1. VACS Scientific Meeting Houston, TX February 2004
Predictors of Risky Sexual Behavior among Veterans with and without HIV Infection: Results from VACS 5
VACS Scientific Meeting
Houston, TX
February 2004
Robert L. Cook MD, MPH
University of Pittsburgh

2. Sexual Behavior Writing Group
Robert Cook
Kevin Kraemer
Adam Gordon
Joseph Conigliaro
Kathleen McGinnis
Tamra Maidenwald
Jeffrey Samet
Stephen Maisto
Stephen Crystal
David Rimland
Kendall Bryant
Amy Justice

3. Risky sexual behavior among persons with HIV is an important public health issue.

4. Health care providers may be able to intervene with their HIV-infected patients to prevent the spread of HIV to others

5. VACS is planning a future intervention
VACS is planning a future intervention. We wondered, what kind of health system intervention could lead to a reduction in risky sexual behavior among persons with HIV infection? Would a substance-abuse related intervention be effective?

6. Research Questions
Is risky sexual behavior common among persons attending VA Hospital clinics?

7. Research Questions
Is risky sexual behavior common among persons attending VA Hospital clinics?
How does risky behavior differ according to demographic characteristics or HIV-infection status?

8. Research Questions
Is risky sexual behavior common among persons attending VA Hospital clinics?
How does risky behavior differ according to demographic characteristics or HIV-infection status?
Are specific patterns of alcohol/drug use more strongly linked to risky sexual behavior than others?

9. Study Population 1746 Participants in VACS-5 (Feasibility Study)
Recruited in from five VA Hospitals: Atlanta, Bronx, Brooklyn /Manhattan, Houston, LA
Infectious Disease Clinics (n=1018) all provider-approved HIV+ patients eligible
General Medicine Clinics (n=728) HIV- persons matched for age, race and site
> 80% of those approached enrolled in the study

10. Key features of VACS 5 Cross-sectional study
Includes persons with and without HIV infection.
Includes mostly men.
Expanded measures of substance abuse.
Limited measures of risky sexual behavior.

11. Risky Sexual Behavior Measures
Number of sex partners
During the past 12 months, with how many partners have you had sex? (oral, anal, or vaginal) (0, 1, 2-4, ≥5)
Condom use (last intercourse)
“the last time you had sex, did you or your partner use a condom?”
Multiple sex partners AND no condom
2 or more sex partners and no condom use at last intercourse

12. Alcohol and Drug Use Measures
Quantity/ Frequency
0, 1-14, or ≥ 14 drinks per month
AUDIT
10-items (score ≥ 8 suggests alcohol use disorder)
Binge
≥ 6 drinks/occasion at least monthly
DAST
10-items (Score ≥3 suggests drug use disorder)
Injection drug use
Current (past 12 months), past, none
Intoxicated before sex
“The last time you had sexual intercourse were you intoxicated or high from alcohol or drugs?”

13. Research Question 1:
Is risky sexual behavior common among persons attending VA Hospital clinics?

14. Number of sexual partners (Past 12 months)
HIV +
(n = 991)
HIV –
(n = 710)
# partners % 1
2-5
≥ 5 32 22 14 26 54 16 4

15. Risky Sexual Behavior*
HIV +
HIV - P
Behavior %
Did not use condom 27 73
0.00
Multiple partners and no condom -
Alcohol/Drug use prior to sex 23 10
* Among sexually active men

16. Research Question 2:
How does risky behavior differ according to demographic characteristics or HIV-infection status?

17. Factors associated with greater number of sexual partners
HIV +
HIV -
Younger age X
Black race
Higher income
Not married
Sex with men
Depression

18. Factors associated with not using a condom (at last intercourse)
HIV +
HIV -
Over age 40 X
White race
Higher income
Married
Sex with men

19. Factors associated with multiple partners and no condom use
HIV +
HIV -
Age ≥ 40 X
White race
Income
Not married
Sex with men
Depressed
Prevalence of behavior among married men: 12% HIV+ 11% HIV-
Prevalence of behavior among men >age 60: 16% HIV+ 23% HIV-

20. Research Question 3:
Are specific patterns of alcohol/drug use more strongly linked to risky sexual behaviors than others?

21. Drug/alcohol variables associated with multiple sex partners (≥ 2)
HIV +
HIV -
Drinks >14 per week X
Alcohol abuse (AUDIT)
Binge drinking
IVDU
Drug abuse
Intoxicated before sex

22. Drug/alcohol variables associated with no condom (last intercourse)
HIV +
HIV -
Drinks >14 per week
Alcohol abuse
Binge drinking
IVDU
Drug abuse X O
Intoxicate before sex
O means they were MORE likely to use a condom

23. Drug/Alcohol variables associated with multiple partners and no condom use
HIV +
HIV -
Drinks >14 per week
Alcohol abuse X
Binge drinking
IVDU
Drug abuse
Intoxicated before sex

24. Multivariate Analysis: Significant Predictors of Multiple Sex Partners Men with HIV Infection
Odds Ratio
(95% CI)
African-American
1.5
Sex with men
3.8
Married/Stable relationship
0.3
Intoxicated before last intercourse
2.2
* Analysis presented at RSA meeting last year; current results may differ slightly

25. Limitations
Cross-sectional associations. Can not prove cause-effect relationship
Our measures of sexual behavior were not precise.
These represent self-reported information on stigmatized behaviors.
We have not yet completed multivariate analyses.

26. Conclusions
Risky sexual behavior is relatively common in male veterans with HIV infection. 13% had >5 sexual partners in the past year. At least 23% are not using condoms
Among persons with HIV, risky sexual behavior appears to be more common among white men who have sex with men
A situational measure of alcohol/drug use appears to be more strongly associated with risk of HIV transmission, compared to more traditional measures of consumption or abuse.

27. VACS: The Future
More extensive sexual behavior measures are being collected at one-year follow-up.
Clinical outcome measures of STDs.
Prospective analyses

28. Expanded sexual behavior measures include:
Any anonymous/casual sex
Self-reported STDs
Self-reported “did alcohol cause you to have risky sexual behavior”
Self-reported “did specific drugs cause you to have risky sexual behavior”
Sex-related alcohol expectations

29. Sexual Behavior Writers Group Breakfast Meeting 8AM Tuesday B.Y.O.B.