HIV risk behaviors and alcohol intoxication among injection drug users in Puerto Rico
Introduction
Multiple studies have shown that comorbid alcohol abuse and dependence are common among drug users (Kessler et al., 1997, Stein et al., 2000, Burns and Teesson, 2002). However, the relationship between alcohol use disorders and HIV risk behaviors among drug users has received less attention in the research community. This has been attributed to a perception among researchers, clinicians, and drug users that alcohol-related problems are of less importance compared with such problems as trauma and injury; overdose; depression; other health conditions such as HIV, hepatitis, and tuberculosis; and violent death that drug users are likely to suffer.
Moreover, most studies that have addressed HIV risk behaviors have been conducted among subjects enrolled in needle-exchange clinics or drug treatment programs, and have included mainly sexual risk behaviors (Rees et al., 2002, Thomas et al., 1991). Those studies addressing both injection-related and sexual risk behaviors have reported mixed findings. A recent study among patients in a drug detoxification program found alcohol consumption to be significantly associated with sexual risk behaviors but not with drug use-related risk behaviors (Rees et al., 2001). Fenaughty and Fisher (1998) reported that drug users classified as high risk on the basis of current and lifetime alcohol use patterns were significantly more likely to report multiple sex partners and inconsistent use of condoms than drug users without alcohol use. Stein et al. (2001) and Stein et al. (2000) reported that among drug users who were participants in a needle-exchange program, hazardous drinking was significantly associated with higher rates of drug use-related and sexual risk behaviors.
Injection drug use accounts for 50% of all AIDS cases in Puerto Rico (Puerto Rico Department of Health, 2003). The incidence of AIDS among injection drug users (IDUs) has placed the Island among the AIDS epicenters in the United States (Centers for Disease Control and Prevention, 2002). As in other sites in the US, the Island has recorded a decrease in the AIDS incidence rate. However, the prevalence of HIV risk behaviors among Hispanic IDUs in Puerto Rico has continued to be notably high compared with IDUs in other sites in the US, including Puerto Ricans residing in New York City (Deren et al., 2003a). This high rate of HIV risk behaviors among drug users in the Island has persisted even after 10 years of substantial prevention efforts by multiple service organizations, researchers, and drug treatment providers. This study is an effort to increase understanding of the association between alcohol intoxication and HIV risk behaviors among injection drug users in Puerto Rico. The goal is to search for injection drug users’ behaviors that may be related to HIV risk behaviors and that have not been addressed in previous epidemiological surveys and HIV prevention-intervention studies on comorbid substance use.
Section snippets
Subjects
Subjects in this analysis were recruited as part of a research project entitled, “Addressing HIV Risk and Health Care Needs under Managed Care,” a longitudinal experimental study designed to test the efficacy of a two-facet intervention (involving counseling and case management) in reducing drug use and HIV risk behaviors, encouraging participation in a drug treatment program, and increasing self-efficacy among drug injectors. Outreach workers recruited self-identified drug injectors, age 18
Results
Table 1 presents a general profile of the study sample including demographics, type of drug use, and health characteristics. Almost 90% of participants were males; 43% had completed high school; and 6% reported being homeless. The mean age for the sample was 30.0 years (S.D. = 8.7 years), with one-third of participants (36%) classified as young adults (18–24 years). Heroin and cocaine were the most frequently used drugs, each reported by over 90% of the sample. Marijuana and sedative use were
Discussion
Findings of the present study seem to suggest that, among drug injectors, the association between alcohol intoxication and both injection and sexual risk behaviors is straightforward. This differs from previous findings, including those of Stein et al. (2001), who reported that alcohol intoxication was associated with drug use risk behaviors but not with sexual behaviors, and Rees et al. (2001), who found alcohol consumption to be associated with sexual behaviors but not with injection risk
Acknowledgements
This study was supported by a grant from the National Institute on Drug Abuse of the National Institutes of Health (NIDA Grant No. 5 R01 DA10636).
References (24)
- et al.
Psychometric properties of the Beck Depression Inventory: twenty-five years of evaluation
Clin. Psychol. Rev
(1988) - et al.
Alcohol use disorders comorbid with anxiety, depression and drug use disorders: findings from the Australian National Survey of Mental Health and Well Being
Drug Alcohol Depend
(2002) - et al.
Confirmatory factor analysis of the Beck Anxiety and Depression Inventories in patients with major depression
J. Affect. Disord
(1998) - et al.
Alcohol outcome expectancies and risk for alcohol use problems in women with and without a family history of alcoholism
Drug Alcohol Depend
(2003) - et al.
Association of alcohol consumption with HIV sex- and drug-risk behaviors among drug users
J. Subst. Abuse Treat
(2001) - et al.
Alcohol use patterns predict high-risk HIV behaviors among active injection drug users
J. Subst. Abuse Treat
(2000) - et al.
Validity of self-reported drug use among injection drug users and crack cocaine users recruited through street outreach
Eval. Program Plann
(1994) - Centers for Disease Control and Prevention, 2002. HIV/AIDS Surveillance Report. 13,...
- et al.
Between city variation in frequency of injection among Puerto Rican injection drug users: East Harlem, New York, and Bayamón, Puerto Rico
J. Acquir. Immune. Defic. Syndr
(2001) - et al.
Migration and HIV risk behaviors: Puerto Rican drug injectors in New York City and Puerto Rico
Am. J. Public Health
(2003)
Integrating qualitative and quantitative methods: comparing HIV-related risk behaviors among Puerto Rican drug users in Puerto Rico and New York
Subst. Use Misuse
High-risk sexual behavior among drug users. The utility of a typology of alcohol variables
Sex. Transm. Dis
Cited by (25)
Rural and urban comparisons of polysubstance use profiles and associated injection behaviors among people who inject drugs in Puerto Rico
2017, Drug and Alcohol DependenceCitation Excerpt :Polysubstance use among Puerto Rican PWID has been associated with increased injection risk behavior compared to use of primarily one injection substance (Hautala et al., 2017). Others suggest that the use of alcohol with injection drugs also increases injection risk behavior (Matos et al., 2004; Welch-Lazoritz et al., 2017b). Despite suspected risks, the association between various substance use combinations and injection risk behaviors among PWID is not well understood, particularly in Puerto Rico, and particularly for rural users.
Alcohol use disorders are associated with increased HIV risk behaviors in cocaine-dependent methadone patients
2017, Journal of Substance Abuse TreatmentCitation Excerpt :Even after controlling for these other, primarily non-modifiable (with the exception of methadone dose) variables, alcohol use disorder status had a significant impact on these sexual risk behaviors. Results from the current study replicate and extend findings from previous studies, which have shown alcohol use is associated with increased HIV risk behavior in PWID and cocaine-using methadone patients (Arasteh et al., 2008; Magura et al., 1998; Matos et al., 2004; Rees et al., 2001; Stein et al., 2001). Not only do the results from this study show alcohol use disorders are associated with a pattern of risky sexual behavior, they reveal relations between alcohol use disorders and responses to specific HRBS sex-related items, thereby increasing our understanding of relations between alcohol use and sexual risk behavior.
Association between alcohol consumption and injection and sexual risk behaviors among people who inject drugs in rural Puerto Rico
2017, Journal of Substance Abuse TreatmentCitation Excerpt :Stein et al. (2000) evaluated whether alcohol was an independent risk factor for injection risk behaviors. They found that increased levels of alcohol use and alcohol abuse were significantly related to increased levels of overall injection risk (e.g., shared needles, cooker, cotton, etc.) and an increase in needle sharing (Stein et al., 2000), a finding which has been subsequently replicated among diverse PWID samples (Matos et al., 2004; Stein, Charuvastra, Anderson, Sobota, & Friedmann, 2002; Wang et al., 2014). Where Stein et al. (2000) had a sample of injection drug users recruited through a syringe exchange program (SEP), Rees, Saitz, Horton, and Samet (2001) examined a sample of recent drug users (not necessarily injection) recruited from in-patient detoxification units.
Low knowledge and perceived Hepatitis C risk despite high risk behaviour among injection drug users in Kathmandu, Nepal
2016, International Journal of Drug PolicyCitation Excerpt :When exploring correlates of risky injection behaviour, daily drinking proved to be an important predictor. The link between drinking and risky injecting practices is corroborated by past data from the study area (Poudel et al., 2010) as well as from the international research community (Matos et al., 2005; Stein et al., 2000). While less than a fifth of daily drinkers engaged in risky injection practices in the past week, the prevalence of risky injection was over three times that of non-daily drinkers.
Correlates of sharing injection equipment among male injecting drug users in Kathmandu, Nepal
2010, International Journal of Drug PolicyDeterminants of alcohol consumption in HIV-uninfected injection drug users
2010, Drug and Alcohol Dependence