Racial/ethnic disparities in the patterns and correlates of HIV risk behaviors among youth in substance abuse treatment programs

Background: African Americans are disproportionately affected by the HIV/AIDS epidemic. This study examines the patterns and correlates of sexual risk behaviors among African American and Caucasian youth with substance abuse (SA) problems.

Methods: We used data collected from 5,616 sexually active 12-24 year old youth (73% male; 29.5% African American, 70.5% Caucasian) who were admitted into federally funded SA treatment programs throughout the United States. Logistic and linear regression analyses were used to examine racial/ethnic differences in and correlates of sexual risk behaviors. Socio-demographic characteristics, socio-environmental risk factors, and SA and co-occurring psychosocial problems served as potential covariates/correlates.

Results: African Americans, compared to Caucasians, were less likely to have sex while high on drugs but were more likely to purchase sex, have multiple partners, and use drugs to enhance sexual experience. Although no significant difference was detected in rates of sex without a barrier, African Americans had significantly higher counts of risky sexual behaviors than Caucasians after controlling for covariates. Older age, victimization, and SA and co-occurring problems predicted sexual risk similarly in both groups. In contrast, alcohol and amphetamine abuse predicted sexual risk among African Americans, whereas being female and abusing cocaine predicted sexual risk among Caucasians.

Conclusions: African American youth with substance use problems are at greater risk for HIV infection because of their multiple sexual risk behaviors. Differences in socio-environmental risk, SA and co-occurring problems explain only a small proportion of the racial/ethnic disparities in sexual risk behaviors. Implications of these findings for HIV prevention are discussed.