Substance use and risky sexual behavior among homeless and runaway youth

Sex out of marriage and condom use among homeless youth in Iran

OBJECTIVES

Sexual behaviors of homeless youth in Iran have not been well studied. This study aimed to measure the frequency and associated factors of sex out of marriage and condom use among homeless youth in Kerman, Iran.

STUDY DESIGN

In this cross-sectional study, we recruited 202 homeless youth (age: 15-29 years who experienced 30 or more days of homelessness in the last 12 months) from 11 street locations between September to December 2017.

METHODS

Of 202 participants, 169 (83.7%) reported sex in the last 12 months and were include in this analysis. We assessed the prevalence of sex out of marriage in the last 12 months, condom use in last sex, and then evaluated their covariates in multivariable logistic regression analysis.

RESULTS

The prevalence of sex out of marriage was 19.6% (95% confidence intervals [CIs]: 13.8%, 26.3%) and the prevalence of condom use was 43.8% (95% CI: 36.2%, 51.6%). Sex out of marriage was significantly correlated with male gender (adjusted odds ratio [AOR]: 24.38; 95% CI: 3.1-192.1) and being unmarried (AOR: 5.94; 95% CI: 2.3-15.5). Condom use was significantly correlated with male gender (AOR: 2.16; 95% CI: 1.1-4.2) and higher educational status (AOR: 4.30; 95% CI: 2.1-8.8).

CONCLUSION

Our findings indicate that one in five homeless youth had sex out of marriage, and less than half did no use condom. These should be addressed by adapting education and harm reduction programs targeting this specific population in Iran.

Emergency Department Utilization by Adolescents Experiencing Homelessness in Massachusetts

BACKGROUND

Adolescents who experience homelessness rely heavily on emergency departments (EDs) for their health care.

OBJECTIVES

This study estimates the relationship between homelessness and ED use and identifies the sociodemographic, clinical, visit-level, and contextual factors associated with multiple ED visits among adolescents experiencing homelessness in Massachusetts.

RESEARCH DESIGN

We used the Healthcare Cost and Utilization Project State Emergency Department Databases on all outpatient ED visits in Massachusetts from 2011 to 2016. We included all adolescents who were 11-21 years old. We estimated the association between homelessness and ED utilization and investigated predictors of multiple ED visits among adolescents who experience homelessness using multivariate logistic and negative binomial regressions.

RESULTS

Our study included 1,196,036 adolescents, of whom about 0.8% experienced homelessness and this subset of adolescents accounted for 2.2% of all ED visits. Compared with those with stable housing, adolescents who were homeless were mostly covered through Medicaid (P<0.001), diagnosed with 1 or more comorbidities (P<0.001), and visited the ED at least once for reasons related to mental health; substance and alcohol use; pregnancy; respiratory distress; urinary and sexually transmitted infections; and skin and subcutaneous tissue diseases (P<0.001). Homeless experience was associated with multiple ED visits (incidence rate ratio=1.18; 95% confidence intervals, 1.16-1.19) and frequent ED use (4 or more ED visits) (adjusted odds ratio=2.21; 95% confidence interval, 2.06-2.37). Factors related to clinical complexity and Medicaid compared with lack of coverage were also significant predictors of elevated ED utilization within the cohort experiencing homelessness.

CONCLUSIONS

Adolescents who experience homelessness exhibit higher ED use compared with those with stable housing, particularly those with aggravated comorbidities and chronic conditions. Health policy interventions to integrate health care, housing, and social services are essential to transition adolescents experiencing homelessness to more appropriate community-based care.

Substance Use and Treatment Among Youth Experiencing Homelessness: 1992-2017

PURPOSE

This study aimed to describe the patterns in substance use and treatment utilization from admissions to publicly funded treatment programs among youth (aged 12-24 years) experiencing homelessness between the years of 1992 and 2017.

METHODS

We used the concatenated Substance Abuse and Mental Health Services Administration Treatment Episode Data Set Admissions (total youth admissions, n = 5,153,775; and youth reported being homeless at the time of admission, n = 241,310). Prevalence estimates and binary logistic regression models were used to estimate the odds ratios to identify the differences among youth who reported being homeless or housed at the time of the treatment.

RESULTS

Homeless youth had higher odds than housed youth to self-refer for treatment; to enroll in treatment for cocaine/crack, heroin, or methamphetamine; and to receive treatment in 24-hour detoxication facilities or long-term residential facilities. Additional differences were identified among youth aged 12-17 years and youth aged 18-24 years and by sex within the homeless youth population.

CONCLUSIONS

This analysis provides a picture of treatment utilization patterns by youth who are experiencing homelessness and substance use disorder, by exploring differences by housing status among admissions to publicly funded treatment facilities.

Structural Barriers to Women's Sustained Engagement in HIV Care in Southern California

Since the introduction of antiretroviral therapy, the number of women living with HIV (WLHIV) continues to increase. Despite the decrease in HIV diagnosis among women in California, less than half of WLHIV are retained in HIV care. Structural barriers put women at increased risk for delayed HIV diagnosis, delayed entry into HIV care, and poorer treatment outcomes. The objective of this qualitative analysis is to identify how structural barriers negatively impact women's sustained engagement in HIV care in Southern California. WLHIV accessing local HIV support services participated in a qualitative study by completing a semi-structured interview and brief survey between January and April 2015 (n = 30). Poverty, unemployment, housing instability, and needs for transportation emerged as the dominant structural barriers for women when discussing their challenges with sustained engagement in HIV care. System-level interventions that decrease these noted barriers may help improve HIV care continuum for women living in Southern California.

Associations of Alcohol and Marijuana Use With Condom Use Among Young Adults: The Moderating Role of Partner Type

This study used multiple levels of analysis to examine associations of alcohol and marijuana (AM) use with condom use, including the moderating role of partner type, in a general sample of 754 sexually active young adults (mean age = 18.6, SD = 0.63; 77% non-White). Multivariable models examined associations over the past 30 days (global) and at the most recent sexual event (event specific). Over the past 30 days, participants who had a recent casual partner and used both substances reported a higher proportion of condom-protected sexual events during this period compared to AM nonusers, whereas those who had a recent steady partner and used alcohol, marijuana, or both substances reported a lower proportion of condom-protected sexual events compared to AM nonusers. At the most recent sexual event, participants who used both substances were four times more likely than AM nonusers to have condom-protected sex if the event involved a casual partner; however, there were no significant associations if the event involved a steady partner. Marijuana use, particularly combined with alcohol use, deserves greater attention in the context of condom use. Future research should consider different levels of analysis and partner types to fully understand these complex associations.

Association Between Marijuana Use and Condom Use: A Meta-Analysis of Between-Subject Event-Based Studies

OBJECTIVE

With the current public health burden of sexually transmitted infections, it is important to identify factors affecting condom use. The association between marijuana use and condom use is especially important because of the increasing number of U.S. states legalizing marijuana; however, relevant research findings are mixed. The goal of this study was to perform a meta-analysis assessing the relationship between marijuana and condom use at instances of sexual intercourse.

METHOD

A systematic search of four databases was performed. Data were extracted and pooled estimates were calculated using random-effects models with inverse variance weighting. Heterogeneity was evaluated using the Cochran Q chi-square test.

RESULTS

Eleven studies were included. There was a statistically significant relationship between marijuana and condom use in the overall pooled analysis (odds ratio [OR] = 0.71, 95% CI [0.56, 0.89]), and studies were homogeneous, I² = 12%, χ²(10) = 11.37, p = .33. Stratified analyses showed that although the pooled OR was not significant for adults (OR = 0.92, 95% CI [0.64, 1.33]), there was a significant relationship between condom use and marijuana use for adolescents (OR = 0.62, 95% CI [0.47, 0.82]).

CONCLUSIONS

This meta-analysis found that the odds of condom use were lower for those who used marijuana around the time of intercourse than for those who did not, with this effect only significant for adolescents in a subgroup analysis. As the adolescent populations in this analysis were not representative of a general population of adolescents, future research should focus not only on those considered high risk.

LGBTIQ+ Homelessness: A Review of the Literature

Lesbian, Gay, Bisexual, Transgender, Intersex, and Queer (LGBTIQ+) people’s experiences of homelessness is an under-explored area of housing and homelessness studies, despite this group making up 20–40% of homeless populations. Despite this, much of the existing literature focuses on specific elements of LGBTIQ+ homelessness, and often does not consider the intersections of these elements, instead placing them into individual siloes. Our approach is an intersectional one; this paper identifies the key themes in the existing research, and analyses how these themes interact to reinforce the discrimination and stigma faced by LGBTIQ+ people who experience homelessness. This intersectional-systems thinking approach to LGBTIQ+ homelessness can be used to develop well-informed, culturally sensitive support programmes.

Health Issues Associated with Commercial Sexual Exploitation and Sex Trafficking of Children in the United States: A Systematic Review

This article reviews studies examining health issues associated with commercial sexual exploitation and sex trafficking (CSE/ST) of children in the United States. We searched five health and social sciences databases for peer-reviewed articles published in English between January 1990 and April 2017. After independent screening of the records, we identified 27 studies that met the inclusion criteria. Descriptions of the included studies and their definitions of CSE/ST are provided. Most of the studies sampled children and youth in urban, metropolitan areas and employed cross-sectional surveys or reviewed case files and medical records of convenience samples. Studies differed widely in their operationalization of CSE/ST, which limit systematic comparison across studies and the generalizability of findings. Qualitative analysis of the included studies shows that among commercially sexually exploited/trafficked children, there are elevated burdens of substance use and abuse, mental health disorders such as depression, PTSD, suicidal behaviors, and sexual and reproductive health issues including STIs, HIV, and pregnancy. This review underscores the need for more empirical studies, to guide an evidence-based understanding of and response to the range and complexity of the health issues in this population. Of particular utility are studies that address some of the methodological limitations of prior research in this field (e.g., cross-sectional, convenience samples) and those that assess overlooked health issues (e.g., malnutrition, eating disorders, post-trauma growth, and long-term health consequences).

Risk Factors for Substance Use Among Youth Experiencing Homelessness

Background

Youth experiencing homelessness are at high risk for frequent substance use. This study examines individual, interpersonal, and contextual factors associated with substance use among such youth, age 13-24.

Methods

Data were collected through computer-assisted structured interviews with participants (N=474) recruited at service agencies in Los Angeles.

Results

Youth had experienced over two years of homelessness on average. Almost a third used substances frequently; significant risk factors included delinquency, sensation seeking, and ongoing homelessness. Time spent in clubs and organizations was protective.

Conclusions

Providing housing and services to curb delinquency may help protect youth from becoming frequent substance users.

The Relationship between Survival Sex and Borderline Personality Disorder Symptoms in a High Risk Female Population

Engaging in survival sex and mental illness are overrepresented within homeless populations. This article assesses the relationship between symptoms of borderline personality disorder (BPD) and engaging in survival sex among homeless women. One hundred and fifty-eight homeless women completed surveys on self-reported BPD symptomology and sexual history. Bivariate and multivariate analyses conducted in this study provided insights into the association of experiencing BPD symptoms and engaging in survival sex. Results indicate that some symptoms of BPD are robustly correlated with engaging in survival sex among homeless adult women. Implications for service agencies and others working with at-risk female populations are discussed.

Gender Differences in the Path From Sexual Victimization to HIV Risk Behavior Among Homeless Youth

Experiencing sexual victimization prior to becoming homeless is common among homeless youth and is associated with increased HIV risk behavior. This study examined mediating variables that underlie this association, adding to the understanding of gender differences in these paths. Participants were homeless youth in Los Angeles recruited through service access centers who completed a computerized self-administered interview in English or Spanish using an iPad. Findings indicate a high presence of sexual victimization across both genders. Female participants experienced posttraumatic stress disorder and subsequent engagement with exchange sex, whereas male participants were primarily involved in substance use risk pathways. Results indicate paths in the association between sexual victimization and HIV risk behavior differ between male and female homeless youth. Gender-specific, mental-health-informed interventions targeting sexual risk reduction are warranted.

Sexual Risk Behaviors, Sexual Offenses, and Sexual Victimization Among Homeless Youth: A Systematic Review of Associations With Substance Use

The use of substances among youth experiencing homelessness is an important issue in the context of addressing the developing burden of morbidities arising due to illness, injury, physical and mental health concerns, and low rates of health care utilization among this population group. Youth experiencing homelessness report engaging in and being victimized by various forms of sexual behavior. Of interest in this systematic review were published studies investigating substance use in its association with perpetration of sexual offenses, engagement in sexual risk behavior, or experience of sexual victimization among homeless youth. A systematic search of 12 psychology, health, and social science electronic databases was conducted. Search terms included "homeless*," "youth," "sex crimes," "sexual victimization," "survival sex," "rape," "drugs," and "substance abuse." Twenty-three studies were identified that met the inclusion criteria. No studies statistically examining substance use in its association with perpetrating sexual offenses were located. Findings showed substance use was generally associated with sexual risk behavior or sexual victimization; however, it remains unclear whether substance use precedes or follows these behaviors and experiences. It is possible substances are used by homeless youth as a means of coping with sexual risk behavior and victimization. Implications of the review findings in relation to prevention and intervention approaches aimed to decrease the incidence and severity of health concerns among homeless youth are discussed.

Pathways In and Out of Substance Use Among Homeless-Emerging Adults

Although high rates of alcohol and drug use have been found among homeless young people, less is known about who is responsible for their initiation, the reasons for their continued use, and why some individuals eventually transition out of using whereas others do not. Based on qualitative interviews with 40 homeless individuals 19 to 21 years of age in the Midwest, results revealed that the majority of respondents were initiated into substance use by friends and acquaintances, although family also played a significant role. Almost one half of respondents reported using substances to cope with early family abuse, stress, and life on the streets. Additionally, the majority indicated that they had no intentions of quitting. Substance misuse that is left untreated may lead to chemical dependency among homeless emerging adults and may contribute to long-term homelessness.

Prevalence and Correlates of Sex Exchange Among a Nationally Representative Sample of Adolescents and Young Adults

The present study examines prevalence and correlates of exchanging sex for drugs, money, food shelter, or other favors (sex exchange) among a nationally representative sample of youth and young adults. Adolescents and young adults (n = 11,620, 53% female, 47% male) from the National Longitudinal Study of Adolescent Health were used for the current sample. Participants completed in-home interviews at both waves. Results revealed that sex exchange was reported by 4.9% (n = 569) of the population in wave 2 or wave 3, and 4.6% (n = 26) of those who exchanged sex did so at both waves. More males reported exchanging sex than females (n = 332 versus n = 237). Respondents who reported child sexual abuse were more likely to exchange sex (95% CI 2.51-4.28, p < .05) than respondents who reported any other form of child abuse. Both males and females who engaged in sex exchange were at greater risk for sexually transmitted infections; however, the odds of ever exchanging sex were highest among males who ever had gonorrhea (OR = 6.2; 95% CI 3.75-10.3). Although sex exchange has been studied extensively among homeless and runaway youth, the current study reveals sex exchange also occurs in the general population.

Risk Factors for HIV among Zambian Street Youth

The sub-Saharan African region has been disproportionately affected by Human Immunodeficiency Virus (HIV) and Zambia has one of the highest HIV prevalence rates within this region. Moreover, new incidences of HIV infection are increasing most rapidly among those 15 to 24 years of age. Though young people are at high risk for HIV infection, street youth are even more vulnerable given their exposure to high risk behaviors. The current study examines multiple levels of social influence on HIV infection among 250 street youth in Zambia. Results reveal that though the majority of youth understand what behaviors increase their risk for HIV, youth still hold many misconceptions about HIV/AIDS. Additionally, youth who do not have a home to return to and those who report parental drug misuse were significantly more likely to be HIV positive. This study underscores the need for further education among street youth regarding HIV knowledge.

Multi-Level Risk and Protective Factors for Substance Use Among Zambian Street Youth

BACKGROUND

High rates of substance use have been reported among youth in Zambia. This is particularly concerning given that substance use is one of the biggest risk factors placing young people at risk for HIV infection.

OBJECTIVES

The purpose of the current study is to examine how multi-level risk and protective factors (i.e., community, family, peers, individual) influence alcohol and marijuana use.

METHODS

A total of 250 street youth in Lusaka, Zambia were interviewed in the summer of 2014 about their alcohol and marijuana use and reasons for usage. Data were analyzed using descriptive and multivariate methods.

RESULTS

Youth reported high rates of alcohol use. At the multivariate level, peer and individual level variables (e.g., using alcohol or drugs for coping or for fun) explained the most variance, followed by family level factors. Community level variables explained the least variance in all models. Conclusion/Importance: A better understanding of multi-level risk and protective factors for young people's alcohol and marijuana use could lead to the development of better intervention strategies to reduce this behavior among Zambian street youth.

Giving up on Drugs: Homeless Young People and Self-Reported Problematic Drug Use

Numerous studies have revealed high levels of drug-taking among young people experiencing homelessness. This article draws upon 40 in-depth interviews carried out as part of a five-year longitudinal study of homeless young people (Project i). It is noteworthy that almost all of those who identified their drug use as problematic gave up or reduced their level of use without treatment or professional assistance during the period of the study.

The interviews provided insight into the way in which some young people experiencing homelessness view their drug use and the actions they take in light of these understandings. Here we report their stated reasons for giving up or reducing usage and identify some commonalities that may have impacted on the outcomes.

An Inside Look at Homeless Youths' Social Networks: Perceptions of Substance Use Norms

Substance use among homeless young people is a pervasive problem, and there have been many efforts to understand more about the dynamics of this health compromising behavior. The current study examined perceived substance use norms within homeless youths' social networks utilizing in-depth interviews. The sample included 19 homeless individuals aged 16 to 21. Four elements of substance use within networks emerged: substance use choices, drug use safety issues, encouragement and/or discouragement, and appropriate situations in which substance use is condoned. These findings provide unique insight into the norms associated with drug and alcohol use within homeless youths' social networks.

Child Abuse, Street Victimization, and Substance Use Among Homeless Young Adults

Although previous research documents high rates of child abuse, street victimization, and substance use among homeless youth, few studies have investigated these three constructs simultaneously, and thus little is known about how various forms of victimization are uniquely associated with substance use among this population. The purpose of this article is to examine the relationship among child sexual and physical abuse, street victimization, and partner violence with substance use among 172 homeless young adults. Path analysis results revealed that males and those who reported parental drug problems were significantly more likely to have higher rates of substance use. Those who suffered more childhood physical and sexual abuse and those who experienced more types of relationship violence were more likely to report greater frequency of substance use. The intersection of various forms of victimization with substance use may have important implications for service providers working with this population.

Risky Sexual Behavior and Substance Use among Adolescents: A Meta-analysis

This study presents the results of a meta-analysis of the association between substance use and risky sexual behavior among adolescents. 87 studies fit the inclusion criteria, containing a total of 104 independent effect sizes that incorporated more than 120,000 participants. The overall effect size for the relationship between substance use and risky sexual behavior was in the small to moderate range (r = .22, CI = .18, .26). Further analyses indicated that the effect sizes did not substantially vary across the type of substance use, but did substantially vary across the type of risky sexual behavior being assessed. Specifically, mean effect sizes were smallest for studies examining unprotected sex (r = .15, CI = .10, .20), followed by studies examining number of sexual partners (r = .25, CI = .21, .30), those examining composite measures of risky sexual behavior (r = .38, CI = .27, .48), and those examining sex with an intravenous drug user (r = .53, CI = .45, .60). Furthermore, our results revealed that the relationship between drug use and risky sexual behavior is moderated by several variables, including sex, ethnicity, sexuality, age, sample type, and level of measurement. Implications and future directions are discussed.

The paradox of homeless youth pregnancy: a review of challenges and opportunities

Compared to their housed counterparts, homeless youth become pregnant at exceptionally high rates. Causes of such pregnancies are multifaceted, while a paradoxically high proportion of these pregnancies are intended. This review discusses causes and risk factors associated with homeless youth pregnancies, and notes experiences of pregnancy decision-making discord, challenges encountered during and following pregnancy, and difficulties faced by homeless youth when or if they become parents. Because homeless youth face a wide array of unique risks, future research would benefit from exploring alternative approaches to prevention to reduce pregnancies and improve sexual and reproductive health outcomes among this population.

Associations between youth homelessness, sexual offenses, sexual victimization, and sexual risk behaviors: a systematic literature review

Homeless youth commonly report engaging in sexual risk behaviors. These vulnerable young people also frequently report being sexually victimized. This systematic review collates, summarizes, and appraises published studies of youth investigating relationships between homelessness, perpetration of sexual offenses, experience of sexual victimization, and engagement in sexual risk behavior. A systematic search of seventeen psychology, health, and social science electronic databases was conducted. Search terms included "homeless*," "youth," "offend*," "victimization," "crime," "rape," "victim*," and "sex crimes." Thirty-eight studies were identified that met the inclusion criteria. Findings showed homeless youth commonly report being raped and sexually assaulted, fear being sexually victimized, and engage in street prostitution and survival sex. Rates of victimization and sexual risk behavior were generally higher for females. Given the paucity of longitudinal studies and limitations of current studies, it is unclear whether homelessness is prospectively associated with sexual victimization or engagement in sexual risk behavior, and whether such associations vary cross nationally and as a function of time and place. Future prospective research examining the influence of the situational context of homelessness is necessary to develop a better understanding of how homelessness influences the perpetration of sexual offenses, experience of sexual victimization, and engagement in sexual risk behavior among homeless youth.

Understanding Condom Use Decision Making Among Homeless Youth Using Event-Level Data

This is one of the first qualitative event-based studies to understand the various mechanisms through which multiple factors influence condom use decision making among homeless youth. Event-level interviews that explore characteristics of the environment surrounding sexual events were conducted with 29 youth who were asked to describe two recent sexual encounters. In thematic analyses of data across events, reasons that youth gave for engaging in unprotected sex included the expectation of having sex and use of alternative methods of protection against pregnancy. Other nonevent factors that influenced condom use decision making were related to attributes of the partnership (e.g., testing, trust and love, and assessments of risk) and attributes of the youth (e.g., perceptions of diseases, concerns over pregnancy, and discomfort using condoms). Additional event analyses conducted within the same individuals found that decision making was influenced by multiple interacting factors, with different pathways operating for event and nonevent factors. Future interventions should consider taking a multilevel and individualized approach that focuses on event-based determinants of risky sex in this population.

To use or not to use: a stage-based approach to understanding condom use among homeless youth

This study used a stage-based approach to understand condom use behavior in a representative sample of 309 sexually active homeless youth recruited from shelters, drop-in centers, and street sites in Los Angeles County. Focusing on the youth's most recent sexual event, the three stages of condom use examined were: (1) whether the partners decided prior to the event about using condoms; (2) whether a condom was available at the event; and (3) whether a condom was used at the event. Logistic regression analysis was used to identify attitudinal, relationship, and contextual correlates of each of these three stages. Deciding ahead of time about condom use was associated with being Hispanic, level of education, condom attitudes, and various relationship characteristics (e.g., partner type, monogamy, relationship abuse), with the nature of these associations varying depending on the type of decision (i.e., deciding to use, deciding to not use). Condom availability was more likely to be reported by males, if the event was described as being special in some way, or if the event lacked privacy. Condom use was more likely among youth with more positive condom attitudes and among youth who decide ahead of time to use a condom, but less likely among those in monogamous relationships or when hard drugs were used prior to sex. Whether sexual intercourse is protected or unprotected is the end result of a series of decisions and actions by sexual partners. Results from this study illustrate how condom use can be better understood by unpacking the stages and identifying influential factors at each stage. Each stage may, in and of itself, be an important target for intervention with homeless youth.

Is cannabis use associated with HIV drug and sex risk behaviors among Russian HIV-infected risky drinkers?

BACKGROUND

While cannabis use has been associated with increased HIV drug and sex risk behaviors, its impact on risk behaviors among HIV-infected individuals has not yet been established.

METHODS

This study examined data from Russian HIV-infected risky drinkers enrolled in a randomized controlled trial of a behavioral intervention. The primary independent variable was cannabis use (current [past 30 days use], recent past [use but not in past 30 days] vs. no past year use). Primary outcomes were needle sharing and number of unprotected sexual episodes. Secondary outcomes were drug injection, number of injections, and multiple sex partners. Longitudinal regression analyses controlled for age, gender, marital status, education, CD4 count, ART use, risky alcohol use, other drug use, depressive symptoms and randomization group.

RESULTS

Cannabis use was common with 20% current and 26% recent past use at baseline. In longitudinal analyses current, but not recent past, cannabis consumption was significantly associated with needle sharing (AOR 2.23 current vs. none, 95% CI: 1.46, 3.36), drug injection (AOR 3.05 current vs. none, 95% CI: 2.06, 4.53) and number of injections (adjusted IRR 1.50 current vs. none, 95% CI: 1.19, 1.89). Current and recent past cannabis use were significantly associated with multiple sex partners but not with number of unprotected sex episodes.

CONCLUSION

Cannabis use was associated with drug and sex risk behaviors among Russian HIV-infected risky drinkers. Inquiry about cannabis use among HIV-infected patients may reveal a patient group at higher risk for sex and drug use behaviors that lead to HIV transmission.

Correlates of HIV risk behaviors among homeless and unstably housed young adults

OBJECTIVES

Homeless young adults are exposed to multiple risk factors for HIV infection. We identified HIV risk behaviors and their correlates among homeless young adults in Portland, Oregon.

METHODS

We conducted a community-based, cross-sectional survey of HIV risk behaviors among homeless young adults aged 18-25 years in 2010. Participants completed three study components: (1) an interviewer-administered survey of HIV risk behaviors; (2) a brief, client-centered HIV risk-based counseling session; and (3) rapid HIV testing.

RESULTS

Among 208 participants, 45.8% identified as racial/ethnic minority groups, 63.8% were male, and 35.7% self-identified as nonheterosexual. Six participants, all from sexual minority groups, had positive HIV screening results (two newly identified, four previously known) for a seropositivity rate of 2.9%. Female sex, belonging to a sexual minority group, frequent traveling between cities, depression, and alcohol use to intoxication were significantly associated with unprotected sex in univariate analysis. Female sex and high perceived risk of HIV were significantly associated with unprotected sex in multivariate analysis.

CONCLUSIONS

Our findings support the need for enhanced HIV prevention interventions for homeless young adults.

Marijuana use is associated with risky sexual behaviors in treatment-seeking polysubstance abusers

BACKGROUND

Multiple types of substance use are associated with HIV risk behaviors, but relatively little research has examined the association between marijuana use and risky sexual activities in treatment-seeking polysubstance abusing patients.

OBJECTIVES

This study evaluated the relationship between marijuana use and sexual behaviors in 239 patients with cocaine, opioid or alcohol use disorders who were initiating outpatient substance use treatment.

METHODS

Participants completed the HIV Risk Behavior Scale and were classified into one of three groups based on their marijuana use histories: never (n = 66), past but not current use (n = 124) or current use (n = 49).

RESULTS

Compared to never marijuana users, current and former marijuana users had a greater likelihood of having more than 50 lifetime sexual partners (odds ratio [OR] and 95% confidence interval [CI] = 3.9 [1.0-15.7] and 5.2 [1.6-17.3], respectively). Former marijuana users had increased risk of low frequency condom use with casual partners relative to never users (OR [95% CI] = 2.9 [1.1-7.6]). Moreover, current marijuana users were more likely than never users to have had more than two recent sexual partners (OR [95% CI] = 8.1 [1.94-33.44]).

CONCLUSION

Treatment-seeking polysubstance abusers with current or past marijuana use histories may be at greater risk of HIV infection than their counterparts who do not use marijuana. These data underscore the importance of increasing awareness about the potential association between marijuana use and increased high-risk sexual behavior among polysubstance abusing patients.

The relationship between victimization and substance use among homeless and runaway female adolescents

Each year, thousands of female adolescents run away from home due to sexual abuse, yet they continue to be victims of sexual assault once on the street. To date, few studies have examined how various forms of victimization are related to different types of substance use. The purpose of this article is to investigate the relationship between street exposure, childhood abuse, and different forms of street victimization with alcohol and marijuana use among 137 homeless and runaway female adolescents. Results from path analysis revealed that child sexual abuse was positively linked to trading sex and sexual and physical victimization. In addition, those who have traded sex experienced greater physical victimization, and who have spent more time away from home, used alcohol more frequently. Moreover, trading sex and experiencing more types of sexual victimization were positively linked to more frequent marijuana usage. Age, age at first run, longest time away from home, sexual abuse, and trading sex had significant indirect effects on alcohol and/or marijuana use. Together, these factors accounted for 27% of the variance in alcohol use and 37% of the variance in marijuana use.

The relationship between victimization and substance use among homeless and runaway female adolescents

Each year, thousands of female adolescents run away from home due to sexual abuse, yet they continue to be victims of sexual assault once on the street. To date, few studies have examined how various forms of victimization are related to different types of substance use. The purpose of this article is to investigate the relationship between street exposure, childhood abuse, and different forms of street victimization with alcohol and marijuana use among 137 homeless and runaway female adolescents. Results from path analysis revealed that child sexual abuse was positively linked to trading sex and sexual and physical victimization. In addition, those who have traded sex experienced greater physical victimization, and who have spent more time away from home, used alcohol more frequently. Moreover, trading sex and experiencing more types of sexual victimization were positively linked to more frequent marijuana usage. Age, age at first run, longest time away from home, sexual abuse, and trading sex had significant indirect effects on alcohol and/or marijuana use. Together, these factors accounted for 27% of the variance in alcohol use and 37% of the variance in marijuana use.

Individual and Social Network Sexual Behavior Norms of Homeless Youth at High Risk for HIV Infection

Although previous research shows that homeless youth engage in numerous risky sexual behaviors, little is known about whether or not specific rules govern this conduct within their social networks and how group norms influence subsequent sexual actions. The current study utilizes 19 in-depth interviews with homeless youth to investigate different elements of their sexual behavior. Findings reveal that their decision to have sex generally depends on chemistry and physical appearance whereas a potential partner's risky sexual history and heavy substance use discourages youth from engaging in sex. Both males and females discuss condom usage as it relates to unknown sexual history, availability, pregnancy, and the prevention of sexually transmitted infections (STIs). Sixteen homeless youth indicate that they do not discuss safe sex practices with their partners or social network members.

Social network and individual correlates of sexual risk behavior among homeless young men who have sex with men

PURPOSE

There is growing interest in network-based interventions to reduce HIV sexual risk behavior among both homeless youth and men who have sex with men. The goal of this study was to better understand the social network and individual correlates of sexual risk behavior among homeless young men who have sex with men (YMSM) to inform these HIV prevention efforts.

METHODS

A multistage sampling design was used to recruit a probability sample of 121 homeless YMSM (ages: 16-24 years) from shelters, drop-in centers, and street venues in Los Angeles County. Face-to-face interviews were conducted. Because of the different distributions of the three outcome variables, three distinct regression models were needed: ordinal logistic regression for unprotected sex, zero-truncated Poisson regression for number of sex partners, and logistic regression for any sex trade.

RESULTS

Homeless YMSM were less likely to engage in unprotected sex and had fewer sex partners if their networks included platonic ties to peers who regularly attended school, and had fewer sex partners if most of their network members were not heavy drinkers. Most other aspects of network composition were unrelated to sexual risk behavior. Individual predictors of sexual risk behavior included older age, Hispanic ethnicity, lower education, depressive symptoms, less positive condom attitudes, and sleeping outdoors because of nowhere else to stay.

CONCLUSIONS

HIV prevention programs for homeless YMSM may warrant a multipronged approach that helps these youth strengthen their ties to prosocial peers, develop more positive condom attitudes, and access needed mental health and housing services.

Homeless youth's overwhelming health burden: A review of the literature

Homelessness has reached epidemic proportions in Canada. Canadian children and adolescents are the most vulnerable because youth comprise the fastest growing segment of the homeless population. A systematic literature review was undertaken using MEDLINE, Web of Science and the Homeless Hub (www.homelesshub.ca) to encompass the time frame from January 1990 to June 2009. The following terms were used as key words: 'homelessness', 'homeless youth', 'poverty', 'street youth' and 'runaway'. The present review identified an intersection among education deficits, social service insufficiencies, and poor mental and physical health in homeless youth. Health care delivery to homeless youth was often nonanticipatory, inconsistent and perceived as discriminatory. However, street youth were identified as requiring health care for pregnancy, mental health concerns, sexually transmitted illnesses, respiratory conditions, substance abuse and a myriad of other illnesses. Plenty of work is still required to reduce health inequalities and improve the daily living conditions of Canadian youth living in poverty.

Substance use and other risk factors for unprotected sex: results from an event-based study of homeless youth

This study used an event-based approach to understand condom use in a probability sample of 309 homeless youth recruited from service and street sites in Los Angeles County. Condom use was significantly less likely when hard drug use preceded sex, the relationship was serious, the partners talked about "pulling out", or sex occurred in a non-private place (and marginally less likely when heavier drinking preceded sex, or the partnership was monogamous or abusive). Condom use was significantly more likely when the youth held positive condom attitudes or were concerned about pregnancy, the partners talked about condom use, and the partners met up by chance. This study extends previous work by simultaneously examining a broad range of individual, relationship, and contexual factors that may play a role in condom use. Results identify a number of actionable targets for programs aimed at reducing HIV/STI transmission and pregnancy risk among homeless youth.

Correlates of service utilization among homeless youth

Though few studies exist on service utilization among homeless youth in the U.S., services are important because without them, many of these young people may resort to delinquent strategies in order to meet their daily survival needs. The current study examines frequency and correlates of service utilization (i.e., shelters, food programs, street outreach, counseling, STI and HIV testing) among a sample of 249 homeless youth ages 14 to 21. Multivariate analysis revealed significant differences in service usage by sex, age, and sexual orientation. Experiencing family physical and/or sexual abuse, being kicked out of the family home, spending more nights per week sleeping on the street, and having ever stayed in a group home facility were significant correlates of homeless youths' service usage.

The mental and physical health of homeless youth: a literature review

Youth homelessness is a growing concern in the United States. Despite difficulties studying this population due to inconsistent definitions of what it means to be a youth and homeless, the current body of research indicates that abuse, family breakdown, and disruptive family relationships are common contributing factors to youth homelessness. Moreover, the experience of homelessness appears to have numerous adverse implications and to affect neurocognitive development and academics, as well as mental and physical health. Substance use, sexually transmitted infections, and psychiatric disorders are particularly prevalent in this population. Whereas some of these problems may be short-lived, the chronic stress and deprivation associated with homelessness may have long-term effects on development and functioning. Further, difficulties accessing adequate and developmentally-appropriate health care contribute to more serious health concerns. Suggestions for future research and interventions are discussed.

Decision Processes about Condom Use among Shelter-Homeless LGBT Youth in Manhattan

Health behavior interventions based on Theory of Planned Behavior address participants' personally-held beliefs, perceived social norms, and control over the behavior. New data are always needed to "member check" participants' decision processes and inform interventions. This qualitative study investigates decision processes around condom use among 81 homeless LGBT youth ages 18-26. Findings indicated considerable endorsement of the conventional policy of always using condoms, promulgated in HIV prevention education targeting this population. Although some participants reported risk behavior in contexts of sex work, survival sex, casual encounters, open relationships, and substance use, most were aware of these risks and consistently safe in those situations. Condoms use boundaries became vulnerable in states of emotional need and negative mood. The only effect participants acknowledged of homelessness on condom use was indirect, through negative mood states. The most prevalent context of condom non-use was with long-term primary partners, a potential area of vulnerability because, of 13 participants for HIV or HCV, nine mentioned how they had been infected, and all nine believed they had acquired it from a primary partner. Findings imply programs should emphasize HIV risk potential within long-term romantic partnerships and mental health services to remediate negative mood states.

The influence of marijuana and alcohol use on condom use behavior: findings from a sample of young adult female bar drinkers

Prevalence data indicate that alcohol and marijuana are frequently used intoxicants among young adults in the United States. In a number of studies, both alcohol use and marijuana use have been associated with failure to use condoms, a high-risk sexual behavior. The purpose of the current study was to assess the individual and additive effects of alcohol and marijuana use on this risky sexual behavior among 251 young adult, female bar drinkers. Multilevel modeling was used to assess the likelihood of condom use during sexual events that occurred as a function of substance use (none, only alcohol, only marijuana, or both) prior to and partner type (known or casual) during the event, as well as individual differences in sexual assertiveness. Initial model testing (Levels 1 and 2) revealed that there were significant main effects for partner type (known), substance use (alcohol and marijuana) and sexual assertiveness (refusal, pregnancy/STI prevention) on risky sex. Final model testing indicated that sexual assertiveness interacted with substance use to influence risky sex. Women who were low in sexual assertiveness refusal were more likely to engage in risky sex on days when they had consumed both alcohol and marijuana prior to the sexual activity. These findings highlight the complex nature of the relationship between substance use and risky sex.

Risk and protective factors related to HIV-risk behavior: a comparison between HIV-positive and HIV-negative young men who have sex with men

The objective of this study was to assess and compare the prevalence of high-risk sexual behaviors among young HIV-negative (n=8064) and HIV-positive (n=171) men who have sex with men (MSM) on predictors of unprotected anal intercourse (UAI). Using venue-based time-space sampling, 8235 MSM aged 15-25 were anonymously surveyed as a part of the Community Intervention Trial for Youth (CITY). The Project was conducted in 13 communities across the USA from 1999 to 2002. Forty percent of HIV-positive men and 34% of HIV-negative men reported that they had UAI in the previous 3 months. HIV-positive MSM were more likely than their uninfected peers to have traded sex within the previous year, to have had sex while high during their last sexual encounter, and to have UAI with a greater number of partners. Multivariate analyses indicated that for HIV-negative men, positive peer norms regarding safer sex and being Black or Latino predicted avoidance of UAI. Among HIV-positive men, having social support for safer sex and positive peer norms predicted avoidance of UAI. Young HIV-positive MSM are a relevant subgroup for prevention because they constitute a significant source from which future infections could be generated.

TREATMENT TRIAL AND LONG-TERM FOLLOW-UP EVALUATION AMONG COMORBID YOUTH WITH MAJOR DEPRESSION AND A CANNABIS USE DISORDER

OBJECTIVE

This study compared the acute phase (12-week) and the long-term (1 year) efficacy of fluoxetine versus placebo for the treatment of the depressive symptoms and the cannabis use of youth with comorbid major depressive disorder (MDD) and an cannabis use disorder (CUD)(cannabis dependence or cannabis abuse). We hypothesized that fluoxetine would demonstrate efficacy in the acute phase trial and at the 1-year follow-up evaluation. Data is also provided regarding the prevalence of risky sexual behaviors in our study sample.

METHODS

We recently completed the first double-blind placebo-controlled study of fluoxetine in adolescents and young adults with comorbid MDD/CUD. A total of 70 persons participated in the acute phase trial, and 68 of those persons (97%) also participated in the 1-year follow-up evaluation. Results of the acute phase study have already been presented (Cornelius, Bukstein, et al., 2010), but the results of the 1 year follow-up assessment have not been published previously. All participants in both treatment groups also received manual-based cognitive behavioral therapy (CBT) and motivation enhancement therapy (MET) during the 12-week course of the study. The 1-year follow-up evaluation was conducted to assess whether the clinical improvements noted during the acute phase trial persisted long term.

RESULTS

During the acute phase trial, subjects in both the fluoxetine group and the placebo group showed significant within-group improvement in depressive symptoms and in cannabis-related symptoms. However, no significant difference was noted between the floxetine group and the placebo group on any treatment outcome variable during the acute phase trial. End of study levels of depressive symptoms were low in both the fluoxetine group and the placebo group. Most of the clinical improvements in depressive symptoms and for cannabis-related symptoms persisted at the 1-year follow-up evaluation.

CONCLUSIONS

Fluoxetine did not demonstrate greater efficacy than placebo for treating either the depressive symptoms or the cannabis-related symptoms of our study sample during the acute phase study or at the 1-year follow-up assessment. The lack of a significant treatment effect for fluoxetine may at least in part reflect efficacy of the CBT/MET psychotherapy. A persistence of the efficacy of the acute phase treatment was noted at the 1-year follow-up evaluation, suggesting long-term effectiveness for the CBT/MET psychotherapy.

Risk Factors for Homelessness Among Lesbian, Gay, and Bisexual Youths: A Developmental Milestone Approach

Lesbian, gay, and bisexual (LGB) youths are over-represented in the homeless population. To examine why some LGB youths become homeless, this report compares homeless and non-homeless LGB youths. Of the 156 LGB youths, 48% reported ever being homeless (i.e., running away or being evicted from home). Results indicate that sexual orientation awareness and the initiation of sexual behavior occurred earlier in homeless than in non-homeless LGB youths and predated the first homeless episode. Substance use was more frequent and first occurred at an earlier age in homeless as compared to non-homeless LGB youths; however, substance use occurred subsequent to first homelessness. Childhood sexual abuse was associated with homelessness; and, early sexual orientation development was related to homelessness among youths without a history of sexual abuse. Findings suggest that interventions should help youths cope with their unfolding sexual orientation and work to prevent or address the consequences of sexual abuse.

Increased substance use and risky sexual behavior among migratory homeless youth: exploring the role of social network composition

Travelers are a migratory subgroup of homeless youth who may be especially prone to engaging in risky behavior. This study compared the substance use and sexual behavior of young homeless travelers and non-travelers to evaluate the extent and possible sources of travelers' increased risk. Data came from face-to-face interviews with 419 homeless youth (36.6% female, 34.0% white, 23.9% African American, and 20.0% Hispanic) between the ages of 13 and 24 years (M = 20.1 years, SD = 2.5) who were randomly sampled from 41 shelters, drop-in centers, and street sites in Los Angeles. Travelers were almost twice as likely as non-travelers to exhibit recent heavy drinking, 37% more likely to exhibit recent marijuana use, and five times as likely to have injected drugs. Travelers also had more recent sex partners and were more likely to report having casual or need-based sexual partners and combining sex with substance use. Mediation analyses suggest that travelers' deviant peer associations and disconnection to conventional individuals and institutions may drive their elevated substance use. Differences in sexual risk behaviors are likely attributable to demographic differences between the two groups. Overall, these differences between travelers and non-travelers suggest different service needs and the need for different service approaches.

Correlates of engaging in survival sex among homeless youth and young adults

Using a sample of 1,625 homeless youth and young adults aged 10 to 25 from 28 different states in the United States, this study examines the correlates of having engaged in survival sex. Findings suggest that differences exist based on demographic variables (gender, age, race, and sexual orientation), lifetime drug use (inhalants, Valium™, crack cocaine, alcohol, Coricidin™, and morphine), recent drug use (alcohol, ecstasy, heroin, and methamphetamine), mental health variables (suicide attempts, familial history of substance use, and having been in substance abuse treatment), and health variables (sharing needles and having been tested for HIV). In addition to replicating previous findings, this study's findings suggest that African American youth; gay, lesbian, or bisexual youth; and youth who had been tested for HIV were significantly more likely to have engaged in survival sex than White, heterosexual youth, and youth who had not been tested for HIV, respectively. Implications for interventions with youth and suggestions for future research are discussed.

Homelessness among lesbian, gay, and bisexual youth: implications for subsequent internalizing and externalizing symptoms

Although lesbian, gay, and bisexual (LGB) youth with a history of homelessness (running away or being evicted from their homes by parents) report more psychological symptoms than homeless heterosexual peers, it is unclear whether symptoms are due to homelessness, given the absence of a non-homeless comparison group. This study longitudinally investigates whether LGB youth with a history of homelessness report more subsequent psychological symptoms than non-homeless LGB youth and examines potential mediators of any such relationships. Of the 156 LGB youth interviewed (49% female; 78% non-White), 48% reported past homeless experiences. Homelessness was associated with subsequent symptoms of anxiety, depression, conduct problems, and substance abuse and to changes in symptoms over time even after controlling for childhood sexual abuse and early development of sexual orientation. Stressful life events, negative social relationships, and social support from friends mediated the relationships between homelessness and symptomatology. These findings suggest the need for interventions to reduce stress and enhance social support among LGB youth with a history of homelessness in order to reduce psychological symptoms.

Event-level marijuana use, alcohol use, and condom use among adolescent women

BACKGROUND

It is widely believed that marijuana use and alcohol use directly intercede on successful condom use. However, measurement differences and inconsistent findings in past research remain unclear whether marijuana and alcohol work directly to influence condom behavior, or spuriously function through other factors that actually reflect an increased likelihood of vaginal sex. The current study prospectively disentangles the association of marijuana and alcohol use on condom behavior among adolescent women.

METHODS

Young women (N=387; 14-17 years) provided daily sexual diaries as part of a longitudinal cohort study (1999-2009) of sexual behavior and sexual relationships. To separate the effects of marijuana and alcohol use on vaginal sex from condom use (when vaginal sex occurs), we estimated a 3-category outcome variable (no vaginal sex, vaginal sex with a condom, vaginal sex without a condom), alternating no sex (Model 1) and sex without a condom (Model 2) as the referent categories. Generalized estimating equation multinomial logistic regression adjusted odds ratios for multiple sexual events from the same young woman over time.

RESULTS

Subjects contributed 14,538 coital events; 30% of these events were condom-protected. Neither marijuana nor alcohol use was directly associated with lower condom use; the strongest effect of condom use (adjusted odds ratio) and nonuse was performance of these behaviors in the past week.

CONCLUSIONS

This study finds no evidence of a relationship between marijuana or alcohol use and condom nonuse. Both condom use and nonuse were identified as consistent behavioral patterns, regardless of the effect of marijuana and alcohol use.

The effect of drug and sexual risk behaviours with social network and non-network members on homeless youths' sexually transmissible infections and HIV testing

BACKGROUND

The study examined whether engaging in drug and sexual risk behaviours with social network and non-network members (strangers) differentially affected the decision to test for sexually transmissible infections (STIs) and HIV.

METHODS

A cross-sectional survey was conducted among 249 homeless youths aged 14-21 years.

RESULTS

Multivariate analyses revealed that females were over three times more likely than males to test for STIs (adjusted odds ratio (AOR) = 3.34; 95% confidence interval (CI) = 1.54-7.25). For every one unit increase in age, there was a 37% increase in the likelihood of having tested for STIs (AOR = 1.37; 95% CI = 1.12-1.68). Youths who had sex after using alcohol and drugs with strangers were approximately 3.5 times more likely to have tested for STIs (AOR = 3.45; 95% CI = 1.38-8.61). For every one unit increase in age, there was a 26% increase in the likelihood of having tested for HIV (AOR = 1.26; 95% CI = 1.05-1.51). Youths who had sex with a stranger after using alcohol or drugs were over three times more likely to test for HIV (AOR = 3.22; 95% CI = 1.42-7.31). No social network variables reached significance for STI or HIV testing.

CONCLUSIONS

Being older and engaging in drug and sexual risk behaviours with strangers are important correlates of STI and HIV testing. Females are more likely than males to be tested for STIs. Engaging in risky behaviours with social network members was not a key factor in deciding whether to be tested.

Social control correlates of arrest behavior among homeless youth in five U.S. cities

This study identified homelessness, substance use, employment, and mental health correlates of homeless youths' arrest activity in 5 cities. Two hundred thirty-eight street youth from Los Angeles, Austin, Denver, New Orleans, and St. Louis were recruited using comparable sampling strategies. Ordinary least squares (OLS) regression results reveal that being arrested for criminal activity is associated with length of homelessness, history of juvenile detention and incarceration, receiving income from theft, substance abuse, and mental illness. Arrests are also associated with interactions between lack of formal employment income and receiving income from theft and between drug and alcohol abuse/ dependency. Understanding the health and situational factors associated with homeless youths' delinquent activity has implications for providing more comprehensive health, mental health, and substance abuse services.

Protective factors associated with fewer multiple problem behaviors among homeless/runaway youth

Although homeless youth exhibit numerous problem behaviors, protective factors that can be targeted and modified by prevention programs to decrease the likelihood of involvement in risky behaviors are less apparent. The current study tested a model of protective factors for multiple problem behavior in a sample of 474 homeless youth (42% girls; 83% minority) ages 12 to 24 years. Higher levels of problem solving and planning skills were strongly related to lower levels of multiple problem behaviors in homeless youth, suggesting both the positive impact of preexisting personal assets of these youth and important programmatic targets for further building their resilience and decreasing problem behaviors. Indirect relationships between the background factors of self-esteem and social support and multiple problem behaviors were significantly mediated through protective skills. The model suggests that helping youth enhance their skills in goal setting, decision making, and self-reliant coping could lessen a variety of problem behaviors commonly found among homeless youth.

The effect of early maltreatment, victimization, and partner violence on HIV risk behavior among homeless young adults

PURPOSE

The purpose of our study was to examine the relationship between child maltreatment, physical and sexual victimization, and partner violence victimization with human immunodeficiency virus (HIV) risk behaviors among a sample of homeless young adults from the midwestern United States.

METHODS

Data are from the Homeless Young Adult Project. A total of 199 young adults aged 19-26 years were interviewed over 14 months using a systematic sampling strategy. The final sample included 172 young adults who were homeless or had a history of running away and being homeless.

RESULTS

Results from the path analysis revealed that sexual abuse is directly linked with street sexual victimization which was positively associated with a greater number of HIV risk behaviors. Experiencing more types of physical abuse and neglect were positively correlated with partner violence victimization, which was, in turn, associated with more HIV risk behaviors. Those who suffered from more types of neglect also experienced more forms of sexual and physical victimization.

CONCLUSIONS

These findings have implications for service providers. Clinicians who serve homeless youth should recognize the potential effect that experiencing a variety of forms of victimization may have on health risk behaviors.

The contribution of male and female partners' substance use to sexual risks and STDs among African American HIV serodiscordant couples

Growing evidence suggests that drug and alcohol use are fueling the heterosexual transmission of HIV among African Americans. This study aims to examine the relative contribution of drug and alcohol use of male and female partners to risks of heterosexual transmission of HIV among 535 African American HIV serodiscordant couples (N = 1,070 participants) who participated in an HIV prevention trial. Associations found between use of drugs and alcohol by one or both partners and sexual risk indicators varied by type of substance and whether male or female partner or both partners reported use. The findings suggest multiple ways in which substance use of male and female partners may be contributing to the heterosexual transmission of HIV and other STDs among African Americans and underscore the need for HIV prevention strategies to address dyadic patterns of substance use that lead to sexual risks.