Predictors of High Risk Sexual Behavior Among HIV-Infected Crack Cocaine Users in Two US Urban Centers Público
Boole, Lindsay Carol (2011)
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
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