HIV Sex Risk Behaviors among Young Adult, Non-Medical Users of Pharmaceutical Opioids Daniulaityte, R., Falck, R., & Carlson, R. Introduction In the United States, it is estimated that almost 1.2 million people are living with HIV, and about 50,000 individuals are infected each year (Centers for Disease Control and Prevention (CDC), February 2013). Studies have shown that alcohol and other drug use increases risky sex behaviors which account for a large proportion of new HIV infections. However, there is a limited understanding of sex risk behaviors among non-medical users of pharmaceutical opioids. Over the past decade, illicit use of pharmaceutical opioids has emerged as a major public health problem in the U.S., with lifetime rates as high as 24.3% among young adults (18 to 25 years old) (SAMHSA), 2010). This study identifies socio-demographic and drug use factors associated with having multiple sex partners and unprotected sex among young adult (18-23-year-old), non-medical users of pharmaceutical opioids in a midwestern city in the USA.   Methods  Between April 2009 and May 2010, 396 young adults were recruited to participate in the natural history study of illicit pharmaceutical opioid use. Respondent-driven sampling was used to recruit participants (Daniulaityte, Falck, Li, Nahhas, & Carlson, 2012). To be eligible, participants had to: 1) be 18–23 years old; 2) reside in the Columbus, Ohio, area; 3) self-report the non-medical use of pharmaceutical opioids on at least 5 occasions in the past 90 days; 4) show no lifetime DSM-IV dependence on opioids ; 5) have no history of heroin use or drug injection; 6) not be engaged in a formal drug abuse treatment program in the last 30 days; and 7) not currently be awaiting trial or have pending criminal charges. Informed consent was obtained from all participants following a protocol that was approved by Wright State University’s Institutional Review Board. Interviews were conducted in private project offices. Baseline structured interviews ranged from 1.5 to 2.5 hours. The questionnaire was largely interviewer-administered in a face-to-face session. Questions on sex risk behaviors were administered via audio computer-assisted self-interview. Participants were compensated $50 for the baseline assessment and $10 for transportation. Results The sample was about 55% male and 50% white (Table 1). About 50% reported having unprotected sex (no condom use during vaginal and/or anal sex) and 25% reported having multiple sex partners in the past 30 days (Figure 1). Rates and frequency of past 30 day drug use are shown in Figures 2 and 3. The majority reported using illicit pharmaceutical opioids 1-2 days per week, and over 40% of the sample reported using cannabis on most days of the week. Logistic regression analysis results (Table 2) indicate that being male was linked to greater odds of having multiple sex partners but lower odds of unprotected sex. Being of African American or “other” ethnicity was related to increased odds of having multiple sex partners but showed no association with condom use. Being in a committed relationship was related to decreased odds of having multiple sex partners and increased odds of unprotected sex. In terms of drug use, alcohol use (getting drunk) was related to increased odds of both sex risk behaviors. Illicit use of pharmaceutical tranquilizers was related to a greater likelihood of having multiple sex partners. Marijuana, MDMA, pharmaceutical opioid and stimulant use showed no significant association with sex risk behaviors. Conclusions  The study adds new insights about the relationship between drug use behaviors among young adult users of illicit pharmaceutical opioids and sex behaviors that present risk for HIV infection and other sexually transmitted diseases. Our findings extend prior research studies that documented a strong association between sex risk behaviors and alcohol use (Graves & Leigh, 1995; Scherer, Trenz, Harrell, Mauro, & Latimer, 2013; Shillington, Cottler, Compton, & Spitznagel, 1995). Even with the new generation of illicit drug users, sometimes referred to as “Rx generation,” alcohol use remains a pivotal factor for sex risk behaviors, but illicit use of pharmaceutical tranquilizers also presents an increased risk. Our findings help identify specific socio-demographic characteristics and drug use behaviors that require targeted harm reduction interventions. Limitations of this study include use of self-reported data, although there is substantial support for the veracity of such data. The sample was recruited from one area of the U.S., so the results cannot be generalized. Finally, the study is limited to non-dependent pharmaceutical opioid users; sex risk behaviors among dependent illicit prescription opioid users may be quite different and is an important area for future research.  References   Centers for Disease Control and Prevention (CDC). (February 2013). HIV surveillance report, 2011  . MMWR, (23), May 13, 2013. Daniulaityte, R., Falck, R., Li, L., Nahhas, R. W., & Carlson, R. G. (2012). Respondent-driven sampling to recruit young adult non-medical users of pharmaceutical opioids: Problems and solutions. Drug and Alcohol Dependence, 121(1-2), 23-29. Graves, K. L., & Leigh, B. C. (1995). The relationship of substance use to sexual activity among young adults in the United States. Family Planning Perspectives, 27(1), 18-22, 33. Scherer, M., Trenz, R., Harrell, P., Mauro, P., & Latimer, W. (2013). The role of drinking severity on sex risk behavior and HIV exposure among illicit drug users. The American Journal on Addictions, 22(3), 239-245. Shillington, A. M., Cottler, L. B., Compton, W. M.,3rd, & Spitznagel, E. L. (1995). Is there a relationship between "heavy drinking" and HIV high risk sexual behaviors among general population subjects? The International Journal of the Addictions, 30(11), 1453-1478. Substance Abuse and Mental Health Services Administration (SAMHSA). (2010). Results from the 2009 National Survey on Drug Use and Health: Detailed Tables. Rockville, MD: Office of Applied Studies. Center for Interventions, Treatment, and Addictions Research Department of Community Health, Boonshoft School of Medicine, Wright State University • 3640 Colonel Glenn Hwy., Dayton, OH 45435 • Phone: (937) 775-2066 • Fax: (937) 775-2214 • www.med.wright.edu/citar/ • raminta.daniulaityte@wright.edu Financial support was provided by NIDA (R01DA023577; Carlson, PI). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute on Drug Abuse or the National Institutes of Health. Table 1. Demographic Characteristics (N=396) Gender Number  % Men 216 54.5% Women 180 45.5% Ethnicity   White 197 49.7% African American 175 44.2% Other 24 6.0% Age 18-20 164 41.0% 21–23 236 59.0% Relationship status Engaged or married 19 4.8% Living as married 113 28.5% Single/never married 262 66.2% Divorced/separated 2 0.5% Table 2. Logistic Regression Analysis: Risk factors for Sex Risk Behaviors   Variables Multiple sex partners 1 Unprotected sex 2 Odds Ratio p value p value2 Sex (Female vs. Male) 0.44 <0.01 1.85 Race African American vs. White 2.84 0.001 0.75 0.26 "Other" vs. White 2.89 0.04 1.16 0.77 Committed relationship 0.42 3.36 <0.001 Illicit pharmaceutical opioid use 1-2 days/week (vs. less than 1 day/week) 0.99 1.34 0.33 3+ days/week (vs. less than1 day/week) 1.07 0.85 1.62 0.12 Cannabis use 4 days/week or less (vs. no use) 1.02 0.95 1.48 0.20 More than 4 days/week (vs. no use) 1.30 0.45 1.18 0.56 Alcohol use (Getting drunk) Less than 1 day/week (vs. no use) 1.66 0.14 1.09 1 day/week or more (vs. no use) 2.16 0.02 2.34 MDMA/"Ecstasy" use 1.41 0.41 1.25 0.58 Illicit pharmaceutical stimulants use 1.54 0.32 1.27 0.55 Illicit benzodiazepine use 2.19 1.00 Cocaine use 0.36 1.51 0.40 Hallucinogen use 0.51 0.25 0.52 0.17 1Hosmer-Lemeshow test: X² =5.9, df=8, p=0.66 2 Hosmer-Lemeshow test: X² =7.5, df=8, p=0.48