Patterns of substance use and engagement in sexual risk behavior among HIV positive adults over 50

Background: The CDC estimated that by 2015 more than half of those living with HIV will be age 50 and older, a population that has not garnered substantial attention in past HIV research. The limited available research has shown significantly higher rates of alcohol and substance use among this population than their general age cohort. Additional research has also pointed to a link between substance use and higher sexual risk behavior among older adults with HIV. METHOD: HIV-positive men and women over age 50 from the New York City area (n=540) were surveyed via telephone. The survey included demographic information; self-reported immunologic functioning; and behavioral data related to recent (past 30 days) HIV medication adherence, unprotected intercourse (UI), protected intercourse (PI), and drug and alcohol use. RESULTS: Four patterns of substance use emerged: “Primary marijuana use;” “Primary crack use;” “primary alcohol use;” and “poly-substance use” (elevated rates of all substances assessed). Regression analyses suggested that UI with a main partner was positively associated with UI with a casual partner. Those with primary alcohol use and those with poly-substance use reported increased engagement in sexual activity; however, substance use was not associated with UI vs. PI. DISCUSSION: These results suggest two primary concerns. First, the concurrence of UI with main and casual partners represents a risk for within-partner STI transmission. Second, if abstinence from drugs is associated with sexual abstinence, then sexual concerns may be important barriers to reducing substance use or maintaining abstinence.