1. Characteristics of Poly-Substance Users Engaging in High HIV-Risk Behaviors
Kristen Williams, Jonathan J.K. Stoltman, and Mark K. Greenwald
Substance Abuse Research Division, Department of Psychiatry and Behavioral Neurosciences
Wayne State University School of Medicine, Detroit, MI
Table 1. Chi-Square Results for
Low and High HIV Risk Groups
Figure 1. Non-Medical Use of Specific Opioids in Low and High HIV Risk Groups (%)
Compared to males, females reported engaging in greater HIV sex risk behaviors. Compared to African American participants, White participants reported engaging in greater HIV drug risk behaviors.
INTRODUCTION .
More than 1 million people in the United States are living with HIV, with > 50,000 new infections diagnosed each year (CDC, 2013).
Use of illegal drugs, e.g., cocaine and heroin, has been associated with increased risk of HIV infection and transmission, both through unsafe sexual practices and by sharing drug paraphernalia (e.g., Strathdee & Stockman, 2010).
Recent data suggest that only 55% of substance use treatment facilities offer HIV education/counseling/support groups, and only 28% offer on-site testing (SAMHSA, 2010).
Treatment providers may benefit from knowledge of demographic and substance use characteristics of drug users at highest risk for HIV infection and transmission to target HIV prevention and early intervention resources.
Low-Risk
High-Risk
Female
31%
56%
White
20%
50%
Non-Medical Opioid Use
15%
42%
Table 3. t-Test Results for Gender on HIV Risk Behavior df
t-value
p-value
RAB Drug Risk Score 74
1.23
0.22
RAB Sex Risk Score 60
2.19
0.03
Table 4. t-Test Results for Race on HIV Risk Behavior df
t-value
p-value
RAB Drug Risk Score 73
-4.38
0.01
RAB Sex Risk Score
-1.32
0.13
Individuals reporting high HIV-risk behaviours were: female, white and endorsed higher lifetime prevalence of non-medical opioid use
DISCUSSION & CONCLUSIONS
Table 2. t-Test Results for Low and High HIV Risk Groups
In this non-treatment sample, cocaine/heroin using individuals who reported engaging in high HIV-risk behaviors were: younger; more often white and female; and endorsed earlier age of onset of cocaine use, greater lifetime prevalence of non-medical opioid use, and greater past-month levels of heroin use.
Risky sex behavior was greater among females than males (but this sample lacked the highest sex risk group – homosexual males). Risky injection behavior was greater among Whites than African Americans.
These findings may be used to identify individuals who could benefit from education regarding HIV infection and transmission. df
t-value
p-value
Age 73
2.52
0.01
First Cocaine Use
2.42
0.02
Regular Cocaine Use 72
2.14
0.04
First Heroin Use 52
1.45
0.15
Regular Heroin Use 51
0.55
0.60
Past Month Cocaine Use
-1.74
0.09
Past Month Alcohol Use 63
1.01
0.32
Past Month Heroin Use 71
-2.81
METHODS
Participants: Data were analyzed from 149 (100 male, 49 female) out-of-treatment cocaine/heroin users. Participants ranged in age from years (M = 41.6). Seventy-two percent of the sample identified as African American and 28% identified as White.
Procedure: Participants were recruited for experimental laboratory studies on cocaine and heroin dependence. As part of screening, participants completed a battery of questionnaires.
Measures: Lifetime and current substance use was assessed with a Drug History and Use Questionnaire. Past 6-month HIV drug-risk and sex-risk behaviors were assessed with the Risk Assessment Battery (RAB; Navaline et al. 1994).
The extreme quartile groups significantly (p < .05) differed in gender, race, and age, such that those in the high HIV-risk behavior group were more likely to be white, female, and younger.
Individuals in the high HIV-risk group reported significantly earlier ages of first cocaine use and regular cocaine use, but not earlier ages of first heroin use or regular heroin use.
The extreme quartiles did not significantly differ in days used past- month of cocaine or alcohol, however the high HIV risk behavior group reported greater past-month use of heroin. The high HIV-risk behaviour group also reported significantly higher rates of current non-medical opioid use.
To further assess demographic differences, follow-up tests were conducted (Table 3 and Table 4).
REFERENCES CITED
Centers for Disease Control and Prevention (2013). HIV in the United States. Retrieved from
Navaline, H.A., Snider, E.C., Petro, C.J., Tobin, D., Metzger, D., Alterman, A.I., et al. (1994). An automated version of the Risk Assessment Battery (RAB): Enhancing the assessment of risk behaviors. AIDS Research & Human Retroviruses, 10, S281–S283.
Strathdee, S.A., Stockman, J.K., (2010). Epidemiology of HIV among injecting and non-injecting drug users: current trends and implications for interventions. Current HIV/AIDS Reports, 7, 99–106.
Substance Abuse and Mental Health Services Administration (2010). National Survey of Substance Abuse Treatment Services (N-SSATS). Retrieved from
RESULTS
The sample was divided into quartiles based on RAB total score to create low- (RAB < 6) and high- (RAB > 9) risk groups (Ns = 42 and 34).
Chi-square tests (Table 1) and t-tests (Table 2) indicated significant differences between high- and low-risk groups.
GRANT SUPPORT & CONFLICT OF INTEREST
The authors declare no conflicts of interest regarding this work. This research was supported by NIH R01 DA from NIDA (to MKG), Joe Young, Sr./Helene Lycaki Funds (State of Michigan), and the Detroit/Wayne County Mental Health Authority.