Gender Differences in the Relationship Between Education, Alcohol Use Disorder, and Unprotected Sex

  • Sexual contact is the primary vector for HIV transmission, present in 90.2% of new infections.
  • Data suggest that men and women are impacted differently by sexual risk in the context of heterosexual sex, and often this risk includes the combination of substance use and sexual behavior.
  • Two NIDA Clinical Trials Network studies of gender-specific HIV sexual risk reduction interventions for men and women (CTN-0018 and CTN-0019) offered a platform for identifying predictors of HIV heterosexual risk behavior. The current study aimed to examine gender differences in the relationship between sociodemographic characteristics and HIV sexual risk behavior (i.e., unprotected sexual occasions (USO)) in men and women when accounting for substance use disorders.

    Baseline assessments of male (N=430) and female (N=377) participants included demographic characteristics; past 3-month sexual activity; and a diagnostic assessment for alcohol, cocaine/stimulant, and opioid use disorders.

    Using mixed effects generalized linear modeling of the main outcome USO, two-way interactions of gender with age, race/ethnicity, and education were evaluated and adjusted by alcohol, cocaine/stimulant, or opioid use disorder.

    The analysis revealed that, when adjusted for alcohol use disorder, the interaction of education and gender was significant:

    • for men, a high school or greater education was significantly associated with more unprotected sexual occasions compared to men with less than high school
    • for women, greater than high school education was significantly associated with less USO compared to women with less than high school.

    None of the other interactions were significant when adjusted for cocaine/stimulant or opioid use disorder.

    Conclusions: This study demonstrates gender differences in the relationship of education, alcohol use disorder, and main partner USO in individuals in substance use disorder treatment. This underscores the importance of considering demographic and substance use factors in HIV sexual risk behavior and crafting prevention messages for this population.  These findings underscore the need for clinicians to adopt a “gender lens” when delivering treatment and services, while also maintaining a “comorbidity lens” in conducting HIV interventions.

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    Funding for this Addiction Science Made Easy project is provided by the Addiction Technology Transfer Center National Office, under the cooperative agreement from the Center for Substance Abuse Treatment of SAMHSA.

    Articles were written based on the following published research:

    Kidd JD, et al. Sociodemographic and Substance Use Disorder Determinants of HIV Sexual Risk Behavior in Men and Women in Outpatient Drug Treatment in the NIDA National Drug Abuse Treatment Clinical Trials Network. Substance Use & Misuse 2017 (in press).