Elsevier

Drug and Alcohol Dependence

Volume 76, Issue 3, 7 December 2004, Pages 229-234
Drug and Alcohol Dependence

HIV risk behaviors and alcohol intoxication among injection drug users in Puerto Rico

https://doi.org/10.1016/j.drugalcdep.2004.05.007Get rights and content

Abstract

This paper reports results of an analysis of the association between alcohol intoxication and injection and sexual HIV risk behaviors among 557 Hispanic heroin and cocaine injectors, not in treatment, who were recruited in poor communities in Puerto Rico. Subjects were part of a longitudinal prevention-intervention study aimed at reducing drug use and HIV risk behaviors. Participants reported a high prevalence of co-occurring conditions, particularly symptoms of severe depression (52%) and severe anxiety (37%), measured by Beck’s Depression Index and Beck’s Anxiety Index, respectively. Alcohol intoxication during the last 30 days was reported by 18% of participants. Associations were found between alcohol intoxication and both injection and sexual risk behaviors. In the bivariate analysis, subjects reporting alcohol intoxication were more likely to inject three or more times per day, pool money to buy drugs, share needles, and share cotton. They were also significantly more likely to have a casual or paying sex partner and to have unprotected sex with these partners. After adjustment, sharing needles and cotton, having sex with a paying partner or casual partner, and exchanging sex for money or drugs were significantly related to alcohol intoxication. HIV prevention programs, to be effective, must address alcohol intoxication and its relation to injection and sexual risk behaviors as a central issue in HIV prevention among drug injectors.

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).

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