Rural Center for AIDS/STD Prevention

RAP Time

(Volume 2, No. 2, February 6, 1998)

Issue Contents

Predicting Risky Sexual Behavior for HIV Infection Based on Alcohol Use

HIV prevention interventions to reduce sexual risk behaviors among injecting drug users (IDUs) typically are not specific to the various subgroups of IDUs. Substantial differences among IDUs have been reported. Changing sexual risk behaviors of IDUs has been difficult.

Data from recent interviews with IDUs showed that nearly 30 percent use alcohol to a greater degree than rest of the sample. Those most likely to use alcohol were also most likely to engage in high-risk sexual behaviors for HIV infection.

Collection of Data
A purposeful sample of 238 low income residents of Anchorage, Alaska was interviewed to assess behavioral and personality variables. The sample was 34 percent and 66 percent female and male, respectively.

Fourty-four percent of the sample were white, with 26 percent and 24 percent being black and American Indian/ Alaskan Native, respectively. The median age was 36 years and the median monthly ;income was $500-$999. Participants were out-of-treatment IDUs and/or cocaine smokers who reported at least one sex partner in the previous 30 days.

Study Outcomes
Alcohol use was initiated at a median age of 14 years. Seventy one percent of the sample reported drinking to intoxication at least once in the previous six months. Condoms were used by 32 percent and 27 reported having multiple partners and not always using condoms.

Twenty-five percent responded at least one IDU sex partner and not always using condoms. Forty percent of the females had exchanged sex to get money for drugs in the previous 30 days.

Forty-one percent of the males had exchanged money or drugs to get sex in the past 30 days. Subjects were classified as high risk or low-risk alcohol users based on amount and frequency of alcohol use, frequency of intoxication and age of initiation to alcohol use. IDUs classified as high-risk alcohol users were compared to those classified as low-risk alcohol users on several dimensions of HIV sexual risk behavior. Subjects in the high-risk alcohol user group were more likely than those in the low-risk alcohol user group to:

  • report multiple sex partners,
  • have at least one IDU sex partner without the use of condoms,
  • report a low proportion of protected sexual acts in the past 30 days, and
  • report the exchange of sex to get money for drugs if female.

These findings remained after controlling for the personality variables of risk proneness and sensation seeking behavior.

Findings suggest that patterns of alcohol use among IDUs can be used to identify persons at-risk of HIV/STD infection as a result of sexual behaviors. IDUs enrolled in alcohol treatment programs and out-of-treatment IDUs who fit the profile of a high-risk alcohol users may be specifically targeted for HIV prevention interventions.

SOURCE: Fenaughty, A. M., & Fisher, D. G. (1998). High-risk sexual behavior among drug users: The utility of a typology of alcohol variables. Sexually Transmitted Diseases, 2), 38-43.

Studies Examine Issues for Rural HIV Prevention

A recent article in the Journal of the American Medical Association described a study of rural health care clinics in five states and survey results from rural California physicians. Each study supported a need for increased attention to educational material designed to promote HIV/AIDS awareness in rural areas.

The first study reported results from visits to rural clinics in Georgia, Mississippi, South Carolina, Texas and Washington. HIV education was lacking and unlikely to address the increasing epidemic among women. Barriers to HIV testing and counseling for rural women included denial of risk by clients and health care providers.

A second study reported that two-thirds of 102 rural California physicians had not seen a client with HIV or AIDS in the past six months. Physicians with greater experience treating clients with HIV/AIDS were more likely to recommend HIV testing for clients with other STDs.

SOURCE: Voelker, R. (1998). Rural communities struggle with AIDS. Journal of the American Medical Association, 279, 5-6.

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Peer Networks Increase Effectiveness of HIV Prevention

Community-level HIV prevention programs are more likely to reduce risky sexual behavior if opinion leaders are used to advocate to peers the benefits of behavior change. In a study of eight small United States cities, gay men at bars participated in an assessment of HIV-related sexual behavior and a one year following four cities assigned as controls, prevention education materials were placed in the bars.

In four cities assigned as intervention sites, popular gay men of the community were trained to disseminate behavior messages through their peer networks. At follow-up, significantly fewer occasions of unprotected anal intercourse occurred in the intervention cities as opposed to the control cities. Occasions of unprotected ana intercourse were about 4 times greater in the control cities. Increased numbers of condoms were taken from bars in the intervention c;ties.

SOURCE: Kelly, J. A et al. (1997). Randomised, controlled, community-level HIV-prevention intervention for sexual-risk behavior among homosexual men in US cities. Lancet, 310, 1500-1505.

CDC Evaluates Unique Identifiers to Improve HIV Surveillance

Success in treating HIV infection has made AIDS surveillance less reflective of recent trends in the epidemic. An unique identifier (UI) uses a non-name code to protect identity of the person. Experimental UI testing found limitations indicating need for further development of UIs.

SOURCE: CDC. (1997). Evaluation of HIV case surveillance through the use of non-name unique identifiers--Maryland and Texas, 1994-1996. Morbidity and Mortality Weekly Review, 46, 1254-1271.

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Trichomonas Amplifies HIV Transmission

Lesions created by the immune response to Trichomonas vaginalis probably amplify entry and exit of HIV in women. High incidence rates of Trichomonas combined with lack of symptoms make this STD a cofactor for HIV transmission.

SOURCE: Sorvillo, F., & Kerndt, P. (1998). Trichomonas vaginalis and amplification of HIV transmission (letter). Lancet, 351, 213.