Unprotected Sex Among HIV-Positive Injection Drug-Using Women and Their Serodiscordant Male Partners

University of California, San Francisco, San Francisco, California, United States
JAIDS Journal of Acquired Immune Deficiency Syndromes (Impact Factor: 4.56). 07/2006; 42(2):222-8. DOI: 10.1097/01.qai.0000214813.50045.09
Source: PubMed


We investigated the characteristics of human immunodeficiency virus (HIV)-positive injection drug-using women who reported unprotected vaginal and/or anal sex with HIV-negative or unknown serostatus (serodiscordant) male partners. Of 426 female study participants, 370 were sexually active. Of these women, 39% (144/370) and 40% (148/370) reported vaginal and/or anal sex with serodiscordant main and casual partners, respectively. Sixty percent of women inconsistently used condoms with their serodiscordant main partners, whereas 53% did so with casual partners. In multivariate analysis, during sex with main partners, inconsistent condom users were less likely to feel confident about achieving safe sex (self-efficacy), personal responsibility for limiting HIV transmission, and that their partner supported safe sex. Inconsistent condom use was also more likely among women who held negative beliefs about condoms and in couplings without mutual disclosure of HIV status. Regarding sex with casual partners, inconsistent condom users were more likely to experience psychologic distress, engage in sex trading, but they were less likely to feel confident about achieving safe sex. These findings suggest that there are widespread opportunities for the sexual transmission of HIV from drug-using women to HIV-uninfected men, and that reasons vary by type of partnership. Multifaceted interventions that address personal, dyadic, and addiction problems are needed for HIV-positive injection drug-using women.

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Available from: Julia H Arnsten, Apr 13, 2014
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    • "In a study of female injection drug users living with HIV/AIDS, self-efficacy more strongly predicted unsafe sex with serodiscordant partners when partners were described as " casual " as opposed to " steady " (Latka, Metsch, Mizuno, Tobin, Mackenzie, et al. 2006). But among men living with HIV/AIDS, self-efficacy was associated with unprotected sex regardless of partner type or perceived partner serostatus (Purcell, Mizuno, Metsch, Garfein, Tobin, Knight, & Latka, 2006). "
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    ABSTRACT: Evidence of the effects of negative affect (NA) and sexual craving on unprotected sexual activity remains scant. We hypothesized that NA and sexual craving modify the same day association between low self-efficacy to use condoms and unprotected anal or vaginal sex, and the same-day association between alcohol use during the 3 hours prior to sexual activity and unprotected sex. We used an electronic daily diary, drawing on a sample of 125 men and women recruited from an agency serving economically disadvantaged persons living with HIV/AIDS. Casual or steady partner type designation and perceived partner HIV serostatus were also examined. Findings support the hypothesized moderating effects of high NA and sexual craving on the association between low self-efficacy and unprotected sex, and the association between alcohol use and unprotected sex. Implications are discussed.
    Full-text · Article · Dec 2010 · Psychology of Addictive Behaviors
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    • "In this study, as in prior research with IDUs, contextual factors, such as partner norms that support condom use, were determinants of consistent condom use with both main and casual partners (Corby et al. 1996; Jamner et al. 1998; Latka et al. 2006; Purcell et al. 2006). Yet among IDUs with main partners, individuals who reported partner norms opposing condom use were also more likely to report consistent condom usage. "
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    ABSTRACT: We investigated the longitudinal influence of individual-, relationship- and social-level factors on condom use by partner type among young injections drug users (IDUs) enrolled in the Collaborative Injection Drug Users Study-III/Drug Users Intervention Trial (CIDUS-III/DUIT) from 2002 to 2004. Based on longitudinal analysis using generalized estimating equations (GEE), consistent condom use with main partners was more commonly reported among males and those with greater self-efficacy for condom use; main partner's desire for pregnancy and needle sharing were negatively associated with consistent condom use. Among those with casual partners, having fewer sex partners was associated with consistent condom use. Positive attitudes toward condom use and partner norms supporting condom use were associated with greater consistent condom use with both partner types. These findings suggest that intervention strategies targeting individual- and partner-level factors may provide avenues for intervening upon sexual risks among young IDUs.
    Full-text · Article · Jun 2009 · AIDS and Behavior
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    • "Based upon their meta-analytic review of associations between negative affective states and HIV sexual risk behavior, Crepaz and Marks (2001) concluded that there is no compelling evidence to suggest that negative affective states are associated with sexual risk. Negative attitudes toward condom use have also been shown to be associated with inconsistent condom use among non-drug using (Carballo-Diequez and Dolezal, 1996; Catania et al., 1994; Reilly and Woo 2001; Sheeran et al., 1999) and drug using individuals (Latka et al., 2006). Personal responsibility, i.e. responsibility to protect others from HIV, has been found to be a motivational factor associated with increased condom use (van Kesteren et al., 2005). "
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    ABSTRACT: The purpose of this cross-sectional study was to classify a sample of HIV-seropositive African-American crack cocaine smokers into homogenous HIV drug use and sexual risk groups using a two step multivariate cluster analysis. Two hundred and fifty-eight crack cocaine smokers participated in the study. Cluster analysis revealed three distinct HIV risk groups. The highest risk group, the largest one, was characterized by frequent, daily crack use, multiple sex partners, trading sex, and inconsistent condom use. The consistent condom use group, the smallest group, was characterized by consistent condom use. The inconsistent condom use group, the second largest group, was distinguished by inconsistent condom use. Comparisons of the three HIV risk groups revealed that the highest risk group had a higher proportion of illegal sources of income, higher proportion of binged crack use, frequent, daily, alcohol use, same gender sex partners, and scored higher on depressive symptoms. Members of the consistent condom use group were more likely to have been HIV diagnosed for a shorter time, to have HIV serodiscordant casual sex partners, higher psychological motivation for condom use, and a lower frequency of vaginal sex. Members of the inconsistent condom use group were more likely to have a main sex partner, to be married, to be on public assistance, to know the HIV serostatus of their casual partner, and less likely to conceal their HIV serostatus. An alarming finding was that a large number of participants inconsistently used condoms with HIV serodiscordant sex partners. Interventions aiming to prevent the secondary spread of HIV infection in African-American crack cocaine smokers should take this variability in account and focus on the differences.
    Full-text · Article · Oct 2008 · Drug and Alcohol Dependence
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