Dose-response relationship between alcohol, substance use and high-risk sexual activity: Findings from National HIV Behavioral Surveillance (NHBS) in New York State

Background: The CDC-sponsored NHBS monitors HIV/AIDS-related behaviors among networks of high-risk individuals. We investigated the relationship between the degree of alcohol and substance use and sexual behavior outcomes.

Methods: Respondent-driven sampling was used to recruit heterosexuals in high HIV prevalence areas in Long Island for a structured interview. Non-injection drug use was grouped into 3 categories: 0 drugs, 1-2 drugs, and ≥3 drugs. Binge drinking in the past month was categorized as <1 episode/month, 1-4 episodes/month, and >1 episode/week. Outcome variables included unprotected vaginal/anal sex and multiple partners. Statistical analysis included chi-square tests, one-way analysis of variance and multiple logistic regression.

Results: Among 679 HIV-negative participants, those who reported binge drinking of 1-4 episodes/month were more likely to report unprotected sex (OR=1.95; p=0.006) and multiple partners (OR=1.82; p=0.008) compared to those who reported <1 episode/month. Those who reported >1 episode/week were even more likely to report unprotected sex (OR=3.62; p<0.0001) and multiple partners (OR=4.81; p<0.0001). Similarly, compared to individuals with no drug use, those who reported 1-2 drugs were more likely to report unprotected sex (OR=2.14; p=0.001) and multiple partners (OR=3.23; p<0.0001). Individuals reporting ≥3 drugs were even more likely to report unprotected sex (OR=9.46; p<0.0001) and multiple partners (OR=10.84; p<0.0001).

Conclusions: Our findings indicate a strong dose-response relationship between alcohol and substance use and sexual risk behavior outcomes among high-risk heterosexuals in New York State, emphasizing the importance of assessments that measure the degree of alcohol and substance use rather than simply their occurrence in general.