Alcohol consumption, drug use, and condom use among STD clinic patients

Condom Use at Last Sex and Sexual Negotiation Among Young African American Women in North Carolina: Context or Personal Agency

African American women are 10.8 times more likely to be diagnosed with HIV compared with White women. This descriptive study fills a gap by examining associations among social and contextual factors and sexual communication, condom use, and safer sex negotiation among African American women. Study participants between 18 and 25 years of age and who reported recent substance use were recruited from three North Carolina counties. A risk behavior survey was administered via audio computer-assisted self-interview, and logistic regression analyses were conducted to assess associations between social and contextual variables and condom use at last sex with a main partner. Education (AOR: 2.078; 95% CI: 1.214, 3.556), sexual communication with a main partner (AOR: 1.079; 95% CI: 1.050, 1.109), and condom use relationship scale (AOR: 1.059; 95% CI: 1.023, 1.098) were positively associated with condom use at last sex, whereas living with a main partner (AOR: 0.447; 95% CI: 0.210, 0.950) and the alcohol and drug problem scale (AOR: 0.971; 95% CI: 0.944, 0.998) were negatively associated with condom use (p < 0.05). The study findings show that among young African American women at risk for HIV, contextual and personal factors may influence condom use. A socio-ecological approach combining personal empowerment, interpersonal, structural, and biobehavioral strategies is necessary in implementing holistic gender-focused HIV prevention programs.

Elevated risk of sexually transmitted infections among adolescents and young adults with borderline personality disorder: a retrospective longitudinal nationwide population-based study

In this study, we examined the risk of sexually transmitted infections (STIs) among adolescents and young adults (AYAs) with borderline personality disorder (BPD). A total of 4649 AYAs with BPD and 46,490 age-, sex-, and socioeconomic-matched controls without BPD were enrolled from the National Health Insurance Research Database of Taiwan from 2001 to 2009 and were followed up until the end of 2011. Participants who contracted any STI during the follow-up period were identified. Cox regression analysis was conducted to examine the risk of contracting any STI among both patients and controls. A total of 4649 AYAs with BPD and 46,490 age-, sex-, and socioeconomic-matched controls without BPD were enrolled from the National Health Insurance Research Database of Taiwan from 2001 to 2009 and were followed up until the end of 2011. Participants who contracted any STI (ICD-9-CM code 042, 091-097, 087.11, 078.8, 078.88, 131, and 054.1) during the follow-up period were identified. Cox regression and sub-analyses stratified by sex, age, psychiatric comorbidity subgroups, and psychotropic medication usage were conducted to assess STI risk. AYAs with BPD were at a higher risk of contracting any STI (hazard ratio [HR] = 50.79, 95% confidence interval [CI] = 33.45-77.11) in comparison with controls, including HIV, syphilis, genital warts, gonorrhea, chlamydia, trichomoniasis, and genital herpes. The association of BPD with an increased risk of any STI was prevalent in both sexes, adolescents, and young adult patients. BPD with or without psychiatric comorbid subgroup were all associated with an elevated risk of contracting any STI relative to the control group. AYAs with BPD are highly susceptible to contracting STIs. Future studies should examine the role of the core symptoms of BPD, sexual orientation, risky sex behaviors, depressive and anxiety symptoms, and substance use before sex in the risk of STIs among AYAs with BPD.

Sexual behavioral factors of the subjects visiting the clinic of sexually transmitted infections in Northern Finland: A cross-sectional study among 775 subjects

Background and Aims

Sexually transmitted infections (STI) are among the most common infections globally. However, the sexual behavioral factors and sexual history of people visiting STI clinics have only been surveyed in a few studies. We aimed to evaluate the characteristics of the patients visiting the open STI clinic.

Methods

This is a prospective observational study performed in the STI clinic in the premises of Department of Dermatology, Oulu University Hospital. All individuals (n = 775) attending the STI clinic between February and August 2022 were included to the study and the profile of the patients was evaluated.

Results

We found that the majority of the STI clinic attendees (58.5%) were female. Mean age of the study population was 28.9 years, with females being significantly younger than males (p < 0.001). Only one-third (30.6%) of the patients reported having symptoms at the time of attending. Most commonly, patients had had one sex partner in the last 6 months. However, one-fifth (21.7%) reported several sex partners (over four). Almost half of the patients (47.6%) reported using a condom only randomly. Those with heterosexual orientation had fewer multiple-sex partners (p < 0.001) than those with homo- or bisexual orientation (p < 0.05).

Conclusion

It is important to increase knowledge about the profile of STI clinic visitors to effectively target STI prevention on the groups at the highest risk of STIs.

Screening for co-infections in patients with substance use disorders and severe bacterial infections

Background

Patients with substance use disorders admitted for severe bacterial infection are in a prime position to be screened for important co-infections. However, data suggest that standard screening for co-infections in this population during hospital admission can vary in frequency and type of testing.

Methods

We performed a retrospective review of patients to evaluate screening for co-infections during admission, followed by a case-control analysis to determine factors associated with lack of any screening.

Results

We identified 280 patients with 320 eligible admissions. Most were male and Caucasian with unstable housing. Only 67 (23.9%) patients had a primary-care provider. About 89% (n = 250) of our cohort were screened for one or more co-infection during their first admission with one patient never screened despite subsequent admissions. Of those screened, the greatest proportion was HIV (219, 81.4% of those without history of HIV), HCV (94, 79.7% of those without a prior positive HCV antibody), syphilis (206, 73.6%), gonorrhea, and chlamydia (47, 16.8%) with new positive tests identified in 60 (21.4%) people. Screening for all five co-infections was only completed in 15 (14.0%) of the 107 patients who had screening indications. Overall, a high proportion of those screened had a new positive test, including three cases of neurosyphilis, highlighting the importance of screening and treatment initiation. One patient was prescribed HIV pre-exposure prophylaxis at discharge and only 37 (34.6%) of those eligible were referred for HCV treatment or follow-up. In multivariable case-control analysis, non-Medicaid insurance (OR 2.8, 95% CI: 1.2-6.6, p = 0.02), use of only 1 substance (OR 2.9, 95% CI: 1.3-6.5, p < 0.01), and no documented screening recommendations by the infectious disease team (OR 3.7, 95% CI: 1.5-8.8, p < 0.01), were statistically significantly associated with lack of screening for any co-infection during hospital admission.

Conclusion

Our data suggest additional interventions are needed to improve inpatient screening for co-infections in this population.

The effect of expressive writing on sexual risk behavior among college women

Objective: The current study tested an expressive writing intervention aimed at reducing alcohol use and sexual risk behavior among college women that consume alcohol. Methods: A 2 X 2 mixed between- within-subjects experimental design was utilized to test the effect of expressive writing on alcohol use and sexual risk behavior over time among college women that drink. Study participants completed baseline assessments of alcohol use and sexual risk behavior and were randomly assigned to either a control writing condition (first day of college) or an expressive writing condition (negative alcohol-related event). Participants completed baseline assessments 30 days later. Data for this study were collected in the Fall 2017 semester. Results: A significant interaction effect was found for writing condition over time on sexual risk behavior. Conclusion: Findings provide preliminary support for the use of expressive writing as mechanism to reduce sexual risk behavior among college women that consume alcohol.

Sex Under the Influence of Drugs Among People Who Use Drugs in Cambodia: Findings From a National Survey

Studies in drug use settings rarely use sex under the influence of drugs as an indicator of sexual risk behaviors. This study explored the prevalence of sex under the influence of drugs and its correlates among people who use drugs (PWUD) in Cambodia. We included 1147 PWUD from 12 provinces in this study. A multiple logistic regression analysis was conducted to identify factors associated with sex under the influence of drugs. Of the total, 39.7% reported having had sex under the influence of drugs in the past three months. After adjustment, sex under the influence of drugs was significantly associated with living in urban areas (AOR 2.97, 95% CI 1.68-5.27), having two to three (AOR 2.48, 95% CI 1.76-3.49) and four or more sexual partners (AOR 6.46, 95% CI 4.24-9.85), engaging in transactional sex (AOR 1.69, 95% CI 1.19-2.39), using methamphetamine (AOR 2.97, 95% CI 2.06-4.31), using drugs for three years or longer (AOR 1.67, 95% CI 1.15-2.41), having been to a drug rehabilitation center (AOR 1.77, 95% CI 1.18-2.41), having a network of ten or more PWUD (AOR 1.82, 95% CI 1.25-2.66), and having high psychological distress (AOR 1.66, 95% CI 1.25-2.22). This study documents the high prevalence of sex under the influence of drugs and its risk factors among male and female PWUD in Cambodia. These findings point to the need for integrating HIV and harm-reduction programs using innovative approaches to address the overlapping risks in this key population.

Role of the Intersections of Gender, Race and Sexual Orientation in the Association between Substance Use Behaviors and Sexually Transmitted Infections in a National Sample of Adults with Recent Criminal Legal Involvement

Limited research has focused on how substance use and sexual risk behaviors differ among individuals impacted by the criminal legal system based on social identities. Using the National Survey on Drug Use and Health, we estimated relative risk for reporting a sexually transmitted infection (STI) among intersectional social groups with criminal legal involvement using a modified Poisson regression. We then utilized multivariate logistic regression and marginal effects to measure associations between substance use behaviors and STIs and to estimate whether these varied among the intersectional social groups with elevated STI rates. Three groups had elevated risk of reporting an STI compared to white, heterosexual men: white, heterosexual women (1.53, 95% CI: 1.05-2.20); Black, heterosexual women (2.03, 95% CI: 1.18-3.49); and white, gay or bisexual men (5.65, 95% CI: 2.61-12.20). Considering the intersections of gender, race, and sexual orientation, elevated risks for STIs among white and Black heterosexual women were mitigated after adjusting for substance use alongside other confounders. Only those who identified as white, gay or bisexual, and male had increased STI risk after controlling for substance use. Interventions targeting Black and white heterosexual women's sexual health following incarceration should focus on substance use and interventions targeting white, gay or bisexual men should focus on healthy sexual behaviors, HIV/STI screening, and care continuum efforts.

Substance Use-Related Intentional Nonadherence to Antiretroviral Therapy Among Young Adults Living with HIV

Antiretroviral therapy (ART) reduces HIV disease burden, increases life expectancy, and prevents HIV transmission. Previous research suggests that believing that it is harmful to take ART when using substances (i.e., interactive toxicity beliefs) leads to intentional ART nonadherence; however, these associations have not been investigated among younger adults living with HIV and have not been linked to clinical outcomes. We examined the associations among interactive toxicity beliefs, intentional nonadherence, and HIV clinical outcomes in young adults living with HIV. People living with HIV younger than the age of 36 years who tested positive for at least one substance use biomarker (N = 406) completed a 1-month pretrial run-in study that included computerized interviews, substance use biomarkers, HIV viral load, and unannounced pill counts for ART adherence. Analyses compared three HIV clinical outcome groups: (1) HIV viral unsuppressed, (2) HIV viral suppressed and ART nonadherent, and (3) HIV viral suppressed and ART adherent, on substance use, interactive toxicity beliefs, and substance use-related intentional ART nonadherence. Results showed that a majority of participants reported intentional nonadherence. Participants with unsuppressed HIV reported greater interactive toxicity beliefs and intentional nonadherence. We conclude that intentional nonadherence adds to the detrimental impacts of substance use on ART adherence and interactive toxicity beliefs that foster these behaviors may be amenable to interventions.

Computer delivered intervention for alcohol and sexual risk reduction among women attending an urban sexually transmitted infection clinic: A randomized controlled trial

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Unhealthy alcohol use is prevalent among women attending STI clinics.

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We tested whether CBI or CBI-IVR-TM, reduced alcohol use among women in this setting.

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Neither CBI nor CBI-IVR-TM reduced alcohol use more than control.

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2/3 of women had an alcohol use disorder, 65% substance use, 28% depressive symptoms.

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CBI is insufficient for alcohol reduction in this high severity, high comorbidity setting.

Objective

We sought to determine if a computer delivered brief alcohol intervention (CBI) with or without interactive voice response counseling and text messages (CBI-IVR-TM), reduced alcohol use and sexual risk behaviors compared to attention control.

Methods

We conducted a 3-arm RCT among women (n = 439) recruited from Baltimore City Sexually Transmitted Infection (STI) Clinics. Eligibility included: 1) consumption of >7 drinks per week or 2) ≥2 episodes of heavy episodic drinking or ≥2 episodes of sex under the influence of alcohol in the prior three months. Research assessments conducted at baseline, 3, 6 and 12 months included a 30-day Timeline Followback querying daily alcohol use, drug use, and sexual activity. We used the MINI International Neuropsychiatric Interview-DSM-IV to ascertain drinking severity. Primary alcohol outcomes included: drinking days, heavy drinking days, drinks per drinking day. Secondary sexual risk outcomes included number of sexual partners, days of condomless sex, and days of condomless sex under the influence of drugs and alcohol.

Results

Median age was 31 (IQR 25–44 years), 88% were African American, 65% reported current recreational drug use, and 26% endorsed depressive symptoms. On the MINI 66% met criteria for alcohol use disorder (49% alcohol dependence, 18% abuse). At follow-up, all three groups reduced drinking days, heavy drinking days, drinks per drinking day and drinks per week with no significant differences between study arms. There was no difference in sexual risk outcomes among the groups.

Conclusions

 Among women attending an urban STI clinic single session CBI with or without IVR and text message boosters was insufficient to reduce unhealthy alcohol use or sexual risk behaviors beyond control. The high severity of alcohol use and the prevalence of mental health symptoms and other substance use comorbidity underscores the importance of developing programs that address not only alcohol use but other determinants of STI risk among women.

Alcohol-Antiretroviral Therapy Interactive Toxicity Beliefs and Intentional Medication Nonadherence: Review of Research with Implications for Interventions

The successful treatment of HIV infection relies on adherence to antiretroviral therapy (ART). Alcohol use remains a threat to ART adherence, including the beliefs held by people who drink alcohol that it is harmful to take ART when consuming alcohol (i.e., alcohol-ART interactive toxicity beliefs, AA-ITB). We reviewed the current research that has investigated AA-ITB and their relationship to intentional ART nonadherence. The review of 17 published studies found that AA-ITB are prevalent among people receiving ART and that AA-ITB are directly associated with ART nonadherence and incomplete HIV suppression. Family, friends and healthcare providers are common sources and reinforcers of AA-ITB. Studies suggest that AA-ITB may best be explained by the Medication Necessity and Concerns Beliefs Model, treating AA-ITB as a specific circumstance of medication concerns. Interventions are needed to communicate the realities of potential medication interactions and dispel myths that it is harmful to mix alcohol with ART, while not inadvertently suggesting that it is safe to drink with all medications, which could undermine adherence to ART by increasing alcohol use.

Individual and poly-substance use and condomless sex among HIV-uninfected adults reporting heterosexual sex in a multi-site cohort

BACKGROUND

We analyzed the association between substance use (SU) and condomless sex (CS) among HIV-negative adults reporting heterosexual sex in the Seek, Test, Treat, and Retain (STTR) consortium. We describe the impact of SU as well as person/partner and context-related factors on CS, identifying combinations of factors that indicate the highest likelihood of CS.

METHODS

We analyzed data from four US-based STTR studies to examine the effect of SU on CS using two SU exposures: 1) recent SU (within 3 months) and 2) SU before/during sex. Behavioral data were collected via 1:1 or self-administered computerized interviews. Adjusted individual-study, multivariable relative risk regression was used to examine the relationship between CS and SU. We also examined interactions with type of sex and partner HIV status. Pooled effect estimates were calculated using traditional fixed-effects meta-analysis. We analyzed data for recent SU (n = 6781; 82% men, median age = 33 years) and SU before/during sex (n = 2915; 69% men, median age = 40 years).

RESULTS

For both exposure classifications, any SU other than cannabis increased the likelihood of CS relative to non-SU (8-16%, p-values< 0.001). In the recent SU group, however, polysubstance use did not increase the likelihood of CS compared to single-substance use. Cannabis use did not increase the likelihood of CS, regardless of frequency of use. Type of sex was associated with CS; those reporting vaginal and anal sex had a higher likelihood of CS compared to vaginal sex only for both exposure classifications (18-21%, p < 0.001). Recent SU increased likelihood of CS among those reporting vaginal sex only (9-10%, p < 0.001); results were similar for those reporting vaginal and anal sex (5-8%, p < 0.01). SU before/during sex increased the likelihood of CS among those reporting vaginal sex only (20%; p < 0.001) and among those reporting vaginal and anal sex (7%; p = 0.002). Single- and poly-SU before/during sex increased the likelihood of CS for those with exclusively HIV-negative partners (7-8%, p ≤ 0.02), and for those reporting HIV-negative and HIV-status unknown partners (9-13%, p ≤ 0.03).

CONCLUSION

Except for cannabis, any SU increased the likelihood of CS. CS was associated with having perceived HIV-negative partners and with having had both anal/vaginal sex.

Sexually transmitted infections (STIs) and its changing scenario: A scoping review

Sexually transmitted infections (STIs) and reproductive tract infections (RTIs) have existed worldwide since ancient time, causing significant morbidity and mortality. To maintain healthy sexual and reproductive life, it is highly essential to prevent STIs, RTIs and related illnesses. STIs are transmitted by swapping body fluids among people during sexual intercourse. The etiological agents for STIs are bacteria, virus and parasites for most cases, but proportions by different aetiology are changing. Various studies have shown that STIs are increasing, and its primary aetiology is changing worldwide. That should be considered seriously and needs necessary actions. Several factors related to hosts and disease-causing agents have identified to influence STIs' current strategies in the prevention and control program. The present assessment attempts to review the history, changing aetiology and antimicrobial resistance in STIs. This review has also highlighted the prevalence of STIs at the global level and their past and present trends in India, emphasising its future challenges and perspectives for making effective public health policies to prevent and control STIs.

A Brief Clinic-Based Intervention to Reduce Alcohol Misuse and Sexual Risk Behavior in Young Women: Results from an Exploratory Clinical Trial

This exploratory trial determined the feasibility, acceptability, and preliminary efficacy of a brief intervention (BI), supplemented with text messaging and a curated Web site, on alcohol use and sexual risk behavior among young women. Young women seeking care at a reproductive health clinic were screened for alcohol misuse and sexual risk behavior. Those who screened positive and who agreed to participate (N = 48; M = 22.67 years) were randomized to either (a) a brief in-person session during which personalized feedback regarding alcohol use and sexual risk taking was provided and discussed, or (b) a control condition. Feasibility was assessed by recruitment and retention rates. Acceptability was assessed with participant ratings of their intervention. Efficacy was measured using self-reported alcohol use and sexual behavior at baseline and during a 3-month follow-up. We supplemented the quantitative data with qualitative data from semi-structured interviews. Feasibility data indicated that 64% of eligible women agreed to participate, 74% of eligible women were enrolled, and 86% of enrolled women were retained through follow-up. Acceptability data showed that women who received the BI reported strong satisfaction with their intervention (M = 4.65 vs. 3.98 on a five-point scale) and also reported that text messaging was helpful (M = 4.73 on a seven-point scale) and acceptable (M = 5.27 on a seven-point scale). Qualitative data provided additional support for BI feasibility and acceptability. Efficacy data showed that women in both conditions reduced alcohol use and sexual risk behavior over time; women who received the BI reduced their maximum daily alcohol intake more than controls (BI from 7.68 to 4.82 standard drinks vs. control from 6.48 to 5.65; Wald χ² = 4.93, p < .05). Women in the BI reported fewer occasions of condomless sex (median = 2.50) than controls (median = 5.00) at the follow-up, but this difference was not statistically significant (OR = 0.61, 95% CI [0.32, 1.15]). A brief intervention, supplemented with text messaging and a Web site, that targeted alcohol use and sexual behavior was feasible and acceptable to young women and led to lower levels of alcohol misuse and sexual risk behavior.

Intimate Partner Violence and Coerced Unprotected Sex Among Young Women Attending Community College

The present study examined the mediating role of sexual assertiveness in the relationship between psychological, physical, and sexual intimate partner violence (IPV) victimization and unprotected sex as a result of condom use resistance among sexually active young women attending community college. Women reported engagement in unprotected sex as a result of a partner's use of one of 32 forms of condom use resistance (e.g., physical force, deception, or other forms of coercion to avoid using a condom during intercourse). Women ages 18-24 years (N = 212) attending community college were recruited through paper advertisements to complete assessments of social and dating behavior in the campus computer laboratory. Only the women with a history of sexual intercourse (N = 178; 84% of the sample) were included in analyses. More frequent engagement in unprotected sex as a result of a partner's condom use resistance was associated with physical, psychological, and sexual IPV victimization. Sexual assertiveness mediated the relationship between physical IPV victimization and the frequency of unprotected sex as a result of condom use resistance. Efforts to prevent dating violence and enhance the sexual health of community college women may benefit from focusing on targeting sexual assertiveness as a protective factor.

Condom Use, Multiple Rounds of Sex, and Alcohol Use Among South African Women Who Use Alcohol and Other Drugs: An Event-Level Analysis

BACKGROUND

High rates of alcohol and other drug use contribute to the ongoing generalized human immunodeficiency virus epidemic in South Africa. Despite the general link between alcohol use and condomless sex, findings from event-level studies of the relationship between alcohol use and condomless sex during the same encounter have been inconsistent.

METHODS

We conducted event-level analyses of the most recent sexual encounter reported by 636 women who use substances in Pretoria. Data were collected via a questionnaire that included questions about the number of rounds of vaginal and anal sex and condom use during each round. We used multiple logistic regression analyses to model the associations between alcohol use by both partners and having multiple rounds of sex, and alcohol use and condom use during all rounds of sex.

RESULTS

Over 50% of encounters involved multiple rounds of vaginal or anal sex. Encounters that involved multiple rounds of sex were associated with inconsistent condom use. Encounters in which both partners drank alcohol were more likely to involve condomless sex, as compared with encounters in which one or neither partner drank alcohol.

CONCLUSIONS

These findings raise the possibility that prior event-level studies, which do not ask about multiple rounds of sex, may underestimate the prevalence of condomless sex. The association between alcohol use by both partners and condomless sex may partially explain inconsistent associations between alcohol use and condom use in event-level studies that did not assess the number of partners drinking.

Alcohol Use and Sexual Risk Behavior in Young Women: A Qualitative Study

Alcohol use and sexual behavior co-occur frequently in young women, increasing risk for HIV and other sexually transmitted infections. To inform preventive interventions, we used qualitative methods to better understand how women think about the contribution of alcohol use to sexual risk-taking. Young women (N = 25; M = 22.8 years; 64% White) were recruited from a community-based reproductive health clinic to attend focus groups; a semi-structured agenda was used to investigate both a priori explanatory mechanisms as well as participant-driven explanations for the alcohol-sex association. Women reported that alcohol reduced their social anxiety, helped them to feel outgoing and confident, and lowered inhibitions and other barriers to sexual encounters (consistent with alcohol expectancies). During drinking events, women described being less concerned with risks, less discriminating regarding sexual partners, and less likely to insist on safer sex practices (consistent with alcohol myopia). These empirical findings support previous theory-based guidance for tailoring preventive programs for alcohol use and sexual risk reduction for young women.

Mechanisms of behavior change in a brief dual-target motivational intervention: Reduction in alcohol use mediates intervention effects on risky sex

To examine the mechanisms underlying the efficacy of a dual-target motivational intervention (MI) to reduce heavy drinking and risky sex. A priori hypotheses were that: increases in alcohol-related readiness to change (RTC) and self-efficacy would mediate the effect of MI on alcohol use; increases in sex-related RTC and self-efficacy would mediate the effect of MI on risky sex; and reductions in alcohol use would mediate reductions in risky sex. Patients in Emergency Departments who screened positive for heavy drinking and risky sex were randomly assigned to receive MI or brief advice. RTC and self-efficacy were assessed at baseline and immediately postintervention. Alcohol use and sexual behavior was assessed at baseline, 3-, 6-, and 9-month follow up. Single- and serial-mediation models were tested. Patients who received MI had higher postintervention RTC and self-efficacy, but neither mechanism mediated the effects of MI on behavioral outcomes. Reduction in heavy drinking mediated the effect of MI on frequency of sex under the influence (SUI). Further, the effect of MI on condomless sex was mediated by an indirect path in which reductions in heavy drinking at 3 months predicted less SUI at 6 months, which in turn predicted reduction in condomless sex at 9-months. Although some effect of dual-target MI on risky sex is independent of drinking, treatment-related reduction in heavy drinking does account for a significant portion of reduction in risky sex, providing support for the utility of this intervention in patient populations where heavy drinking and risky sex co-occur. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Alcohol Use and Unprotected Sex Among HIV-Infected Ugandan Adults: Findings from an Event-Level Study

While alcohol is a known risk factor for HIV infection in sub-Saharan Africa (SSA), studies designed to investigate the temporal relationship between alcohol use and unprotected sex are lacking. The purpose of this study was to determine whether alcohol used at the time of a sexual event is associated with unprotected sex at that same event. Data for this study were collected as part of two longitudinal studies of HIV-infected Ugandan adults. A structured questionnaire was administered at regularly scheduled cohort study visits in order to assess the circumstances (e.g., alcohol use, partner type) of the most recent sexual event (MRSE). Generalized estimating equation logistic regression models were used to examine the association between alcohol use (by the participant, the sexual partner, or both the participant and the partner) and the odds of unprotected sex at the sexual event while controlling for participant gender, age, months since HIV diagnosis, unhealthy alcohol use in the prior 3 months, partner type, and HIV status of partner. A total of 627 sexually active participants (57% women) reported 1817 sexual events. Of these events, 19% involved alcohol use and 53% were unprotected. Alcohol use by one's sexual partner (aOR 1.70; 95% CI 1.14, 2.54) or by both partners (aOR 1.78; 95% CI 1.07, 2.98) during the MRSE significantly increased the odds of unprotected sex at that same event. These results add to the growing event-level literature in SSA and support a temporal association between alcohol used prior to a sexual event and subsequent unprotected sex.

Understanding Sorority Women's Privacy Management About Condom Use

Sorority women are at risk for engaging in unsafe sexual behavior. Fortunately, the positive influence of peer communication about condom use can mitigate the risk these women face. To better understand this communication, this article investigates sorority women's communication about condom use through focus groups, using the lens of the theory of Communication Privacy Management. The results revealed the criteria for privacy rules sorority women use to negotiate privacy and engage in comfortable communication with other women in the sorority. The analysis also revealed an external privacy boundary; the women sought to maintain a good reputation for their social group, and followed explicit and implicit privacy management rules to do so. The implications for this study include better understanding of the personal and collective boundaries of privacy management, and improvements in sorority and college student sexual health programs.

Pilot Studies Examining Feasibility of Substance Use Disorder Screening and Treatment Linkage at Urban Sexually Transmitted Disease Clinics

BACKGROUND

Sexually transmitted disease (STD) clinics provide critical public health services for screening and treatment of sexually transmitted infections throughout the United States. These settings serve high-risk populations, often on a walk-in basis, and may be promising venues for integrating substance use disorder (SUD) services.

METHODS

We report findings from 2 pilot studies conducted at Baltimore City Health Department's STD clinics. The screening study characterized rates of SUDs among STD clinic patients. Patients waiting for services completed a diagnostic interview mapping to Diagnostic and Statistical Manual of Mental Disorders, 5th Edition SUD criteria (n = 100). The Treatment Linkage Feasibility study examined the feasibility of linking STD clinic patients with opioid and/or cocaine use disorders to SUD treatment in the community (n = 21), using SUD-focused Patient Navigation services for 1 month after the STD clinic visit. Assessments were conducted at baseline and 1-month follow-up.

RESULTS

In the screening study, the majority of STD clinic patients met diagnostic criteria for alcohol and/or drug SUD (57%). Substance-specific SUD rates among patients were 35% for alcohol, 31% for cannabis, 11% for opioids, and 8% for stimulants (cocaine/amphetamines). In the Treatment Linkage Feasibility study, 57% (12/21) of participants attended at least 1 SUD service, and 38% (8/21) were actively enrolled in SUD treatment by 1-month follow-up. The sample reported significant reductions in past 30-day cocaine use from baseline to follow-up (P = 0.01).

CONCLUSIONS

SUD rates are high among STD clinic patients. STD clinics are viable settings for initiating SUD treatment linkage services. Larger-scale research on integrating SUD services in these settings is needed.

Using Integrative Data Analysis to Examine Changes in Alcohol Use and Changes in Sexual Risk Behavior Across Four Samples of STI Clinic Patients

BACKGROUND

Patients in sexually transmitted infection (STI) clinics report high levels of alcohol use, which are associated with risky sexual behavior. However, no studies have examined how changes in alcohol use relate to changes in sexual risk behavior.

PURPOSE

We used parallel process latent growth modeling to explore how changes in alcohol use related to changes in sexual behavior across four samples of clinic patients.

METHODS

Patients participating in HIV prevention trials from urban clinics in the Northeastern and Midwestern USA (N = 3761, 59 % male, 72 % Black) completed measures at 3-month intervals over 9-12 months. Integrative data analysis was used to create composite measures of alcohol use across samples. Sexual risk measures were counts of partners and unprotected sex acts. Parallel process models tested whether alcohol use changes were correlated with changes in the number of partners and unprotected sex.

RESULTS

Growth models with good fit showed decreases that slowed over time in sexual risk behaviors and alcohol use. Parallel process models showed positive correlations between levels of (rs = 0.17-0.40, ps < 0.001) and changes in (rs = 0.21-0.80, ps < 0.05) alcohol use and number of sexual partners across studies. There were strong associations between levels of (rs = 0.25-0.43, ps < 0.001) and changes in (rs = 0.24-0.57, ps < 0.01) alcohol use and unprotected sex in one study recruiting hazardous drinkers.

CONCLUSIONS

Across four samples of clinic patients, reductions in alcohol use were associated with reductions in the number of sexual partners. HIV prevention interventions may be strengthened by addressing alcohol use.

Predictors of HIV Risk Behaviors Among a National Sample of Russian Men Who Have Sex with Men

Russia has one of the fastest growing HIV epidemics in the world and is at the point of transitioning from injection drug use to sexual transmissions. We sought to identify factors associated with unprotected sex among men who have sex with men (MSM) in Russia, separately for Moscow, St. Petersburg and the rest of the country. Multivariable data from a national cross-sectional study (n = 5035) demonstrate that significant correlates of unprotected anal intercourse (UAI) with a non-steady partner across all areas were visiting sex-related venues (AOR range 1.35-1.96) and access to condoms (AOR range 0.37-0.52). In Moscow and St. Petersburg, being HIV-positive was correlated with UAI (AOR 2.13 and 2.69). The dynamics of the HIV epidemic among MSM in Russia appear to be both similar, and different, across various areas and factors associated with unprotected sex should be seen as part of an environment of exogenous factors impacting MSM's sexual behaviors.

The role of young adult social bonds, substance problems, and sexual risk in pathways between adolescent substance use and midlife risky sexual behavior among urban African Americans

African Americans are disproportionately affected by HIV/AIDS and other sexually transmitted infections relative to other racial groups. Although substance use has been linked to risky sexual behavior, the understanding of how these associations develop over the life course remains limited, particularly the role of social bonds. This study uses structural equation modeling to examine pathways from adolescent substance use to young adult sexual risk, substance problems, and social bonds and then to midlife risky sexual behavior among African American men and women, controlling for childhood confounders. Data come from 4 assessments, 1 per developmental period, of a community-based urban African American cohort (N = 1,242) followed prospectively from ages 6 to 42 years. We found that greater adolescent substance use predicts greater young adult substance problems and increased risky sexual behavior, both of which in turn predict greater midlife sexual risk. Although greater adolescent substance use predicts fewer young adult social bonds for both genders, less young adult social bonding is unexpectedly associated with decreased midlife risky sexual behavior among women and not related for men. Substance use interventions among urban African American adolescents may have both immediate and long-term effects on decreasing sexual risk behaviors. Given the association between young adult social bonding and midlife risky sex among females, number of social bonds should not be used as a criterion for determining whom to screen for sexual risk among African American women. Future studies should explore other aspects of social bonding in linking substance use and risky sexual behavior over time. (PsycINFO Database Record

Substance use and STI acquisition: Secondary analysis from the AWARE study

OBJECTIVES

Sexually transmitted infections (STIs) are significant public health and financial burdens in the United States. This manuscript examines the relationship between substance use and prevalent and incident STIs in HIV-negative adult patients at STI clinics.

METHODS

A secondary analysis of Project AWARE was performed based on 5012 patients from 9 STI clinics. STIs were assessed by laboratory assay and substance use by self-report. Patterns of substance use were assessed using latent class analysis. The relationship of latent class to STI rates was investigated using Poisson regression by population groups at high risk for STIs defined by participant's and partner's gender.

RESULTS

Drug use patterns differed by risk group and substance use was related to STI rates with the relationships varying by risk behavior group. Substance use treatment participation was associated with increased STI rates.

CONCLUSIONS

Substance use focused interventions may be useful in STI clinics to reduce morbidity associated with substance use. Conversely, gender-specific sexual health interventions may be useful in substance use treatment.

Sex Partner Type, Drug Use and Condom Use Self-Efficacy Among African Americans from Disadvantaged Neighborhoods: Are Associations with Consistent Condom Use Moderated by Gender?

Gender inequalities in sexual behavior are explored from the perspective of the theory of gender and power. This study focused on the effect of sex partner type (steady versus casual), drug use, and condom use self-efficacy regarding consistent condom use (CCU) among a community-based sample of adults. The sample included 1,357 African American men and women (M age 37.0, SD 13.1 years; 44% women, 66% men) from 61 disadvantaged census block groups in Atlanta, GA as part of a study of individual and neighborhood characteristics and HIV risk-taking. Having a steady partner decreased the odds of CCU, while higher condom use self-efficacy increased the odds of CCU. Among non-drug users, having a drug-using partner was associated with decreased odds of condom use for women only. Women with drug-using partners, especially a steady partner, were least likely to report CCU. Therefore, interventions intended to empower CCU among women need to expand beyond acknowledging the reduced control that women who use drugs demonstrate to also consider those who have drug-using sexual partners.

Event-level analyses of sex-risk and injection-risk behaviors among nonmedical prescription opioid users

BACKGROUND

Nonmedical prescription opioid use has been linked to hepatitis C virus (HCV) infection among people who inject drugs and with using high dead space syringes that retain more blood and transfer more HIV if shared. Little is known regarding its effects on sex-risk behaviors.

OBJECTIVES

This paper examines event-level associations between nonmedical prescription opioid use and sharing high dead space syringes (injection risk) and unprotected intercourse (sex risk) behaviors.

METHODS

We recruited 1,985 participants from two overlapping risk groups-drug users and men who have sex with men (MSM)-and their sex partners. Participants completed an interview that included event-level sex questions with recent sex partners and injection questions with recent injection partners. We used multivariable generalized estimating equations (GEE) to assess the associations between nonmedical prescription opioid use and unprotected intercourse during sexual encounters and sharing syringes during injection episodes, while adjusting for within-person correlations.

RESULTS

When both partners used nonmedical prescription opioids, its use was independently associated with unprotected intercourse in sexual encounters (OR = 2.24; 95% CI = 1.12, 4.49). The use of nonmedical prescription opioids was also associated with sharing high dead space syringes during injection episodes (OR = 6.57; 95% CI = 1.63, 26.51).

CONCLUSION

Nonmedical prescription opioid use is associated with an increase in the risk of unprotected sex and sharing high dead space syringes. HIV and HCV prevention interventions for nonmedical prescription opioid users should address sex-risk behaviors and encourage the use of acceptable low dead space needles and syringes.

Prediction of HIV Sexual Risk Behaviors Among Disadvantaged African American Adults Using a Syndemic Conceptual Framework

The focus of this paper is on HIV sexual risk taking among a community-based sample of disadvantaged African American adults. The objective is to examine multiple factors associated with sexual HIV risk behaviors within a syndemic conceptual framework. Face-to-face, computer-assisted, structured interviews were conducted with 1535 individuals in Atlanta, Georgia. Bivariate analyses indicated a high level of relationships among the HIV sexual risks and other factors. Results from multivariate models indicated that gender, sexual orientation, relationship status, self-esteem, condom use self-efficacy, sex while the respondent was high, and sex while the partner was high were significant predictors of condomless sex. Additionally, a multivariate additive model of risk behaviors indicated that the number of health risks significantly increased the risk of condomless sex. This intersection of HIV sexual risk behaviors and their associations with various other behavioral, socio-demographic, and psychological functioning factors help explain HIV risk-taking among this sample of African American adults and highlights the need for research and practice that accounts for multiple health behaviors and problems.

Alcohol Use Predicts Number of Sexual Partners for Female but not Male STI Clinic Patients

This study tested the hypothesis that greater alcohol involvement will predict number of sexual partners to a greater extent for women than for men, and that the hypothesized sex-specific, alcohol-sexual partner associations will hold when controlling for alternative sex-linked explanations (i.e., depression and drug use). We recruited 508 patients (46 % female, 67 % African American) from a public sexually transmitted infections (STI) clinic. Participants reported number of sexual partners, drinks per week, maximum drinks per day, frequency of heavy drinking; they also completed the AUDIT-C and a measure of alcohol problems. As expected, men reported more drinking and sexual partners. Also as expected, the association between alcohol use and number of partners was significant for women but not for men, and these associations were not explained by drug use or depression. A comprehensive prevention strategy for women attending STI clinics might include alcohol use reduction.

Alcohol Use and Unintended Sexual Consequences among Women Attending an Urban Sexually Transmitted Infections Clinic

BACKGROUND

Although alcohol use has been linked with a variety of sexual behaviors, we lack an understanding of what precise events occur when women drink that may lead to emotional or physical harms.

METHODS

To fill this gap, we qualitatively explored the unintended sexual events occurring while drinking among a particularly at-risk clinic population: urban women attending a public sexually transmitted infections (STI) clinic. This was a secondary data analysis of 20 semistructured, in-depth interviews conducted between December 2009 and August 2010 with 20 sexually active adult women attending the Baltimore City Health Department STI Clinic. We purposively sampled women presenting for care in the STI clinic who reported either binge drinking in the past 6 months or engaging in vaginal or anal intercourse while under the influence of alcohol. Interviews were analyzed using a grounded theory approach.

RESULTS

Five major unintended sexual events emerged: sex with new partners; alternative sexual activities, including anal sex and "rough" sex; unprotected sex; blacked out sex or sex occurring during alcohol-related amnesia; and rape. Themes often overlapped, and sexual victimization was a common thread throughout multiple themes. An additional theme, alcohol and prey, largely occurring in bars and nightclubs, emerged as an important precursor to many of the unintended events described.

CONCLUSIONS

Alcohol use was associated with a variety of--often dangerous--unintended sexual events. Our results highlight the link between alcohol use and sexual victimization and the need for intervention development to reduce the emotional and physical harms resulting from the unintended consequences of alcohol use.

Differential risk factors for HIV drug and sex risk-taking among non-treatment-seeking hospitalized injection drug users

Injection drug users (IDUs) are at increased risk of contracting HIV. From a clinical trial assessing an intervention to enhance the linkage of hospitalized patients to opioid treatment after discharge, we conducted multivariate analysis of baseline data from hospitalized IDUs with a history of opioid dependence (n = 104) to identify differences in factors predicting HIV drug and sex risk behaviors. Factors significantly associated with HIV drug risk were being non-Hispanic Caucasian and recent cocaine use. Being female, binge drinking, and poorer mental health were significantly associated with higher sex risk. Because factors predicting HIV sex risk behaviors differ from those predicting HIV drug risk, interventions aimed at specific HIV risks should have different behavioral and substance use targets.

Predictors of condom use in women receiving court-mandated drug and alcohol treatment: implications for intervention

Women who abuse substances are at a high-risk for contracting HIV. Condom use interventions are important in reducing HIV in high-risk populations, but current interventions have small effects. The aim of this study is to examine the relative impact of substance use, personal variables (sexual impulsivity and condom expectancies), and relationship variables (perceptions of relationship commitment and partner risk, perceptions of power within the relationship) on condom use in women in court-mandated substance abuse treatment. Information was collected from 312 sexually active women in an inpatient drug and alcohol treatment facility in the Southeastern US Participants completed questionnaires and were interviewed using the Timeline Follow-back method and provided information about sexual activity in the 30-days prior to intake, including type of sexual event, co-occurrence with substance use, condom use, and characteristics of sexual partners and the nature of the relationship. Multilevel logistic modeling revealed that perception of relationship commitment, condom outcome expectancies, and age significantly affected condom use for women in the sample. Specifically, condom use was least likely when women reported that the relationship was committed (odds ratio [OR] = 0.31, 95% confidence interval [CI]: 0.23, 0.43) or when the participant was older (OR = 0.96, 95% CI: 0.94, 0.99), and more likely when women reported more positive condom outcome expectancies (OR = 1.02, 95% CI: 1.00, 1.03). The findings suggest that perceptions of relationship commitment, regardless of perceptions of partner risk, strongly affect condom use among women court-mandated into drug and alcohol treatment. In addition, positive outcome expectancies (e.g., positive self-evaluations and perceived positive partner reactions) are associated with a greater likelihood of condom use. These findings have important implications for condom use interventions, which have failed to produce large or lasting effects within this population.

Australian women's fertility experiences prior to a termination of pregnancy

Objective. This research aimed to investigate the fertility management of women aged over 30 years prior to a termination of pregnancy (TOP) to inform primary health care service delivery providers and policy makers. Design. An ethically approved, two-phase sequential explanatory mixed methods design was used. This paper reports on part of that study. Setting. The study was conducted in five South Australian TOP clinics. Patients. Women aged over 30 years attending for a TOP in 2009 were invited to participate. Interventions. The Contraception Sexual Attitude Questionnaire (modified version) of women attending termination of pregnancy services was used. Main Outcomes Measures. Quantitative data analysis utilized SPSS V16 where simple descriptive statistics were described. Results. There were 101 questionnaire respondents where 70.5% were Australian women, predominantly married and with children. Women used contraception but experienced method failure, were beginning a new method, or were afraid of side effects. Risk-taking behaviours were reported such as putting the possibility of pregnancy out of their mind, getting carried away and not thinking of pregnancy risk, or frequently having unprotected intercourse. Conclusion. Service delivery needs to include age specific programs, and policy makers need to include policies which are adequately funded and evaluated. Further research is required to provide greater depth of knowledge in this area.

The impact of alcohol use on HIV/STI intervention efficacy in predicting sexually transmitted infections among young African-American women

The impact of alcohol use on the efficacy of an HIV/STI intervention designed for young African-American women in predicting STIs was examined. Eight hundred forty-eight African-American women, 18-29 years, were randomly assigned to either the HIV/STI intervention or a control condition. Participants were assessed on alcohol use and provided two vaginal swab specimens for STI testing. Women in the intervention who consumed alcohol were less likely to test STI-positive than women in the control and abstainers (AOR = 2.47, 95 % CI = 1.01-6.22). STI risk factors may vary across different populations. Further research on heavy drinking and HIV intervention efficacy is needed.

Methamphetamine use among women attending sexually transmitted disease clinics in Los Angeles County

BACKGROUND

Methamphetamine (meth) use is a continuing problem in the United States and is associated with increased risk of HIV and sexually transmitted infections (STIs). However, few studies have examined the meth use/STI risk association among women.

METHODS

We conducted a cross-sectional study of women attending public sexually transmitted disease clinics in Los Angeles County, California, from 2009 to 2010. Routinely collected clinic intake data were used to compare the prevalence of meth use among women with different demographics/sexual behaviors. Multivariable logistic regression was used to identify predictors of meth use.

RESULTS

There were 1.4% (n = 277) women who reported meth use, with a mean age of 29 years. Prevalence was highest among Whites and those reporting both male and female partners. Most women who reported meth use also reported polysubstance use. In a multivariable model controlling for age, race/ethnicity, condom use, having a new sex partner, and other illicit substance use, women who reported sex with an injection drug user were nearly 10 times more likely to report meth use as compared with those who did not (adjusted odds ratio [AOR], 9.90; 95% confidence interval [CI], 5.86-16.75). Other factors associated with meth use included sex with a recently incarcerated partner (AOR, 3.24; 95% CI, 2.16-4.86), anonymous partner (AOR, 2.49; 95% CI, 1.54-4.04), and transactional sex (AOR, 3.26; 95% CI, 1.69-6.32). Women who tested positive for chlamydia/gonorrhea were 1.48 times more likely to use meth as compared with those who did not.

CONCLUSIONS

Female meth users have high-risk behaviors that could increase their risk for STIs/HIV.

Associations of mental illness and substance use disorders with prescription contraception use among women veterans

OBJECTIVE

To investigate whether mental illness and substance use disorder (SUD) are associated with having a prescription contraceptive method among women veterans.

STUDY DESIGN

We conducted a retrospective analysis of National Veterans Administration (VA) administrative and clinical data for women veterans aged 18-45 years who made at least one primary care visit in 2008. We assessed associations between mental illness (depression, posttraumatic stress disorder, anxiety, bipolar disorder, schizophrenia and adjustment disorder) and SUD (drug/alcohol use disorder) with having a prescription contraceptive method from VA (pill, patch, ring, injection, implant and intrauterine device) using multivariable logistic regression with random effects for VA facility, adjusting for confounders.

RESULTS

Among 94,115 reproductive aged women, 36.5% had mental illness only, 0.6% had SUD only, 5.3% had both mental illness and SUD and 57.7% had neither diagnosis. In these groups, 22.1%, 14.6%, 18.2% and 17.7% (p<0.001), respectively, had documentation in 2008 of prescription contraception. After adjusting for potential confounders, women with mental illness only were as likely as women with neither diagnosis to have a prescription method and were more likely to use a highly effective prescription method (implant or intrauterine device) if using contraception [adjusted odds ratio (aOR) 1.17, 95% confidence interval (CI) = 1.08-1.27]. Women with SUD (with or without mental illness) were significantly less likely to have a prescription method than women with neither diagnosis (aOR 0.73, 95% CI = 0.57-0.95 and aOR 0.79, 95% CI = 0.73-0.86, respectively).

CONCLUSION

Women veterans with SUD are less likely to have prescription contraception compared to other women, which may increase their risk of unintended pregnancy.

Do alcohol and marijuana use decrease the probability of condom use for college women?

Alcohol and marijuana use are thought to increase sexual risk taking, but event-level studies conflict in their findings and often depend on reports from a limited number of people or on a limited number of sexual events per person. With event-level data from 1,856 sexual intercourse events provided by 297 college women (M age = 18 years; 71% White), we used multilevel modeling to examine associations between alcohol and marijuana use and condom use as well as interactions involving sexual partner type and alcohol-sexual risk expectancies. Controlling for alternative contraception use, partner type, regular levels of substance use, impulsivity and sensation seeking, and demographics, women were no more or less likely to use condoms during events involving drinking or heavy episodic drinking than during those without drinking. However, for drinking events, there was a negative association between number of drinks consumed and condom use; in addition, women with stronger alcohol-sexual risk expectancies were marginally less likely to use condoms when drinking. Although there was no main effect of marijuana use on condom use, these data suggest marijuana use with established romantic partners may increase risk of unprotected sex. Intervention efforts should target expectancies and emphasize the dose-response relationship of drinks to condom use.

Test of a web-based program to improve adherence to HIV medications

We evaluated the effectiveness of a web-based version of the Life-Steps intervention combined with modules for stress reduction and mood management, designed to improve medication adherence among HIV infected individuals. 168 HIV+ adults were randomized into either the Life-Steps program or a waitlist control condition. All participants completed a baseline assessment and provided a 2-week electronic pill (MEMS) cap baseline reading. Follow up data collection was conducted at 3, 6 and 9 months. Patients in the web-based Life-Steps condition had significantly higher antiretroviral medication adherence rates than patients in the control group over the nine-month period as measured by the MEMS cap. In addition, analysis of viral load data indicated that the program also resulted in a significant decrease in viral load. These findings indicate that a web-based Life-Steps program can be a useful and implementable tool for helping patients living with HIV maintain medication adherence.

Condom use and concurrent partnering among heterosexually active, African American men: a qualitative report

African Americans are overrepresented among heterosexual cases of HIV/AIDS in the USA. Inconsistent condom use and concurrent partnering are two sexual behaviors driving the heterosexual HIV epidemic in the African American community. To inform the development of an HIV prevention behavioral intervention to decrease concurrent partnering and increase condom use among African American heterosexual men, we conducted formative research, including 61 structured interviews, 5 focus groups with 25 men, and 30 in-depth qualitative interviews between July and December 2009. We used a grounded theoretical approach and categorizing strategies to code and analyze the qualitative data. Results around condom use confirmed earlier findings among heterosexual men in general: condoms diminish pleasure, interfere with erection, and symbolize infidelity. Although valued by some as a form of disease prevention and pregnancy prevention, condoms are often used only with specific types of female partners, such as new or casual partners, or due to visual risk assessment. Sex partner concurrency was described as normative and ascribed to men's "natural" desire to engage in a variety of sexual activities or their high sex drive, with little recognition of the role it plays in the heterosexual HIV epidemic. Fatherhood emerged among many men as a crucial life event and compelling motivation for reducing sexual risk behavior. Based on these results, we conclude that existing HIV prevention efforts to improve attitudes towards and motivate use of condoms either have not reached or have not been successful with African American heterosexual men. In designing behavioral interventions to decrease concurrent partnering and increase condom use, addressing negative attitudes towards condoms and partner risk assessment is critical, as is integrating novel motivational approaches related to identity as fathers and men in the African American community.

Optimizing the scientific yield from a randomized controlled trial (RCT): evaluating two behavioral interventions and assessment reactivity with a single trial

Randomized controlled trials (RCTs) remain the gold standard for evaluating intervention efficacy but are often costly. To optimize their scientific yield, RCTs can be designed to investigate multiple research questions. This paper describes an RCT that used a modified Solomon four-group design to simultaneously evaluate two, theoretically-guided, health promotion interventions as well as assessment reactivity. Recruited participants (N = 1010; 56% male; 69% African American) were randomly assigned to one of four conditions formed by crossing two intervention conditions (i.e., general health promotion vs. sexual risk reduction intervention) with two assessment conditions (i.e., general health vs. sexual health survey). After completing their assigned baseline assessment, participants received the assigned intervention, and returned for follow-ups at 3, 6, 9, and 12 months. In this report, we summarize baseline data, which show high levels of sexual risk behavior; alcohol, marijuana, and tobacco use; and fast food consumption. Sexual risk behaviors and substance use were correlated. Participants reported high satisfaction with both interventions but ratings for the sexual risk reduction intervention were higher. Planned follow-up sessions, and subsequent analyses, will assess changes in health behaviors including sexual risk behaviors. This study design demonstrates one way to optimize the scientific yield of an RCT.

Risky sexual behaviors in emerging adults: longitudinal changes and within-person variations

This study examined longitudinal changes in condom use inconsistency and sexual encounters involving alcohol use and the within-person associations of these two risky sexual behaviors with other personal and contextual factors. Data were drawn from a sample of college students who completed surveys on four occasions across 3 years and included 317 participants (48 % male; 32 % African American, 28 % Latino American, and 40 % European American) who reported recent penetrative sexual activities on at least one of the occasions. Multilevel models revealed that, although condom use inconsistency increased and then leveled off over time, sexual encounters involving alcohol use showed a linear increase. Moreover, at times when students held more negative attitudes toward condoms than usual, they used condoms less consistently than usual; at times when students felt more anxious about HIV/AIDS than usual, they had more sexual encounters involving alcohol use than usual; and at times when students were involved in a serious relationship, they used condoms less consistently and had fewer sexual encounters involving alcohol use than usual. Findings demonstrate the utility of a developmental perspective in understanding sexual behaviors, the importance of examining the unique correlates of different risky sexual behaviors, and the distinctiveness between within-person versus between-person associations.

Quantity, not frequency, of alcohol use moderates the association between multiple sexual partners and Trichomonas vaginalis among women attending an urban STD clinic

OBJECTIVE

The purpose of this study is to investigate alcohol use, sexual risk behaviour and trichomoniasis in a sample of low-income, largely minority, women patients at a publicly funded sexually transmitted disease (STD) clinic in the USA.

METHODS

Baseline data, collected as part of a clinical trial, were used. Patients (688 women, 46% of the overall sample) completed an audio computer-assisted self-interview that included questions about their alcohol use and sexual behaviours. Trichomoniasis was determined from vaginal swab specimens obtained during a standard clinical exam.

RESULTS

Women (n=580; 18-56 years of age; 64% African-American) who reported that they had consumed alcohol at least once in the past year were included in the analyses. Of the 580 women, 157 were diagnosed with an STD and 80 tested positive for trichomoniasis. Trichomoniasis was associated with having multiple sexual partners (OR=1.09; 95% CI 1.01 to 1.17) but not with the number or proportion of unprotected sex events (p>0.05) in the past 3 months. Quantity of alcohol use (drinks per drinking day, drinks per week, and peak consumption) moderated the association between the number of sexual partners and trichomoniasis.

CONCLUSIONS

The number of sexual partners predicted the probability of trichomoniasis when women reported drinking large quantities of alcohol. Because having multiple sexual partners increases the risk for STD transmission, interventions designed for at-risk women should address the quantity of alcohol consumed as well as partner reduction to reduce the risk for trichomoniasis.

Inebriation, drinking motivations and sexual risk taking among sexually transmitted disease clinic patients in St. Petersburg, Russia

We investigated whether inebriation was associated with having non-main partners and unprotected sex with non-main partners and whether drinking motivations were associated with sexual risk behaviors among patients attending an STD clinic in St Petersburg, Russia. A cross-sectional behavior survey was applied to 362 participants between 2008 and 2009. Multivariate logistic regression was used for analysis. At-risk drinking per Alcohol Use Disorders Identification Test (AUDIT-C) criteria (OR 2.5, 95% CI 1.4–4.4) was independently associated with having non-main sexual partners. Inebriation (OR 3.2, 95% CI 1.3–8.1) but not at-risk drinking or drinking prior to sex was associated with unprotected sex with non-main partners. Among drinkers, the consumption of alcohol to facilitate sexual encounters (OR 2.7, 95% CI 1.6–4.5) was associated with having non-main sexual partners. HIV prevention programs in Russia must address inebriation in addition to conventional patterns of problem drinking such as those measured by AUDIT-C and consider individuals’ motivations to drink that lead to sexual risk taking.

Correlates of unprotected sexual intercourse among women who inject drugs or who have sexual partners who inject drugs in St Petersburg, Russia

OBJECTIVES

To assess risk for unintended pregnancy, this study describes the correlates of unprotected sexual intercourse (UPSI) among women who inject illicit drugs or who have sexual partners who inject drugs in St Petersburg, Russia.

METHODS

Data from a cross-sectional survey and biological test results collected between 2005 and 2008 from 202 Russian women (143 drug injectors and 59 non-drug injectors) were analysed. Multivariate regression was used to investigate the correlates of UPSI occurring at the women's last sexual act. Independent variables included socio-demographics, age at sexual debut, first sexual encounter perceived as involuntary, number of pregnancies and number of children for which the participant is the primary caretaker, heavy sporadic drinking (i.e. consuming more than five drinks in 2&emsp14;hours at least twice a month), at-risk drinking per the Alcohol Use Disorder Identification Test (AUDIT-C) score, and sexually transmitted infections (HIV-1, syphilis serology, Chlamydia trachomatis and Neisseria gonorrheae).

RESULTS

Sixty-seven percent of women reported UPSI at last intercourse. UPSI was independently associated with heavy sporadic drinking [odds ratio (OR) 2.8, 95% CI 1.2-6.6] and having been pregnant (OR 2.25, 95% CI 1.1-4.6).

CONCLUSIONS

Despite the high risk for HIV acquisition or transmission and unintended pregnancy, condom use among the study population is low. Programmes to investigate and improve contraceptive use, including condom use, among this vulnerable group of women are needed. Such programmes may require identifying and targeting female reproductive health concerns and problem drinking, particularly heavy sporadic drinking, rather than conventional measures of alcohol misuse.

Factors associated with condom use problems during vaginal sex with main and non-main partners

BACKGROUND

Incorrect condom use is a common problem that can undermine their prevention impact. We assessed the prevalence of 2 condom use problems, breakage/slippage and partial use, compared problems by partnership type, and examined associations with respondent, partner, and partnership characteristics.

METHODS

Data were collected at 3-month intervals during a 12-month period (1999-2000) among urban sexually transmitted disease (STD) clinic users. Condom use problems were compared between partnership types using z tests for equality of proportions. Logistic generalized estimating equations modeling accounted for within-participant correlation of repeated measures.

RESULTS

Overall 3297 respondents reported 9304 main and 6793 non-main partnerships; condoms were used at least once in 4942 (53.0%) and 4523 (66.6%) of these partnerships, respectively. Condom breakage/slippage was reported during 6.0% of uses (5.1% main, 9.4% non-main) and partial use during 12.5% of uses (12.8% main, 11.5% non-main). The proportion of respondents experiencing any condom use problem in the prior 3 months was higher among main compared with non-main partnerships: 39.1% versus 29.9% had either problem; 22.5% versus 19.0% had breakage/slippage only; 21.8% versus 18.7% had partial use; and 8.7% versus 7.1% had both use problems. In multivariable analysis, factors associated with condom use problems varied by partnership type and respondent sex. The most common predictors of problems across models were sex while high and inconsistent condom use.

CONCLUSIONS

This study highlights the diverse set of risk factors for condom use problems at the individual, partner, and partnerships levels.

Prevalence and factors associated with condom use among Chinese monogamous female patients with sexually transmitted infection in Hong Kong

INTRODUCTION

Monogamous female sexually transmitted infection (STI) patients are at high risk of recurrent STI, but there is no study investigating their risk behaviors.

AIM

We investigated the prevalence of male condom use and associated factors among monogamous STI female patients.

MAIN OUTCOME MEASURES

Independent variables included socio-demographic characteristics, STI history, nature of relationship, and cognitions (Health Belief Model). Dependent variables included the use of male condoms in the past two months and intention to use male condoms consistently in the future 6 months.

METHODS

A cross-sectional survey using a structured questionnaire was conducted among STI female patients with only one male sex partner in the last 12 months and attended a major government STI clinic in Hong Kong.

RESULTS

Among the 538 participants, 25.1% used condoms consistently (every time) during sex in the past 2 months, while 35.2% intended to do so in the next 6 months. A multiple stepwise logistic regression model identified three statistically significant factors associated with lower likelihoods of consistent condom use in the past 2 months: type of sole sex partner (cohabitant vs. husband: OR = 0.29, 95% CI = 0.12 to 0.70; regular boyfriend vs. husband: OR = 0.52, 95% CI = 0.30 to 0.91), being financially dependent (OR = 0.45, 95% CI = 0.27 to 0.75), and partner's dislike of condom use (OR = 0.23, 95% CI = 0.15 to 0.39). In a similar model, the same three factors were found to be significantly associated with the intention to use condoms consistently in the next 6 months. The low prevalence of intention to use condoms consistently in the future suggested that our study population might be victimized again. The impact of financially dependent relationships and men's dislike of using condoms on condom use may operate through imbalanced gender power.

CONCLUSIONS

Interventions are greatly warranted and should increase risk awareness and empower this vulnerable population.

Age at first alcoholic drink as predictor of current HIV sexual risk behaviors among a sample of injection drug users (IDUs) and non-IDUs who are sexual partners of IDUs, in St. Petersburg, Russia

This study investigates whether age at first alcoholic drink is associated with sexual risk behaviors among injection drug users (IDUs) and non-IDUs who are sexual partners of IDUs in St. Petersburg, Russia. A path analysis was used to test a model of age at first drink, age at sexual debut, age at first drug use, current substance use patterns and current sexual risk behaviors among 558 participants. Results revealed that age at first drink had an effect on multiple sex partners through age at sexual debut and injection drug use, but no effect on unprotected sex. Age at first drug use was not related to sexual risk behaviors. Investigation of age of drinking onset may provide useful information for programs to reduce sexual risk behaviors and injection drug use. Different paths leading to unprotected sex and multiple sexual partners call for different approaches to reduce sexual risk behaviors among this population.

Patterns of alcohol use and sexual behaviors among current drinkers in Cape Town, South Africa

OBJECTIVE

This study examined the association between alcohol use and sexual behaviors among South African adults who reported current drinking.

METHOD

Street-intercept surveys were administered to adults residing in neighborhoods in a South African township.

RESULTS

Analyses were restricted to participants reporting current drinking (N=1285; mean age=32; 27% women; 98% Black). Most participants (60%) reported heavy episodic drinking (i.e., 5 or more drinks on a single occasion) at least once per week in the past 30 days. Compared to non-heavy episodic drinkers, participants who reported heavy episodic drinking were more likely to drink before sex (79% vs. 66%) and have sex with a partner who had been drinking (59% vs. 44%). Overall, drinking before sex (self or partner) and heavy episodic drinking was associated with multiple sexual partners, discussing condom use with sexual partner(s), and proportion of protected sex. The frequency of condom use varied among participants with steady, casual, or both steady and casual sexual partners.

CONCLUSIONS

Alcohol use among South African adults is associated with sexual risk behaviors, but this association differs by partner type. Findings suggest the need to strengthen alcohol use components in sexual risk reduction interventions especially for participants with both steady and casual sex partners.

A review of factors associated with unprotected sex among adult women in the United States

OBJECTIVE

To provide an updated review of research since 2005 on factors associated with unprotected sex among women in the United States.

DATA SOURCES

PubMed, CINAHL, and PsychINFO were searched from January 2006 through April 2011 using the terms unsafe sex, sexual risk taking, contraception, contraception behavior, birth control, condoms, and condom utilization.

STUDY SELECTION

Inclusion criteria included studies written in English on adult women in the United States age ≥ 18. Forty-five publications met inclusion criteria.

DATA EXTRACTION

All factors associated with engagement in unprotected sex are presented.

DATA SYNTHESIS

Unprotected sex has been associated with increasing age, being married, establishment of trust, recent experience of intimate partner violence, contraceptive side effects, infrequent sexual intercourse, and decreased arousal and pleasure due to contraceptive use. Religion, depression, history of abortion, number of children, having children, and number of pregnancies have not been associated with unprotected sex in recent studies. Several other variables have been studied with mixed results, possibly due to differences in research methods and sample characteristics.

CONCLUSIONS

More research is needed to elucidate the impact of cultural factors, relationship factors, attitude to pregnancy and motherhood, and reproductive coercion on prevention of pregnancy and sexually transmitted infections. Nurses can lead research on these topics and implement evidence-based practice based on study findings.

Beyond Sexual Partnerships: The Lack of Condom Use during Vaginal Sex with Steady Partners

PURPOSE

The purpose of this paper is to identify independent correlates of the lack of condom use when engaging in vaginal sex with steady partners among HIV-negative African American adults. The conceptual model includes proximal as well as more distal domains.

METHODS

Cross-sectional data were collected between May 2009 and August 2011. Recruitment involved active and passive recruitment strategies. Computer-assisted, individual interviews were conducted with 1,050 African American adults. Multivariate logistic regression was used to identify independent predictors of a lack of condom use with steady partners in the past 30 days.

RESULTS

In multivariate analysis, being older than 35, being partnered, perceiving having a steady partner as important, and ever having been homeless were associated positively with the odds of a lack of condom use during vaginal sex with steady partners in the past 30 days. On the other hand, reporting more than one steady partner in the past 30 days, having health insurance during the past 12 months, and perceived neighborhood social cohesion were negatively associated.

CONCLUSIONS

These findings highlight the need for HIV risk-reduction prevention and intervention efforts that consider distal as well as proximal domains. Such a perspective allows for a broader sociological inquiry into health disparities that moves beyond epidemiological factors that commonly guide public health research.