Contextual factors that contribute to HIV risk reduction among out-of-treatment substance users

Background: The risky use of alcohol and other drugs in young adulthood is many times accompanied by failure to use protective measures such as condoms, sex with multiple partners, and for some unsafe injection practices. These high-risk HIV transmission behaviors have led to a 21% increase in the rates of HIV among young adults (CDC, 2012). Employing an ecological approach the purpose of this study is to examine longitudinally contextual factors that contribute to HIV risk reduction out of treatment substance users. Methods: Data were collected from a cohort of 265 out of treatment substance users using NIDA's Risk Behavior Assessment (RBA), the Risk Behavior Follow-up Assessment (RBFA). Results: A regression model determined that only the length of time in methadone maintence significantly reduced drug risk behaviors however other contextual factors impacted drug risks. Analysis determined an individual's perception that they had a 50% chance of acquiring HIV at baseline resulted in a significant decrease in drug related risk at follow-up which was not the case for those with a lower or higher perception of their risk. No predictors were found to significantly reduce sexual risk and perception of risk did not significantly alter sexual behaviors. Conclusions: This analysis of data from a cohort of out of treatment drug users found further evidence of the critical importance increasing access to substance use treatment programs and targeting unsafe sexual practices in prevention programs for drug users.