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Relationship between substance abuse treatment outcome
and sexual risk behaviors
Howard
1
Newville ,
James L.
1
Sorensen ,
Donald A.
2
Calsyn
1 University
of California, San Francisco, San Francisco, CA
2 University of Washington, Seattle, WA
Funding information: Supported by the National Institute of Drug Abuse (F32 DA032446, U10 DA13714, U10 DA015815, and P50 DA09253)
Aims
• This secondary data analysis will assess the impact of
drug treatment on HIV risk behaviors
• Hypothesis: decreases in drug and alcohol use at
follow-up will coincide with decreases in sex risk
behaviors
Methods
Setting and design
• NIDA Clinical Trials Network (CTN) study testing
innovative risk reduction against standard education
• Participants recruited from 7 methadone maintenance
(MMT) and 7 outpatient drug free (ODF) programs
• Diverse in terms of region, population density, and HIV
prevalence rates
• Urban (e.g., Philadelphia), suburban (e.g., Norwalk,
CT) and rural (e.g., Huntington, WV)
• Located in the Northeast, South, Midwest,
Southwest, and West
Measures
• Addiction Severity Index (ASI)
• Alcohol and drug composite scores
• Sexual Behavior Interview (SBI) (all behaviors – past 90
days)
1) % protected sex with main sex partner
2) % protected sex with a casual sex partner
3) Number of sex partners (0, 1, >1)
4) Having ≥1 high risk sex partner (“High risk” = IDU,
crack/cocaine, or thought to be HIV+)
5) Any sex under the influence
Multivariate analyses (continued)
• Eligibility requirements: (1) men ≥18 years old, in
substance abuse treatment, (2) reported unprotected
intercourse (past 6 months) (3) willing to be randomly
assigned to one of two interventions, (4) completed all
study assessments, and (5) English speaking
• Exclusion criteria: (1) gross mental status impairment; (2)
primary sexual partner intending to become pregnant
Number of sex partners
ASI alcohol: decreased for those whose number of
partners decreased (OR [95% CI]: 8.40 [1.07, 66.67],
p=0.043), increased for those whose number of
partners increased (OR [95% CI]: 21.87 [1.08, 443.00],
p=0.044) (Figures 1 & 3)
Data analysis
• Severity of drug/alcohol use and frequency of risk
behaviors calculated at baseline and six month follow-up
• Paired sample t-tests (for normal data) and Wilcoxon
signed-rank tests (for non-normal data) to assess
change over time
• Changes in drug/alcohol use severity by changes in risk
behaviors assessed with multinomial logistic regression
• Due to non-normal distributions, risk behaviors were
considered as increasing, decreasing, or stable
• Intervention sessions attended, treatment modality
(MMT vs. ODF), and present engagement in drug
treatment (0 vs. 1-29 vs. 30 days) added as
covariates
Results
Bivariate analyses
Drug use variables
Alcohol CS (Mean [SD])
Baseline – 0.09 (0.15); Follow-up – 0.07 (0.12), p<0.001
Drug CS (Mean [SD])
Baseline – 0.19 (0.14); Follow-up – 0.15 (0.13), p<0.001
Risk variables
% protected sex with a regular partner
Baseline – 11.6%; Follow-up – 20.7%, p<0.001
% protected sex with a casual partner
Baseline – 26.7%; Follow-up – 40.4%, p=0.038
Multiple sex partners
Baseline – 40.1%; Follow-up – 26.5%; p<0.001
At least one high risk sex partner
Baseline – 28.7%; Follow-up – 24.8%; p=0.302
Sex under the influence
Baseline – 70.8%; Follow-up – 51.3%; p<0.001
Treatment engagement (past 30 days)
0 days – 115 (24.9%), 1-29 days – 161 (34.9%), 30 days –
122 (26.5%)
Multivariate analyses
% protected sex w/ regular partner, % protected sex w/
casual partner
All individual items NS (Figures 1 & 3)
Sex under the influence
ASI drug: Those who discontinued SUI had greater
decreases than those who had no SUI at either time
(OR [95% CI]: 27.03 [1.21, 618.67], p=0.038) (Figures 2
& 4)
Figure 1 – ASI Alcohol, Condom Use, and Number of Partners
Change in ASI Alcohol CS
Participants
Figures
*
Frequency
Figure 2 – ASI Alcohol, SUI, and High Risk Partners
At least one high risk sex partner
ASI drug: Those who had high risk partners at both
times had greater decreases than those without high
risk partners at either time (OR [95% CI]: 90.91 [3.91,
2,040.81], p=0.005) (Figures 2 & 4)
Discussion
• Drug/alcohol use severity and most sex risk behaviors
decreased for individuals in drug treatment
• Changes in drug/alcohol use severity associated with
decreases in certain risk behaviors
• As drug treatment can decrease HIV seroconversion
(Farrell et al., 2005), it is viable for risk reduction
• However, not all sex risk behaviors decrease with drug
treatment alone, and further interventions within drug
treatment are necessary
• Innovative risk reduction interventions can decrease
risk (Calsyn et al., 2010)
References
Calsyn DA, Hatch-Maillette M, Tross S, et al. Motivational and
Skills Training HIV/STI Sexual Risk Reduction Groups for Men. J
Subst Abuse Treat. 2009 September ; 37(2): 138–150.
Carey JW, Mejia R, Bingham T, et al. Drug use, high-risk sex
behaviors, and increased risk for recent HIV infection among men
who have sex with men. AIDS Behav 2009; 13:1084-1096.
Des Jarlais DC, Arasteh K, McKnight C, et al. Gender and age
patterns in HSV-2 and HIV infection among non-injecting drug
users in New York City. Sex Transm Dis 2010; 37:637– 643.
Farrell M, Gowing L, Marsden J, Ling W, Ali R. Effectiveness of
drug dependence treatment in HIV prevention. Int J Drug Policy
2005; 16S:S67–75.
Plankey MW, Ostrow DG, Stall R, et al.. The relationship between
methamphetamine and popper use and risk of HIV
seroconversion in the multicenter AIDS cohort study. JAIDS 2007;
45: 85-92.
Sorensen JL, Copeland AL. Drug abuse treatment as an HIV
prevention strategy: A review. Drug Alc Depend 2000; 59:17-31.
Strathdee SA, Sherman SG. The role of sexual transmission of HIV
infection among injection and non-injection drug users. J Urban
Health 2003; 80(suppl 3):iii7–iii14.
Change in ASI Alcohol CS
• Non-injection drug users (NIDUs) have similar HIV rates
as injection drug users (IDUs) (Strathdee, 2003; Des
Jarlais, 2010)
• 13% among IDUs and 12% among NIDUs in a drug
treatment program study, 15% and 17% in a
respondent-driven sampling (RDS) storefront study
(Des Jarlais, 2007)
• The use of stimulants is associated with increased sex
risk behavior (Plankey et al., 2007)
• HIV+ individuals are more likely to have sex under
the influence of stimulants than HIV-negative
individuals (Carey et al., 2009)
• Drug treatment lessens drug use and IDU risk, but its
effects on sexual practices are unknown
• Sex risk behaviors are slower to change (Sorensen
& Copeland, 2000)
• Many substance users in treatment continue to
engage in sex risk behaviors (Farrell, Gowing,
Marsden, Ling & Ali, 2005)
Results (continued)
*
Status
Figure 3 – ASI Drug, Condom Use, and Number of Partners
Change in ASI Drug CS
Methods (continued)
Frequency
Figure 4 – ASI Drug, SUI, and High Risk Partners
*
Change in ASI Drug CS
Introduction
Funding information: Supported by the National Institute of Drug Abuse (F32 DA032446, U10 DA13714, U10 DA015815, and P50 DA09253)
Status