1. HIV Risk Behaviors and Alcohol Intoxication among Injection Drug Users in Puerto Rico Tomás D. Matos, MS Center for Addiction Studies Universidad Central del Caribe Study funded by the NIDA, Grant 5 R01 DA 10636

2. 2 Background: AIDS Puerto Rico ranks 5th in AIDS Incidence among United States AIDS incidence rate – 26.4 / 100,000 pop. Injection Drug use – 50% of cases Heterosexual contact – 25% of cases Men who have sex with men – 16% of cases Deaths - 62.0% of AIDS cases

3. 3 Background: ALCOHOL/DRUG USE 7.7% alcohol abuse – last year 4.9% alcohol dependence – last year 1.2% illicit drug abuse – last year 3.0% illicit drug dependence – last year

4. 4 Background: ALCOHOL DEPENDENCE 31.4% Major depression/Generalized Anxiety disorders 10.6% Received specialized treatment services

5. 5 Background: DRUG DEPENDENCE 41.4%Major depression/Generalized Anxiety disorders 27.3% Received specialized treatment services

6. 6 Methods: Recruitment Design Eligibility Criteria –Injected last 30 days –18 years old or more –Not in treatment

7. 7 Methods: Recruitment Design Recruitment Sites –Cooping Areas –Public Housing Projects –Shooting Galleries –Streets

8. 8 Methods: Structure Interview Variables: –Demographics –Drug use history –Health status –HIV/AIDS Risk Behaviors –Health Services Utilization

9. 9 Intervention Group Control Group Recruitment (Targeted Sampling in Communities of the North Health Care Region) Initial Assessment Randomization Follow-Up Assessment After 6 months Intervention Process: Motivational Interviewing by Community Counselors Inducement to Enter Change Process Motivational Interviewing by Clinical Counselors Skill Building to Change Risk Behaviors Inducement to Enter Treatment and Health Care Outcomes Experimental Design

10. 10 Methods: Measure Alcohol Intoxication Question: During the last 30 days how many days did you drink until intoxicated? ________ number of days

11. 11 Figure 1 Alcohol use - last 30 days

12. 12 Other Measures: Drug injection behaviors: –number of injection years, –number of injections per day, pooling money to buy drugs. Drug injection risky behaviors: –shared needles, cotton, water. Sexual behaviors: –number of casual or paid sex partners. Sexual risk behaviors: –number of occasions of had unprotected sex (principal, casual, paid partner), sex for money or drug.

13. 13 Analyses: The measure of the number of days respondents drank until intoxicated as well as the measures of risk behavior were treated as dichotomous variables in the analyses. Demographic variables of gender, age, education, HIV status, frequency of injection, years of injection, depression and anxiety symptoms were included as covariates. Statistical analyses employed included chi-square tests and multiple logistic regressions. All the statistical procedures were conducted with the Statistical Package for the Social Sciences (Version 11.5, SPSS Inc., Chicago IL).

14. 14 Sample Profile: Gender

15. 15 Sample Profile: Age

16. 16 Sample Profile: High School Education

17. 17 Sample Profile: Self-Considered Homeless

18. 18 Results: Injection Drug Combination

19. 19 Sample Profile: Mental Health Severe depression –51.9% Mean/SD –28.4/13.7 Severe anxiety –37.1% Mean/SD –20.4/16.0

20. 20 HIV Status

21. 21 Table 1. Injection behaviors by alcohol intoxication

22. 22 Table 2. Injection risk by alcohol intoxication

23. 23 Table 3. Sex behaviors by alcohol intoxication

24. 24 Table 4. Sex risk behaviors by alcohol intoxication

25. 25 Table 5a Results of injection risk behaviors regressed against alcohol intoxication

26. 26 Table 5b. Results of injection risk behaviors regressed against alcohol intoxication

27. 27 Table 6. Results of type of sexual partner regressed against alcohol intoxication

28. 28 Table 7a. Results of sexual risk behaviors regressed against alcohol intoxication

29. 29 Table 7b. Results of sexual risk behaviors regressed against alcohol intoxication

30. 30 Summary IDUs who also consume alcohol to intoxication were more likely to: –Had more years of injecting drugs –Injected more frequency –Pooled money to buy drugs –Shared Needles –Shared Cotton –Had a Paid Sex Partner –Had a Casual Sex Partner –Had Sex for Money/Drugs Non-significant differences in sexual risk behavior were observed.

31. 31 Conclusions This study demonstrates the significant impact of alcohol intoxication and drug use on HIV risk behaviors. IDUs who also consume alcohol to intoxication are at greater risk of exposure to HIV injection risk behaviors than IDUs who did not. Prevention interventions to reduce HIV risk and HIV prevalence need to assess and address the dual substance abuse problems of IDU and intoxication. The practices of needle and cotton sharing need to be addressed with preventive interventions that account the risk of alcohol consumption until intoxication.

32. 32 References 1Fenaughty A and Fisher DG. High-risk sexual behavior among drug users: The utility of a typology of alcohol variables. Sexually Transmitted Diseases 1998; 25(1):38-43. 2 Stein MD, Hanna L; Natarajan R, et al. Alcohol use patterns predict high risk behaviors among active injection drug users. Journal of Substance Abuse Treatment 2000; 18:359-363. 3 Stein MD, Anderson B, Charuvastra A, and Friedman PD. Alcohol use and sexual risk taking among drinking drug injectors who attend needle exchange. Alcoholism: Clinical and Experimental Research 2001; 25(10):1487-1493. 4 Rees V, Saitz R, Horton NJ, and Samet J. Association of alcohol consumption with HIV sex- and drug-risk behaviors among drug users. Journal of Substance Abuse Treatment 2001; 21:129-134.