Predictors of Abstinence Self-Efficacy: Examining the role of HIV-risk Sexual Behavior

Abstinence self-efficacy, or the confidence in ones' beliefs in one's ability to effectively engage in behaviors to maintain substance use abstinence, is a crucial recovery resource. However, little research has been conducted on what predicts increases in this recovery resource. Understanding predictors of abstinence self-efficacy could help social service practitioners in creating effective treatment plans/interventions while extending what is presently known in this small body of research. Predictors of abstinence self-efficacy were analyzed among a sample of ex-offenders (224 men and 46 women) who were completing inpatient treatment for substance use disorders. Hierarchical linear regression was conducted to examine changes in participants' abstinence self-efficacy in relation to factors directly related (HIV-risk drug use behaviors, substance use, 12-step meeting attendance) and indirectly related (HIV-risk sexual behaviors, incarceration histories) to substance use. HIV-risk sexual behaviors and substance use predicted significant decreases in abstinence self-efficacy whereas 12-step meeting attendance predicted significant increases. However, incarceration histories and HIV-risk drug use behaviors were not significant predictors of abstinence self-efficacy. Findings suggest HIV-risk sexual behavior should be considered when assessing relapse prevention for persons with substance use disorders, and that researchers should examine behaviors that are not directly related to substance use when investigating recovery resources.

Age and HIV sexual risk among women in methadone treatment

This study examines the relationship between age and HIV sexual risk behaviors among a random sample of 372 women in methadone treatment in New York City. Logistic regression results indicate that women of all ages are at risk for HIV through inconsistent condom use. Exposure to intimate partner violence (IPV), alcohol use, and HIV-negative status are associated with inconsistent condom use during vaginal sex. Age (35-44), having a main sexual partner with an HIV risk factor, IPV, and alcohol use are associated with using crack or cocaine during sex. Similarly, age (35-44), having a main sexual partner with an HIV risk factor, IPV, and drug use are associated with consuming four or more drinks prior to sex. The findings highlight the importance of age-appropriate HIV prevention and intervention strategies, as well as the need to address intimate partner violence, mental health, polysubstance use, and relational factors associated with HIV sexual risk behaviors among women in methadone treatment.

Gender differences in high risk sexual behaviors and injection practices associated with perceived HIV risk among injection drug users

This study compared male and female injection drug users (IDUs) on perceived risk of contracting HIV and examined the associations between risk perceptions and sharing injection drugs or equipment, engaging in casual sex, and engaging in commercial sex. We used baseline data from 271 IDUs recruited between 2000 and 2005 from the Baltimore, Maryland site of the International Neurobehavioral HIV Study. We found that although there was no significant difference in levels of perceived risk between males and females, males reported significantly more casual sex, whereas females reported more commercial sex. Logistic regression analyses with the entire sample indicated that sharing of injection drugs or equipment was consistently associated with greater perceived risk. We also found a significant interaction between gender and having had casual sex, such that females who had engaged in casual sex were significantly more likely to perceive that they were at greater risk for contracting HIV. Our results suggest that male IDUs should be targeted for HIV risk-reduction programs focusing on casual and commercial sex.

Unprotected casual sex and perceived risk of contracting HIV among drug users in Baltimore, Maryland: evaluating the influence of non-injection versus injection drug user status

The purpose of this study was to assess the relative importance and interactive effects of drug use status (i.e. injection or non-injection drug user) and condom use with casual partners in predicting perceived risk of contracting HIV among drug users in Baltimore, Maryland. Baseline data was used from the longitudinal NEURO-HIV Epidemiological Study. This battery of questionnaires assessed a variety of demographic, drug use and sex risk variables. The current study examined these variables in association with perceived risk of contracting HIV. Significant covariates included having at least some college education (AOR=.42, 95%CI=.20, .89), knowing someone who is HIV-positive (AOR = 1.82, 95%CI = 1.15, 2.89), using drugs twice (AOR = 2.02, 95%CI = 1.02, 3.99) or more (AOR = 2.22, 95%CI = 1.22, 4.04) per day and having unprotected casual sex (AOR = 2.51, 95%CI = 1.42, 4.41). These covariates explained 15% of the variance in perceived HIV risk. A significant interaction between type of drug user and having unprotected casual sex revealed that the greatest likelihood of perceived HIV risk associated with unprotected casual sex occurred among non-injection drug users. The results suggest that non-injection drug users are aware of their risk for contracting HIV if they engage in unprotected casual sex. Future HIV-prevention programs should build on this awareness by targeting this subgroup of drug users for condom-use interventions with casual partners. Additional programs should target injection drug users to increase their perceived risk of contracting HIV through unprotected casual sex.