drug use are likely to be driving HIV transmission.
Collapse
Affiliation(s)
- Irene Kuo
- The George Washington University, School of Public Health and Health Services, Department of Epidemiology and Biostatistics, Washington, DC 20037, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
19
|
Cavanaugh CE, Floyd LJ, Penniman TV, Hulbert A, Gaydos C, Latimer WW. Examining racial/ethnic disparities in sexually transmitted diseases among recent heroin-using and cocaine-using women. J Womens Health (Larchmt) 2011; 20:197-205. [PMID: 21314446 DOI: 10.1089/jwh.2010.2140] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND This study examined racial differences in the prevalence of sexual risk behaviors and their associations with sexually transmitted diseases (STDs) among recent heroin-using and cocaine-using women. METHODS Participants were 214 women (59% black, 41% white) who were recruited during 2002-2010 using targeted sampling to participate in a study in Baltimore, Maryland, and reported using heroin, cocaine, or crack during the previous 6 months. Participants completed self-report questionnaires about their drug use, sexual risk behaviors, and lifetime history of one of six STDs, including gonorrhea, syphilis, chlamydia, genital herpes, genital warts, or trichomoniasis. RESULTS More black women (50%) than white women (28%) reported a lifetime STD. Although there were no racial differences in the lifetime prevalence of sexual risk behaviors assessed, there were racial differences in the sexual behaviors associated with ever having a lifetime STD. Simple logistic regressions revealed that ever having a casual sex partner or anal sex were correlates of having a lifetime STD among black women but not among white women. Multiple logistic regression analyses revealed that ever having a casual sex partner was significantly associated with having a lifetime STD among black women, and ever trading sex for money was significantly associated with having a lifetime STD among white women. CONCLUSIONS Findings are consistent with national studies and elucidate racial disparities in STDs and associated sexual behaviors among recent heroin-using and cocaine-using women. Findings underscore the need to tailor STD prevention interventions differently for black and white recent heroin-using and cocaine-using women.
Collapse
|
20
|
Amesty S, Rivera AV, Fuller CM. Overview of HIV among injection drug users in New York City: critical next steps to eliminate racial/ethnic disparities. Subst Use Misuse 2011; 46:285-94. [PMID: 21303248 PMCID: PMC3666177 DOI: 10.3109/10826084.2011.523287] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
At the start of the HIV epidemic, 50% of new infections were among injection drug users (IDUs) in New York City. While HIV has declined among IDUs since the mid-1990s, parenteral transmission continues to overburden Blacks/Hispanic IDUs. Individual risk behaviors do not explain the distribution of HIV/AIDS among IDUs. Social and/or structural factors are likely fueling racial disparities creating a high-risk socioenvironmental context. While increased access to structural interventions (i.e., syringe exchange and pharmacy syringe access) is needed, it may not be sufficient to eliminate HIV/AIDS disparities among IDUs. Research on incorporating structural factors into intervention strategies is needed.
Collapse
Affiliation(s)
- Silvia Amesty
- Center for Family and Community Medicine, College of Physicians and Surgeons, Columbia University, New York, New York 10032, USA
| | | | | |
Collapse
|
21
|
Brooks A, Meade CS, Potter JS, Lokhnygina Y, Calsyn DA, Greenfield SF. Gender differences in the rates and correlates of HIV risk behaviors among drug abusers. Subst Use Misuse 2010; 45:2444-69. [PMID: 20536356 PMCID: PMC3169437 DOI: 10.3109/10826084.2010.490928] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
This study examined gender differences in the rates and correlates of HIV risk behaviors among 1,429 clients participating in multi-site trials throughout the United States between 2001 and 2005 as part of the National Institute on Drug Abuse-funded Clinical Trials Network. 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. Limitations of the study are discussed.
Collapse
Affiliation(s)
- Audrey Brooks
- Department of Psychology, University of Arizona, Tucson, AZ 85721, USA.
| | | | | | | | | | | |
Collapse
|
22
|
Meade CS, Weiss RD, Fitzmaurice GM, Poole SA, Subramaniam GA, Patkar AA, Connery HS, Woody GE. HIV risk behavior in treatment-seeking opioid-dependent youth: results from a NIDA clinical trials network multisite study. J Acquir Immune Defic Syndr 2010; 55:65-72. [PMID: 20393347 PMCID: PMC3148945 DOI: 10.1097/qai.0b013e3181d916db] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess baseline rates of and changes in HIV drug and sexual risk behavior as a function of gender and treatment in opioid-dependent youth. METHODS One hundred fifty participants were randomly assigned to extended buprenorphine/naloxone therapy (BUP) for 12 weeks or detoxification for 2 weeks; all received drug counseling for 12 weeks. HIV risk was assessed at baseline and 4-week, 8-week, and 12-week follow-ups. Behavioral change was examined using generalized estimating equations. RESULTS Baseline rates of past-month HIV risk for females/males were 51%/45% for injection drug use (IDU) (ns), 77%/35% for injection risk (P < 0.001), 82%/74% for sexual activity (ns), 14%/24% for multiple partners (ns), and 68%/65% for unprotected intercourse (ns). IDU decreased over time (P < 0.001), with greater decreases in BUP versus detoxification (P < 0.001) and females versus males in BUP (P < 0.05). Injection risk did not change for persistent injectors. Sexual activity decreased in both genders and conditions (P < 0.01), but sexual risk did not. CONCLUSIONS Overall, IDU and sexual activity decreased markedly, particularly in BUP patients and females, but injection and sexual risk behaviors persisted. Although extended BUP seems to have favorable effects on HIV risk behavior in opioid-dependent youth, risk reduction counseling may be necessary to extend its benefits.
Collapse
Affiliation(s)
- Christina S Meade
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA.
| | | | | | | | | | | | | | | |
Collapse
|
23
|
Gyarmathy VA, Neaigus A. The relationship of sexual dyad and personal network characteristics and individual attributes to unprotected sex among young injecting drug users. AIDS Behav 2009; 13:196-206. [PMID: 17690975 PMCID: PMC2651987 DOI: 10.1007/s10461-007-9285-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2006] [Accepted: 07/16/2007] [Indexed: 10/23/2022]
Abstract
We examine in the heterosexual partnerships (dyads) of IDUs the correlates of engaging in unprotected sex on three levels: individual attributes, social network characteristics, and dyad characteristics. Unprotected sex was significantly less likely to occur in dyads where the participant injected daily or had high safe-sex attitude scores, and in dyads where both members encouraged each other to use condoms. Unprotected sex was significantly more likely to occur in dyads that smoked crack together, shared needles with each other, and where the participant knew that the sex partner had concurrent sex partners. In the sexual dyads of IDUs there is a combined risk of unsafe injecting and unsafe sex. Both injecting and sexual risk, and their combination need to be addressed in interventions that target the sexual partnerships of IDUs. Such interventions should also aim to reduce injected and non-injected crack and other stimulant use associated with high-risk sex.
Collapse
Affiliation(s)
- V Anna Gyarmathy
- National Development and Research Institutes, Inc., 71 W 23rd St., 8th Floor, New York, NY 10010, USA.
| | | |
Collapse
|
24
|
Schumacher CM, Go VF, Nam LV, Latkin CA, Bergenstrom A, Celentano DD, Quan VM. Social injecting and other correlates of high-risk sexual activity among injecting drug users in northern Vietnam. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2008; 20:352-6. [PMID: 19010656 DOI: 10.1016/j.drugpo.2008.09.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2008] [Revised: 09/02/2008] [Accepted: 09/08/2008] [Indexed: 11/17/2022]
Abstract
BACKGROUND Sexual risk and STDs are relatively high among injecting drug users (IDUs) in Vietnam. We sought to determine characteristics of sexually active IDUs and correlates of high-risk sexual practices among IDUs in Bac Ninh province in northern Vietnam. METHODS We used data collected for a community-based cross-sectional pilot study to identify correlates of recent high-risk sex (>1 sex partner and inconsistent/no condom use in the past year). Factors associated with high-risk sex were identified using logistic regression. RESULTS Among 216 sexually active male IDUs, one third (n=72) had engaged in high-risk sex within the last year. IDUs who reported injecting with others more frequently, having someone else inject their drugs at last injection, sharing needles or sharing any injection equipment were more likely to have reported recent high-risk sex. Factors independently associated with high-risk sexual activity were not injecting oneself [AOR: 2.22; 95% CI (1.09-4.51)], and sharing needles in the past 12 months [AOR: 2.57; 95% CI (1.10-5.99)]. CONCLUSIONS IDUs who inject socially and IDUs who share needles are likely to engage in high-risk sexual behaviours and may serve as an important bridge group for epidemic HIV transmission in Vietnam. In addition to messages regarding the dangers of sharing needles and other injection equipment, preventive interventions among newly initiated IDUs should also focus on reducing sexual risk.
Collapse
Affiliation(s)
- Christina M Schumacher
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA
| | | | | | | | | | | | | |
Collapse
|
25
|
Abstract
Gender shapes the experience of drug use and its associated risks. In most parts of the world, however, harm reduction and drug treatment programmes that tailor their services to meet women's needs are rare or nonexistent. Many existing services inadvertently exclude women, and discriminatory policies and social stigma drive women drug users from care and expose them to human rights abuses. Women drug users often provide sex in exchange for housing, sustenance and protection, suffer violence from sexual partners and practise unsafe sex. This paper, drawing upon evidence from existing studies, examines ways in which gender-related factors can increase women drug users' vulnerability and decrease their access to harm reduction, drug treatment and sexual and reproductive health services. It recommends designing services with low-threshold access for women drug users that help them to become more independent, involving the women in designing services and policies, making programmes available for mothers, incorporating sexual and reproductive health into harm reduction services, providing gender-sensitive drug treatment and integrated harm reduction programmes for drug-using sex workers, connecting with domestic violence and rape prevention services and educating mainstream providers. Overall, investigating the circumstances women drug users face will help to formulate policies and programmes that better serve women who use drugs.
Collapse
|
26
|
Weiss ML, Chitwood DD, Sánchez J. Religiosity, Drug Use, and HIV-Related Risk Behaviors among Heroin Injectors. JOURNAL OF DRUG ISSUES 2008. [DOI: 10.1177/002204260803800311] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The association between religiosity and reduced alcohol and drug use in the general population is commonly recognized, but research about the relationship between religiosity and drug-related risk behaviors among illicit drug users has received considerably less attention. This study explores the role of religiosity in explaining heavy polydrug use and other HIV-related risk behaviors among a tri-ethnic sample of 600 male and female active heroin injectors who were recruited from the streets of Miami-Dade County Florida. The effects of three dimensions of religiosity on heavy alcohol use, daily crack-cocaine use, and five HIV-related injection and sex risk behaviors were assessed using multivariate logistic regression techniques that controlled for demographics and self-reported HIV serostatus. The majority of heroin injectors reported some degree of religiosity as expressed by religious intentionality, worship attendance, and religious self-perception. Strong religious intentionality was associated with a decreased likelihood of reusing needles/syringes, but the regression results suggest that religiosity for the most part did not influence heavy polydrug use or other HIV-related risk behaviors of active heroin injectors.
Collapse
|