Predictors of High Risk Sexual Behavior Among HIV-Infected Crack Cocaine Users in Two US Urban Centers Open Access

Abstract

Background: HIV incidence in the United States is largely driven by sexual transmission in urban centers. There are limited data describing correlates of high risk sexual behavior among HIV-infected crack users.

Methods: Interviews were conducted at bedside with sexually active, HIV-infected crack cocaine users who were recruited from the inpatient wards at Jackson Memorial Hospital in Miami, Florida and Grady Memorial Hospital in Atlanta, Georgia, between August 2006 and March 2010. Participants were asked about sociodemographic characteristics, HIV clinical indicators, and psychosocial factors. Scales measuring several hypothesized mediators of sexual behavior, including knowledge, motivation, and preparatory behaviors, were assessed. Multiple logistic regression was performed to identify factors associated with sexual risk behavior.

Results: Among 411 study participants, 34.6% reported high risk sexual behavior in the prior six months. In multivariate modeling, sexual risk behavior was associated with low self-efficacy for condom use (aOR=2.22; 95%CI=1.37-3.60), low perceived risk of HIV transmission (aOR=2.58; 95%CI=1.37-4.87), multiple sexual partners (aOR=2.59; 95%CI=1.60-4.21), and intoxication during most recent sexual encounter (aOR=1.72; 95%CI=1.05-2.79). Participants of black race and men who had sex with men were less likely to engage in high risk sexual behavior (aOR=0.41; 95%CI=0.20-0.86 and aOR=0.40; 95%CI=0.24-0.68 respectively). In stratified analysis of females, high risk sexual behavior was associated with low self-efficacy for condom use (aOR=2.56; 95%CI=1.26-5.21), low perceived risk of HIV transmission (aOR=3.03, 95%CI=1.21-7.61), low social support (aOR=2.02; 95%CI=1.00-4.06), and multiple sexual partners (aOR=4.53, 95%CI=2.19-9.34). Women of black race were less likely to engage in high risk sexual behavior when compared to non-black women (aOR=0.22; 95%CI=0.06-0.74). Among males, low self-efficacy for condom use (aOR=3.27; 95%CI=1.52-7.04) and heterosexual men (aOR=2.96; 95%CI=1.34-6.56) remained significantly associated with high risk sex, lack of risk reduction behaviors (aOR=2.35; 95%CI=1.08-5.12) and engaging in transactional sex (aOR=2.56; 95%CI=1.14-5.71) were additional predictors.

Conclusions: A significant proportion of HIV-infected crack users are participating in high risk sexual behavior. Interventions promoting safe sex in this population should emphasize risk of HIV transmission inherent to sexual encounters with susceptible individuals and should attempt to build condom-specific self-efficacy.

Table of Contents

Chapter I: Background and Literature Review...1

Chapter II: Manuscript...11

Abstract...11
Introduction...12
Methods...13
Results...21
Discussion...30
References...35
Tables...39

Chapter III: Summary, Public Health Implications, and Future Directions...55

About this Master's Thesis

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School	Rollins School of Public Health
Department	Epidemiology
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health
Keyword	sexual behavior crack cocaine HIV/AIDS
Committee Chair / Thesis Advisor	Del Rio, Carlos, Emory University
Partnering Agencies	Emory University schools, faculty or affiliated programs US (Federal) agency other than CDC University, college or educational institution (other than Emory)

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