Transcript Young Adult Ecstasy Users and Multiple Sex Partners

Factors Associated with Condom Use among
Young Adult Ecstasy Users
Hugh Klein, Ph.D.
Emory University & Georgia State University
Claire E. Sterk, Ph.D.
Emory University
Kirk W. Elifson, Ph.D.
Georgia State University
This research was supported by a grant from the National
Institute on Drug Abuse (R01-DA014232).
Background
• Historically, Ecstasy (MDMA) use has been
linked with teenagers and the rave scene, and
the gay male population.
– Recent data suggest that Ecstasy use has moved
beyond these populations and has become more
popular among young adults.
• Our research sample differs from others in that
– it is based on recurrent Ecstasy users,
– it includes mostly people who were not gay male and
not adolescent, and
– it contains one of the “highest end” Ecstasy user
populations we have seen anywhere in the literature.
Background – 2
• Only recently have the risks associated
with the use of this drug been studied,
and typically only within the adolescent
and gay male populations.
• These risks include (among others) sleep
disorders, mood disorders, and increased
risk for HIV.
Purpose
• To identify the prevalence of unprotected
sex in a sample of young adult Ecstasy
users
• To examine the predictors of engaging in
more/less condom use among members
of this population
Methods – 1
• Atlanta metropolitan area
• August 2002 through August 2004
• 18-25 year olds
• Ecstasy use on at least 3 different days during
the past 90 days  to ensure recurrent versus
experimental users
• N = 283  58 persons were not sexually active
during the preceding month, and are excluded
Methods – 2
• Community Identification Process
– used to identify recruitment communities . . .
based on social indicators, economic
indicators, and local experts with knowledge
about locating pockets of Ecstasy users
• Targeted sampling
– to attain broadest representation possible of
varied communities of Ecstasy users
• Street outreach (75%)
– to identify specific persons to participate in
study
Methods – 3
• Passive outreach (25%)
– To identify Ecstasy users who otherwise
might be unfindable using traditional
outreach
– Signs posted in colleges, coffee shops, local
clubs, on the street
• Face-to-face interviews with CASI  ~2 hours
• $25 compensation
Dependent Variable
• Total proportion of all sex acts during the
previous 30 days involving the use of condoms
– Based on vaginal sex, oral sex, and anal sex
– Based on main/steady partner(s), casual
partner(s), and persons known for less than
24 hours
Independent Variables / Predictors – 1
• Demographic Variables
– Gender
– Age (continuous)
– Race (White / not, African American / not)
– Educational attainment (continuous)
– Religiosity (scale, α = .75)
– Marital status (single / not, “involved” / not)
– Income (continuous)
– Sexual orientation (heterosexual / not)
Independent Variables / Predictors – 2
• Background and Experiences Measures
– HIV testing history (ever / never tested)
– Mental health diagnosis (yes / no)
– Number of HIV+ persons known
– Number of persons with AIDS known
– Number of people who died from AIDS known
Independent Variables / Predictors – 3
• Substance Use/Abuse-Related Items
– Living with any substance abusers (yes / no)
– Number of alcohol problems (scale, α = .83)
– Amount of illegal drug use during past month
(Q-F measure, summed for 13 drug types)
– Ever binged on Ecstasy (yes / no)
– Doing things to enhance effects of Ecstasy
(scale, α = .77)
– Drug treatment history (ever / never)
Independent Variables / Predictors – 4
• Sexual and Relationship Characteristics
– Condom use self-efficacy (scale, α = .80)
– Multiple sex partners in past month (yes / no)
– Supportiveness of main partner (scale, α =
.88)
– Number of sex partners in past month
(continuous)
Analysis – 1
• Initial testing of bivariate relationships
between predictor measures and condom
use.
– Simple regression when predictor was a
continuous measure
– Student’s t tests when predictor was a
dichotomous measure
– Analysis of variance when predictor
variable was categorical in nature
Analysis – 2
• Items found to be significant (p<.05) or
marginally-significant (.10>p>.05) in the
bivariate analyses were entered into
multivariate equation.
• Only significant predictors were retained in the
final “best fit” equation.
• Forward selection and backward elimination
procedures were checked; same results
obtained regardless of order of entry of items.
Sample
• Male = 72%, Female = 28%
• Caucasian = 53%, African American = 37%
• Less than high school = 24%, Some college =
40%
• Unemployed = 23%, Full-time employed = 25%,
Part-time employed = 31%
• Single = 45%, “Involved” = 53%
Results – 1
• Overall, only 35.1% of all sexual acts
during the preceding month involved the
use of protection.
• Very few people (14.5%) said that all of
their sexual activity was protected.
• Considerably more (38.2%) said that they
did not use condoms for any of their
sexual activity.
Results – 2
• Sexual protection rates were greater for people
who were not involved with someone than they
were for those who were (49.8% vs 27.8%,
p<.0001).
• Even among persons who were not involved in
a relationship, condom use averaged less than
half the time!
Results – 3
• Sexual protection rates also differed
greatly based on partner type, but were
relatively low for all partner types:
– Main partner – 19.9% protected
• 61.3% never used condoms
• 7.6% always used condoms
– Casual partner – 50.3% protected
• 20.9% never used condoms
• 22.6% always used condoms
– Stranger – 52.6% protected
• 23.1% never used condoms
• 30.8% always used condoms
Multivariate Predictors of Condom Use
PREDICTOR VARIABLE
b
ß
Race = Caucasian
–0.14
0.20 **
Relationship Status = Involved
–0.13
0.17 **
Income from All Sources
–0.00
0.16 **
Multiple Sex Partners – Past 30 Days
0.11
0.14 *
Condom Use Self-Efficacy
0.18
0.26 ***
* p<.05
** p<.01
*** p<.001
R2 = .223
Conclusions – 1
• Condom use rates were low in this study of young
adult Ecstasy users.
– Even among persons who were “involved,” sexual
safety is an issue: 23.5% of “involved” persons
admitted to having had sex with more than one
person during the previous month.
• HIV intervention efforts targeting young adult Ecstasy
users need to emphasize the importance of (1) mutual
monogamy, and (2) using condoms during all sex
acts with all partners.
• Providing HIV education for couples might also be
worthwhile  Published studies have shown this
approach to be valuable and effective.
Conclusions – 2
• Condom use rates were higher among persons
who had more than one sex partner  Good
news / bad news situation
– Good news: The more partners people had,
the more likely they were to use condoms.
– Bad news: Even among those with the
largest number of partners, condom use did
not reach 55%.
• Again, this highlights a need to emphasize the
importance of using condoms with all sex
partners all of the time.
Conclusions – 3
• Two surprising findings:
– Higher rates of unprotected sex were
observed among:
• (1) Caucasians vs racial minority group members
• (2) Persons with higher income vs those with
lower income
• Perhaps these stem from perceptions of
invulnerability to HIV?
– Virtually all media messages about HIV in
recent years have focused on the greater
risks faced by lower-income, inner-city,
minority group members.
Conclusions – 4
• If that explanation is true, then HIV education,
prevention, and intervention efforts need to find
ways to heighten people’s senses of
vulnerability to HIV.
– If they feel more susceptible to contracting
HIV, they may be more willing to take steps
necessary to protect themselves.
• Conducting realistic individual assessments of
HIV risk level would be a wise beginning point.
• Those could be followed by the development of
individualized risk reduction plans.
Conclusions – 5
• We found a direct association between condom
use self-efficacy and actual condom use.
• Intervention programs targeting young adult
Ecstasy users may wish to incorporate
components specifically designed to enhance
condom use self-efficacy:
– (1) teaching condom use negotiation strategies
– (2) introducing people to the female condom
– (3) instructing people about proper condom
application techniques
– (4) enhancing skills regarding conflict resolution and
violence de-escalation