Alcohol and drug use during or before risky sexual behaviors among substance use disorder treatment seekers

Background: Alcohol/drug use during or before sex potentially increases HIV transmission risk.

Objectives: 1) Describe the prevalence of severe drug use and risky sexual behaviors among clients in substance use disorder treatment programs.  2) Examine the associations between severe drug use and risky sexual behaviors among clients having unprotected sex within two hours of using drugs or alcohol.

Methods: A total of 1281 participants from 12 US community-based substance use disorder treatment programs were included in this study.  Chi-square tests, univariate, multiple logistic models were used in this planned secondary analysis of data from CTN-0032, a trial conducted within the National Drug Abuse Treatment Clinical Trials Network.

Results: People using pain medication (OR=3.42, 95% CI=1.76-6.66, p=0.0003), marijuana (OR=1.72, 95% CI=1.08-2.72, p=0.0219), or methamphetamines (OR=5.98, 95% CI=1.16-30.87, p=0.0327) were more likely to report unprotected sex within two hours of using drugs or alcohol. In addition, after controlling for different types of substances used, people having unprotected sex within two hours of using drugs or alcohol were more likely to have multiple sex partners, unprotected vaginal sex, anal sex, unprotected sex acts with non-primary partners and with HIV unknown serostatus partners. Marijuana (41%) was mostly commonly reported, followed by cocaine (37%) and opioids (30%), as the substance used during participants’ most recent episode of risky sex with substance use. 

Conclusions: Results from the current study support the importance of focusing on the association between intoxication and sexual risk behaviors when delivering HIV risk reduction interventions to substance use disorder treatment clients.