Determinants of alcohol consumption in HIV-uninfected injection drug users

Department of Epidemiology, The Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599, USA.
Drug and alcohol dependence (Impact Factor: 3.42). 09/2010; 111(1-2):173-6. DOI: 10.1016/j.drugalcdep.2010.04.004
Source: PubMed


We assess the association between time fixed and time varying participant characteristics and subsequent alcohol consumption in 1968 injection drug users (median age 37 years, 28% female, 90% African-American) followed semi-annually from 1988 to 2008. Median alcohol consumption was seven drinks per week at study entry (first and third quartile: 1, 26) with 36% reporting binge drinking. Alcohol consumption and binge drinking decreased over follow-up. Older individuals and women reported consuming fewer drinks per week. Higher typical alcohol consumption was reported by those participants who reported in the prior 6 months: non-injection cocaine use, injection drug use, having one or more sex partners, or among men, a same sex partner. Associations were generally similar for drinks per week and binge drinking. This study demonstrates that in a large urban cohort of persons with a history of injection drug use, risky drug use and sexual risk behavior are associated with subsequent alcohol consumption.

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    • "Individuals who use substances are likely to engage in sexual risk behaviors while under the influence of drugs and/or alcohol (Abdala et al., 2010; Sander et al., 2010). One explanation for HIV transmission among non-injection drug users is that intoxication through the use of various substances may lead to a lack of attention to engaging in the practice of safe sex or a propensity toward engaging in high-risk sex (Castor et al., 2010; Strathdee and Sherman, 2003). "
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    ABSTRACT: Background: HIV transmission risk among non-injection drug users is high due to the co-occurrence of drug use and sexual risk behaviors. The purpose of the current study was to identify patterns of drug use among polysubstance users within a high HIV prevalence population. Methods: The study sample included 409 substance users from the Pretoria region of South Africa. Substances used by 20% or more the sample included: cigarettes, alcohol, marijuana and heroin in combination, marijuana and cigarettes in combination, and crack cocaine. Latent class analysis was used to identify patterns of polysubstance use based on types of drugs used. Multivariate logistic regression analyses compared classes on demographics, sexual risk behavior, and disease status. Results: Four classes of substance use were found: MJ+Cig (40.8%), MJ+Her (30.8%), Crack (24.7%), and Low Use (3.7%). The MJ+Cig class was 6.7 times more likely to use alcohol and 3 times more likely to use drugs before/during sex with steady partners than the Crack class. The MJ+Cig class was 16 times more likely to use alcohol before/during sex with steady partners than the MJ+Her class. The Crack class was 6.1 times more likely to engage in transactional sex and less likely to use drugs before/during steady sex than the MJ+Her class. Conclusions: Findings illustrate patterns of drug use among a polysubstance using population that differ in sexual risk behavior. Intervention strategies should address substance use, particularly smoking as a route of administration (ROA), and sexual risk behaviors that best fit this high-risk population.
    Drug and alcohol dependence 04/2013; 132(3). DOI:10.1016/j.drugalcdep.2013.03.004 · 3.42 Impact Factor
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    • "Studies from various populations have documented the role of alcohol in the engagement of risky sexual behaviors.10–11 These studies report that individuals who misuse alcohol are more likely to report greater intention to engage in risky sexual behaviors,12 more likely to report having multiple sexual partners,13–14 less likely to use condoms during sex,15 and more likely to have sex with someone who they have just met (unintended).7,16 The underlying assumption of these studies (ie, global association studies) is that drinking alcohol in excessive amounts can increase the likelihood that an individual will engage in unplanned sexual activities or will not use protection when having sex (ie, unsafe sexual practices).17 "
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    ABSTRACT: We examine the association between self-reported alcohol misuse and alcohol use within 2 hours of having sex and the number of sexual partners among a sample of African-American and Latino emergency department (ED) patients. Cross-sectional data were collected prospectively from a randomized sample of all ED patients during a 5-week period. In face-to-face interviews, subjects were asked to report their alcohol use and number of sexual partners in the past 12 months. Data were analyzed using multiple variable negative binomial regression models, and effect modification was assessed through inclusion of interaction terms. The 395 study participants reported an average of 1.4 (standard error = 0.11) sexual partners in the past 12 months, 23% reported misusing alcohol, and 28% reported consuming alcohol before sex. There was no statistically significant association between alcohol misuse and the number of sexual partners; however, alcohol before sex was associated with a larger number of sexual partners in the past year. Moreover, among those who misused alcohol, participants who reported alcohol before sex were 3 times more likely to report a higher number of sexual partners (risk ratio = 3.2; confidence interval [CI] =1.9-5.6). The association between alcohol use before sex and number of sexual partners is dependent upon whether a person has attributes of harmful drinking over the past 12 months. Overall, alcohol use before sex increases the number of sexual partners, but the magnitude of this effect is significantly increased among alcohol misusers. Alcohol misusers and those who reported having more than 1 sexual partner were more likely to cluster in the same group, ie, those who used alcohol before sex. Efforts to reduce the burden of sexually transmitted diseases, including human immunodeficiency virus, and other consequences of risky sexual behavior in the ED population should be cognizant of the interplay of alcohol and risky sexual behaviors. EDs should strive to institute a system for regular screening, brief intervention, and referral of at-risk patients to reduce negative consequences of alcohol misuse, including those of risky sexual behaviors.
    The western journal of emergency medicine 05/2012; 13(2):151-9. DOI:10.5811/westjem.2011.6.6676
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