Individual and poly-substance use and condomless sex among HIV-uninfected adults reporting heterosexual sex in a multi-site cohort

R J Fredericksen; B M Whitney; E Trejo; R M Nance; E Fitzsimmons; F L Altice; A W Carrico; C M Cleland; C Del Rio; A Duerr; W M El-Sadr; S Kahana; I Kuo; K Mayer; S Mehta; L J Ouellet; V M Quan; J Rich; D W Seal; S Springer; F Taxman; W Wechsberg; H M Crane; J A C Delaney

doi:10.1186/s12889-021-12026-7

Individual and poly-substance use and condomless sex among HIV-uninfected adults reporting heterosexual sex in a multi-site cohort

BMC Public Health. 2021 Nov 4;21(1):2002. doi: 10.1186/s12889-021-12026-7.

Authors

R J Fredericksen¹, B M Whitney², E Trejo², R M Nance², E Fitzsimmons², F L Altice³, A W Carrico⁴, C M Cleland⁵, C Del Rio⁶, A Duerr⁷, W M El-Sadr⁸, S Kahana⁹, I Kuo¹⁰, K Mayer¹¹, S Mehta¹², L J Ouellet¹³, V M Quan¹⁴, J Rich¹⁵, D W Seal¹⁶, S Springer¹⁷, F Taxman¹⁸, W Wechsberg¹⁹, H M Crane², J A C Delaney²⁰

Affiliations

¹ UW Center for AIDS Research, Harborview Medical Center, 325 Ninth Avenue, Box 359931, Seattle, WA, 98104-2499, USA. rfrederi@uw.edu.
² UW Center for AIDS Research, Harborview Medical Center, 325 Ninth Avenue, Box 359931, Seattle, WA, 98104-2499, USA.
³ Yale University AIDS Program, 135 College Street, Suite 323, New Haven, CT, 06510-2283, USA.
⁴ Division of Prevention Science and Community Health, University of Miami, 1120 NW 14th St, Miami, FL, 33136, USA.
⁵ Center for Drug Use and HIV Research, NYU School of Global Public Health, 665 Broadway, 11th Floor, New York, NY, 10012, USA.
⁶ Rollins School of Public Health, Emory University, 1518 Clifton Road, NE Room 7011, Atlanta, GA, 30322, USA.
⁷ Fred Hutchinson Cancer Research Center, HIV Vaccine Trials Network, Box 358080 (LE 500), Seattle, WA, 98109, USA.
⁸ Mailman School of Public Health, Columbia University, 722 West 168th Street, 13th floor, New York, NY, 10032, USA.
⁹ National Institute on Drug Abuse, 6001 Executive Blvd, Rockville, Maryland, 20852, USA.
¹⁰ Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, George Washington University, 950 New Hampshire Ave NW #2, Washington, DC, 20052, USA.
¹¹ The Fenway Institute, 1340 Boylston Street, Boston, MA, 02215, USA.
¹² Johns Hopkins University, Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, Maryland, 21205, USA.
¹³ School of Public Health, University of Illinois at Chicago, 1603 W. Taylor St, Chicago, IL, USA.
¹⁴ Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, 615 N. Wolfe Street, Baltimore, Maryland, 21205, USA.
¹⁵ Center for Prisoner Health and Human Rights, Immunology Center, The Miriam Hospital, Warren Alpert Medical School, Brown University, 1125 North Main St, Providence, RI, 02904, USA.
¹⁶ Department of Global Community Health and Behavioral Sciences, School of Public Health and Tropical Medicine, Tulane University, 1440 Canal St, Suite 2200, New Orleans, LA, 70112, USA.
¹⁷ Department of Internal Medicine, School of Medicine, Yale University, 135 College Street, New Haven, CT, 06510, USA.
¹⁸ Center for Advancing Correctional Excellence, Institute of Biohealth Innovation, George Mason University, 4461 Rockfish Creek Lane, Fairfax, VA, 22030, USA.
¹⁹ Department of Health Policy and Management, Gillings School of Public Health, University of North Carolina Chapel Hill, 135 Dauer Dr, Chapel Hill, NC, 27599, USA.
²⁰ College of Pharmacy, University of Manitoba, Apotex Centre, 750 McDermot Avenue, Winnipeg, Manitoba, R3E 0T5, Canada.

Abstract

Background: We analyzed the association between substance use (SU) and condomless sex (CS) among HIV-negative adults reporting heterosexual sex in the Seek, Test, Treat, and Retain (STTR) consortium. We describe the impact of SU as well as person/partner and context-related factors on CS, identifying combinations of factors that indicate the highest likelihood of CS.

Methods: We analyzed data from four US-based STTR studies to examine the effect of SU on CS using two SU exposures: 1) recent SU (within 3 months) and 2) SU before/during sex. Behavioral data were collected via 1:1 or self-administered computerized interviews. Adjusted individual-study, multivariable relative risk regression was used to examine the relationship between CS and SU. We also examined interactions with type of sex and partner HIV status. Pooled effect estimates were calculated using traditional fixed-effects meta-analysis. We analyzed data for recent SU (n = 6781; 82% men, median age = 33 years) and SU before/during sex (n = 2915; 69% men, median age = 40 years).

Results: For both exposure classifications, any SU other than cannabis increased the likelihood of CS relative to non-SU (8-16%, p-values< 0.001). In the recent SU group, however, polysubstance use did not increase the likelihood of CS compared to single-substance use. Cannabis use did not increase the likelihood of CS, regardless of frequency of use. Type of sex was associated with CS; those reporting vaginal and anal sex had a higher likelihood of CS compared to vaginal sex only for both exposure classifications (18-21%, p < 0.001). Recent SU increased likelihood of CS among those reporting vaginal sex only (9-10%, p < 0.001); results were similar for those reporting vaginal and anal sex (5-8%, p < 0.01). SU before/during sex increased the likelihood of CS among those reporting vaginal sex only (20%; p < 0.001) and among those reporting vaginal and anal sex (7%; p = 0.002). Single- and poly-SU before/during sex increased the likelihood of CS for those with exclusively HIV-negative partners (7-8%, p ≤ 0.02), and for those reporting HIV-negative and HIV-status unknown partners (9-13%, p ≤ 0.03).

Conclusion: Except for cannabis, any SU increased the likelihood of CS. CS was associated with having perceived HIV-negative partners and with having had both anal/vaginal sex.

Keywords: Condom use; Substance use.

Publication types

Meta-Analysis
Research Support, N.I.H., Extramural

MeSH terms

Adult
Condoms
Female
HIV Infections* / epidemiology
Heterosexuality
Homosexuality, Male
Humans
Male
Risk-Taking
Sexual Behavior
Sexual Partners
Substance-Related Disorders* / epidemiology
Unsafe Sex

Abstract

Publication types

MeSH terms

Grants and funding