Predictors of recent unsafe sex among high-risk youth

Introduction: Research has demonstrated associations between substance use and unsafe sexual behavior. This study examined whether recent substance use predicts unsafe sex among high-risk youth. Methods: Between October 2009 and March 2011, 596 high risk youth (polydrug users, homeless, and injection drug users) aged 16 to 25, were interviewed in Los Angeles and New York City. Use of prescription and illicit drugs, and condoms in the last 90 days, and current psychosocial correlates were assessed. Multivariate logistic regression analysis was conducted with recent unprotected sex regressed on most significant bivariate predictors. Results: 75% of participants reported unsafe sex in the past 90 days. Significant demographic correlates of unsafe sex include a gender (p<0.001), and current injection drug use (p<0.05). Participants reporting unsafe sex exhibited more anxiety and stress symptoms (p<0.05). Use of prescription opioids (p<0.01), heroin (p<0.01), cocaine (p<0.05) and metamphetmine (p<0.05), and drug use during sex (p<0.05) were significant correlates of unsafe sex. Of the 15 variables included in the multivariate analyses, 4 variables continued to be significant predictors of unprotected sex: female gender (OR=3.04, 95% CI 1.72-5.39), prescription opioids (OR=1.83, 95% CI 1.06-3.16), heroin (OR=2.08, 95% CI 1.01-4.28), and methamphetamine (OR=2.19, 95% CI 1.22-3.95). Conclusions: Results show that female youth using opioids and metamphetamine in the past 90 days were more likely to engage in unsafe sex. Although recent substance use patterns are not to be interpreted as a cause of risky sexual behavior, they may be useful markers to identify youth who are at risk for STI.