Individual, Event Level and Partnership Level Correlates of Sexual Risk in Rural and Urban Drug Users and MSM

Background: Alcohol and other drug use exacerbate the continued spread of HIV among minorities and high risk groups in rural and urban areas in the South. Individual level risk behavior data (e.g. frequency of unprotected sex) provide limited information on the social and situational context in which behaviors occur. This study examined associations among individual, event level and partnership characteristics and unprotected intercourse.

Method: MSM, drug users and their sexual partners were recruited in urban and rural counties in NC. 1378 participants reported on sexual encounters with 2365 partners. Analysis, which adjusted for within subject correlations, was used to identify individual, encounter and partnership factors independently associated with unprotected intercourse at last sex with each partner.

Results: 54% of encounters involved unprotected intercourse. Average age of participants and their partners is 36.5 years. In 65% of partnerships both partners were African-American, in 16% one partner was white and one was African-American and in 12% both partners were white. Individual level variables independently associated with unprotected intercourse included white race and homelessness while being HIV positive was negatively associated with unprotected intercourse. Encounter level variables associated with unprotected intercourse included binge drinking and methamphetamine use. Partnership variables associated with unprotected intercourse included sex with a main partner and closeness of relationship. Sexual concurrency was negatively associated with unprotected intercourse.

Conclusions: Including event and partnership level factors in analyses of sexual risk provides important contextual information beyond what is provided by individual risk behaviors, which may be incorporated into couples' interventions.