Predictors of HIV Sex Risk Behavior Among Women in Treatment for Substance Use Disorders
In the U.S., women account for about 1 in 5 new HIV infections annually, with the vast majority of these (84%) from heterosexual contact. Substance use is often a driver of HIV transmission, either through a partner who is HIV+ and uses drugs or via sexual behavior in the context of alcohol and drug use.
Women in treatment for substance use disorder (SUD) are a population at potential risk for HIV, even if that risk is low overall. While SUD treatment has been shown to significantly reduce HIV drug use risk behavior (e.g., needle sharing), it has not been shown to be sufficient for reducing sexual risk behavior (e.g., condom use or having multiple partners).
This study, an analysis of data from CTN-0019, aimed to identify characteristics associated with HIV sex risk behavior among women in outpatient SUD treatment. Researchers categorized 809 screened women into 3 groups:
- sexually inactive,
- sexually active with consistent condom use,
- sexually active with inconsistent condom use.
After examining demographics, substance use and treatment characteristics, and regional HIV seroprevalence as predictors of sexual risk behavior, younger age and attending psychosocial treatment for primary cocaine use (vs. attending methadone maintenance treatment for primary opioid use) were found to be significantly associated with higher HIV risk.
Conclusions: Grounded in data from a large, geographically heterogeneous, national sample of substance using women in substance abuse treatment, this study identified demographic and clinical characteristics among women with differing levels of HIV risk. Analyses examined established predictors of HIV risk behavior of enduring importance, including: (younger) age, having multiple partners, primary stimulant use, alcohol use, and community HIV risk (as indicated by estimated HIV seroprevalence in injection drug users). HIV prevention should be tailored to address HIV risk in younger women in psychosocial treatment.
Citation: Spector AY, Pavlicova M, Hu M, Nunes EV, Campbell ANC, Tross S. Predictors of HIV Sex Risk Behavior Among Women in US Drug Treatment Programs: NIDA CTN Trial Results. Journal of HIV/AIDS & Social Services 2020 (in press).