title: Alcohol-related risk factors associated with HIV infection among patients entering alcoholism treatment: implications for prevention.
abstract: OBJECTIVE
  Reports suggest that alcoholics may be at risk for HIV infection. In this article we examine several alcohol-related risk factors for HIV infection among patients entering alcoholism treatment in an AIDS epicenter. Our objective was to identify key factors for HIV prevention and screening among populations receiving treatment for alcohol abuse or alcohol dependence.
  
  
  METHODS
  Clients (N = 921) entering five alcoholism treatment centers in the San Francisco Bay area underwent an interview and blind serotesting for HIV antibodies (76% were male, 16% men who had sex with men, 50% black, 10% Latinos and 6.5% were HIV seropositive). Logistic regression was used to predict HIV serostatus from five possible alcohol-associated risk factors, controlling for demographics and traditional HIV risk factors. These were alcohol impairment, attitudes about socializing in bars, increased sexual risk expectancies when drinking, enhanced sexual expectancies when drinking and decreased nervousness when drinking. Male and female heterosexuals and men with a history of homosexuality were analyzed separately.
  
  
  RESULTS
  Among male and female heterosexuals, HIV infection was positively associated with higher alcohol impairment (OR = 2.69, p = .031) and negatively associated with higher sexual risk expectancies when drinking (OR = 0.24, p = .075). Among men who had sex with men, HIV infection was positively associated with higher bar socializing orientations (OR = 10.06, p = .004). Infection was also negatively associated with higher alcohol impairment (OR = 0.34, p = .052) and higher sexual risk expectancies when drinking (OR = 0.26, p = .024) for these men.
  
  
  CONCLUSIONS
  Since these associations were independent of demographics and traditional HIV risk factors, our research suggests it may be important to also focus HIV screening and prevention on alcohol-related risk factors in AIDS epicenters. For heterosexual alcoholics, the focus should be on those with higher alcohol dependence. For male alcoholics who had sex with men, the focus should be on those who primarily socialize in bars. Further research is needed to determine why higher sexual risk perceptions when drinking were associated with lower rates of HIV infection for both groups, since this discovery may have important prevention implications. The negative association between infection and alcohol impairment among homosexual men also warrants further investigation.
authors.affiliation: Center for AIDS Prevention Studies, University of California, San Francisco 94105, USA.
authors.forename: J A
authors.initials: JA
authors.lastname: Boscarino
authors.forename: A L
authors.initials: AL
authors.lastname: Avins
authors.forename: W J
authors.initials: WJ
authors.lastname: Woods
authors.forename: C P
authors.initials: CP
authors.lastname: Lindan
authors.forename: E S
authors.initials: ES
authors.lastname: Hudes
authors.forename: W
authors.initials: W
authors.lastname: Clark
mesh_terms: D000293:Adolescent; D000328:Adult; D000428:Alcohol Drinking / Q000009:adverse effects; D000437:Alcoholism / Q000534:rehabilitation*; D005260:Female; D015658:HIV Infections / Q000517:prevention & control* / Q000635:transmission; D007722:Health Knowledge, Attitudes, Practice; D018451:Homosexuality, Male / Q000523:psychology; D006801:Humans; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D010343:Patient Admission; D012307:Risk Factors; D012495:San Francisco; D012725:Sexual Behavior / Q000187:drug effects; D012931:Social Environment; D016320:Substance Abuse Treatment Centers; D014505:Urban Population