Gender Differences in the Rates and Correlates of HIV Risk Behaviors Among Drug Abusers

Abstract

This study examined gender differences in the rates and correlates of HIV risk behaviors among 1,429 clients participating in multi-site trials throughout the United States between 2001 and 2005 as part of the National Institute on Drug Abuse-funded Clinical Trials Network. Women engaged in higher risk sexual behaviors. Greater alcohol use and psychiatric severity were associated with higher risk behaviors for women, while impaired social relations were associated with decreased risk for men. Specific risk factors were differentially predictive of HIV risk behaviors for women and men, highlighting the need for gender-specific risk-reduction interventions. Limitations of the study are discussed.

RÉSUMÉ

Différences entre les sexes dans les taux et corrélats des comportements à risque pour contracter le VIH chez les toxicomanes.

Cette étude a examiné les differences entre hommes et femmes concernant les comportements à risque pour contracter le VIH et leur corrélats, parmi 1429 clients qui ont participé à des essais multi-sites dans l’essemble des Etats-Unis entre 2001 et 2005, dans le cadre du Réseau d’Expériences Cliniques, financé par l’ Institut National pour la Toxicomanie. Les femmes étaient engagées dans plus de comportements sexuels à risque que les hommes. Parmi les femmes, une consommation d'alcool et un niveau de symptômes psychiatriques plus élevés étaient liés à plus de comportements sexuels à risque, alors que, pour les hommes, une deterioration du cercle social était associée à moins de comportements à risque. Des facteurs de risque spécifiques etaient plus ou moins predictifs de comportements à risque pour contracter le VIH selon qu’il s’agissait d’hommes ou de femmes. Ces resultats mettent en valeur la nécessité de developer des interventions preventives differentes pour les hommes et les femmes. Les limitations de cette étude sont examinées.

SUMARIO

Las diferencias del género en los índices y los correlativos del VIH arriesgan comportamientos entre abusadores de la droga

Este estudio examinó diferencias de género en los índices y los correlativos de los comportamientos del riesgo del VIH en 1,429 clientes que tomaron parte en estudios multicéntricos en los Estados Unidos entre los años 2001 y 2005 como parte de la Red de Investigaciones Clínicas financiado por El Instituto Nacional del Abuso de Drogas. Las mujeres entraron en comportamientos sexuales con más alto riesgo. El mayor uso del alcohol y la severidad de psiquiátrica fueron asociados con comportamientos más altos del riesgo para mujeres, mientras que las relaciones sociales afectadas fueron asociadas al riesgo disminuido para los hombres. Los factores de riesgo específicos eran diferencialmente predictivos del comportamiento del riesgo del VIH para las mujeres y los hombres, destacando la necesidad de intervenciones género-específicas de la reducción del riesgo. Las limitaciones del estudio se discuten.

Keywords :

• HIV risk behavior
• gender
• substance user treatment
• women
• sex risk

THE AUTHORS

Audrey J. Brooks, Ph.D., is a research psychologist in the Department of Psychology at the University of Arizona. Dr. Brooks has been involved in program evaluation, clinical trials, and basic science research for over 20 years. During that time she has served as the methodologist/statistician on several NIH-funded projects across a wide range of topics including substance abuse prevention and treatment, complementary and alternative medicine, and cancer prevention. She is a co-investigator with NIDA National Drug Abuse Treatment clinical trials network. Her research interests include gender and co-occurring disorders.

Christina S. Meade, Ph.D., is an assistant professor of psychiatry and behavioral sciences at Duke University School of Medicine and a member of the Duke Global Health Institute, the Duke Institute for Brain Sciences, and the Duke Center for AIDS Research. Dr. Meade has been funded by the NIDA, NIMH, and NIAID and the American Foundation for AIDS Research to conduct a series of studies examining predictors of HIV risk behavior in adults with substance use and psychiatric disorders, and the relationship between mental health and continued risk behavior in HIV-positive adults. She has a particular interest in the effects of gender and poverty on health outcomes.

Jennifer Sharpe Potter, Ph.D., M.P.H., is an assistant professor of psychiatry at the University of Texas Health Science Center at San Antonio and holds appointments in the Department of Psychiatry at Harvard Medical School and the Alcohol and Drug Abuse Treatment Program at McLean Hospital. She has a NIDA career development award focusing on developing treatments for co-occurring opioid dependence and chronic pain. She is a co-investigator with NIDA national drug abuse treatment clinical trials network.

Yuliya Lokhnygina, Ph.D. After receiving PhD in statistics from North Carolina State University in 2004, Dr. Lokhnygina joined the Department of Biostatistics and Bioinformatics at Duke University and Duke Clinical Research Institute as an assistant professor in biostatistics. She has been involved in design, development, and coordination of multiple clinical trials in cardiology, drug abuse, and pediatric rheumatology. Dr. Lokhnygina's research has been published in leading statistical and medical journals, such as Biometrics, Circulation, and Journal of the American College of Cardiology. Her primary areas of expertise include statistical methods in clinical trials, survival analysis, causal inference, and adaptive designs.

Donald A. Calsyn, Ph.D., counseling psychologist, is a professor of psychiatry and behavioral science at the University of Washington School of Medicine and a research affiliate at the Alcohol and Drug Abuse Institute at the University of Washington. Prior to July 2004 he served as the director of outpatient services in the Addiction Treatment Center at the Department of Veterans Affairs, Puget Sound Health Care System. For nearly 25 years, Dr. Calsyn devoted his career to providing direct care treatment services to veterans with substance abuse disorders as well as evaluating the effectiveness of treatment interventions. For the last 18 years much of his research activities have focused on the prevention of HIV among drug-dependent individuals in treatment.

Dr. Shelly F. Greenfield, M.D., M.P.H., is an associate professor of psychiatry at Harvard Medical School, chief academic officer of McLean Hospital, and director, clinical and health services research and education, division of alcohol and drug abuse, McLean Hospital in Belmont, MA. Dr. Greenfield serves as principal investigator and co-investigator on federally funded research focusing on treatment for substance use disorders, gender differences in substance disorders, and health services for substance disorders. She is a current recipient of a career award in patient-oriented research from National Institute on Drug Abuse (NIDA) and a past recipient of a NIDA-funded early career award. Dr. Greenfield serves as the director of the Harvard Medical School/Partners Addiction Psychiatry Fellowship. She is a member of the board of directors of the American Academy of Addiction Psychiatry and is the editor-in-chief of the Harvard Review of Psychiatry. Dr. Greenfield serves on the addiction psychiatry committee of the American Board of Psychiatry and Neurology. She has been elected to the American College of Psychiatrists and is a distinguished fellow of the American Psychiatric Association.

Notes

1 The reader is reminded that the concept of “risk behaviors” and/or “being at risk” is often noted in the literature, without adequately noting relevant dimensions (linear, non-linear), its “demands,” the critical necessary conditions (endogenously as well as exogenously; from a micro to a macro level), which are necessary for the posited “risk” to operate (begin, continue, become anchored and integrate, change as de facto realities change, cease, etc.) or not to operate, and whether its underpinnings are theory-driven, empirically based, individual and/or systemic stake holder-bound, based upon “principles of faith,” historical observation, or what. This is necessary to clarify and consider if the term is not to remain as yet another shibboleth in a field of many stereotypes.

2 Treatment can be briefly and usefully defined as a planned, goal-directed, temporally structured change process of necessary quality, appropriateness, and conditions (endogenous and exogenous), which is bounded (culture, place, time, etc.) and can be categorized into professional-based, tradition-based, mutual –help-based (AA, NA, etc.) and self-help (“natural recovery”) models. There are no unique models or techniques used with substance users—of whatever types and heterogeneities—which are also not used with non-substance users. In the West, with the relatively new ideology of “harm reduction” and the even newer Quality of Life (QOL) treatment-driven model, there is now a new set of goals in addition to those derived from/associated with the older tradition of abstinence-driven models. Editor's notes.