Continued Sexual Risk Behavior
Among HIV-Seropositive, Drug-Using Men --
Atlanta; Washington, D.C.; and San Juan, Puerto Rico, 1993
Behaviors associated with increased risk for sexual
transmission of
human immunodeficiency virus (HIV) by infected persons include
unprotected
intercourse, multiple sex partners, use of crack cocaine, failure
to
disclose serostatus to sex partners, and trading sex for money or
drugs.
Some sexually active, HIV-infected persons in the United States
continue to
practice risky behaviors (1-4). To characterize continued sexual
risk
behaviors among HIV-positive, illicit-drug-using men, in 1993 CDC
analyzed
data from such men recruited for a small group-intervention program
in
three cities -- Atlanta; Washington, D.C.; and San Juan, Puerto
Rico. This
report summarizes the results of that analysis, which indicate that
some
seropositive men continue to engage in unprotected sex.
Data were collected from interviews administered by trained,
on-site
interviewers of 120 men known to be HIV-seropositive and
illicit-drug
users. They were recruited through support groups and a day
drug-treatment
program for assisting HIV-infected persons; four persons were
excluded
because of incomplete data. The 116 men included 63 from San Juan,
38 from
Atlanta, and 15 from Washington; all reported use of injected drugs
or
noninjection use of cocaine during the preceding year. Information
obtained
during the interviews included demographic data; respondents'
perceptions
of personal health; HIV-related services received; and sexual risk
behaviors, including unprotected sexual intercourse with steady,
nonsteady,
and commercial sex partners (i.e., men who were male prostitutes or
had had
sex with prostitutes). Risk behaviors were reported for sexual
activity
during the preceding 30 days. To assess an association between
unprotected
sex and selected characteristics (i.e., race/ethnicity, age,
perceptions of
health status, services being received, use of crack cocaine, route
of drug
administration, and frequency of drug use), data on the men
reporting
unprotected anal or vaginal sex were analyzed by contingency table
chi-square techniques.
The mean age of the 116 men was 36 years (range: 22-54 years).
The men
had known of their HIV seropositivity for an average of 49 months,
and most
(100 {86%}) were participating in two or more HIV-related services,
including case management, HIV and substance-abuse-related support
groups,
and medical care; 60 (52%) had been admitted to residential drug
treatment
for at least 1 month during the preceding year. Most (83 {72%})
reported
having used crack cocaine.
Of the 116 men, 35 (30%) reported engaging in sexual
intercourse
greater than or equal to 12 times during the preceding 30 days. A
total of
39 (34%) reported two or more sex partners, 32 (28%) reported
having
vaginal or anal sex without a condom, and 22 (23%) reported having
traded
sex for drugs or money. A total of 37 (32%) had not disclosed their
HIV
status to all partners, and 73 (63%) were either unaware of any
partners'
HIV status or believed they were negative.
The 32 men who reported sex without a condom were
significantly more
likely than those who used condoms to report multiple sex partners,
having
oral sex, trading sex for money or drugs, failure to disclose HIV
serostatus, and having intercourse greater than or equal to 12
times (p
less than or equal to 0.05). These men were at high risk for
infecting
their sex partners and reported a mean of four sex partners (range:
one-25)
with an average of 14 sex acts without a condom for all partners
during the
preceding month.
Reported by: SC Kalichman, PhD, Psychology Dept, Georgia State
Univ,
Atlanta. Behavioral Intervention Research Br, Div of STD
Prevention,
National Center for Prevention Svcs, CDC.
Editorial Note
Editorial Note: The findings in this report underscore that some
persons
with HIV infection need ongoing assistance and support to acquire
and
maintain safer sex practices. For example, in this study, men who
reported
not using condoms were more likely than men who reported using
condoms to
report trading sex for money or drugs. This finding indicates the
need for
further characterization of the behavioral and environmental
determinants
of continued unsafe sexual behavior among HIV-seropositive,
illicit-drug
users. In addition, the findings indicate opportunities for
strengthening
prevention because most of these men already were linked to ongoing
community programs that provide drug treatment, mental health
services,
health care, and psychologic support. Such programs also should
educate,
motivate, and assist patients in acquiring skills needed to
maintain safer
practices.
References
Higgins DH, Galavotti C, O'Reilly KR, et al. Evidence for the
effects
of HIV antibody counseling and testing on risk behaviors. JAMA
1991;
266:2419-29.
Cleary PD, VanDevanter N, Rogers TP, et al. Behavior changes
after
notification of HIV infection. Am J Public Health
1991;81:1586-90.
Otten MW, Zaidi AA, Wroten JE, et al. Changes in sexually
transmitted
disease rates after HIV testing and post-test counseling,
Miami, 1988
to 1989. Am J Public Health 1993;83:529-33.
Singh BK, Koman JJ, Catan VM, et al. Sexual risk behavior among
injection drug-using human immunodeficiency virus-positive
clients. Int
J Addict 1993;28:735-47.
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