142nd APHA Annual Meeting and Exposition

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Correlates of substance use during sex among women living with HIV engaged in routine healthcare in 4 U.S. cities

142nd APHA Annual Meeting and Exposition (November 15 - November 19, 2014): http://www.apha.org/events-and-meetings/annual
Tuesday, November 18, 2014

Sari Reisner, ScD , Epidemiology/ The Fenway Institute, Harvard School of Public Health/ Fenway Health, Boston, MA
Kenneth H. Mayer, MD , Infectious Diseases, Harvard Medical School/Beth Israel Deaconess Medical Center/Fenway Community Health, Boston, MA
Chris Grasso, MPH , The Fenway Institute, Fenway Health, Boston, MA
Heidi Crane, MD, MPH , Division of Infectious Diseases, University of Washington School of Medicine, Seattle, WA
Mari Kitahata, MD, MPH , Division of Infectious Diseases, University of Washington School of Medicine, Seattle, WA
Michael Mugavero, MD, MHSc , University of Alabama at Birmingham, Birmingham, AL
Kenneth Saag, MD, MSc , University of Alabama at Birmingham, Birmingham, AL
Joseph Schumacher, PhD , University of Alabama at Birmingham, Birmingham, AL
Wm Christopher Matthews, MD , Department of Medicine, University of California San Diego, LaJolla, CA
Katie Biello, PhD, MPH , The Fenway Institute, Boston, MA
Matthew Mimiaga, ScD, MPH , Department of Epidemiology/ Department of Psychiatry, Harvard School of Public Health/ Harvard Medical School, Boston, MA
Background: Substance use during sex has been shown to be a risk factor for HIV transmission among females; however, viral suppression is rarely considered alongside sexual risk behaviors.

Method: Data were from an observational study of 545 HIV-infected female patients (mean age=45; 66% racial/ethnic minority; 87% never IDU) in routine HIV care in 4 U.S. cities (Seattle WA, Birmingham AL, San Diego CA, Boston MA) in the Centers for AIDS Research Network of Integrated Clinical Systems (CNICS). Generalized estimating equations modeled correlates of past-6 month alcohol and/or drug use just before or during sex, assessed at baseline enrollment (December 2005-April 2010). Models were adjusted for baseline characteristics of age, race/ethnicity, HIV antiretroviral medications, CD4 count, and depression.

Results: The prevalence of past 6-month substance use just before or during sex was 13%. More than half (52%) of women had a detectable viral load (VL) (median=2020 copies/mL; interquartile range=20032). Nearly half (48%) reported past 6-month vaginal sex. Of these, 46% (n=121) reported unprotected vaginal sex (UVS); among those reported UVS, 58% had a detectable VL. UVS with detectable VL (adjustedOddsRatio(aOR)=1.60; 95%CI=1.04, 2.46) and UVS with no VL (aOR=2.41; 95%CI=1.60, 3.63) were both significantly associated with substance use during sex. The same associations were not found for unprotected anal sex.

Conclusions: HIV transmission risk behaviors, particularly UVS, are associated with substance use during sex among HIV-infected females in care. Interventions are needed that specifically address unprotected sex in the context of alcohol and non-parenteral drug use before or during sexual encounters.

Learning Areas:

Epidemiology
Public health or related research
Social and behavioral sciences

Learning Objectives:
Assess the relationship of HIV transmission risk behaviors, with and without viral load suppression, and substance use during sex among women living with HIV engaged in care in 4 U.S. cities. Describe implications of findings for intervention design and development.

Keyword(s): Alcohol Use, Women and HIV/AIDS

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a Postdoctoral Research Fellow in the Department of Epidemiology at Harvard School of Public Health and a Research Scientist at the Fenway Institute at Fenway Health.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

Back to: 4280.0: People Living with HIV/AIDS