Longitudinal changes in sexual risk behavior among HIV+ and HIV- male injecting drug users.
Injecting drug users (IDUs) play a prominent role in the transmission of human immunodeficiency virus (HIV), particularly in urban areas such as New York City, where they comprise nearly half of all adult acquired immunodeficiency syndrome (AIDS) cases. Intervention studies have demonstrated that IDUs are responsive to safer sex messages, but sexual behavior appears to be more resistant to change than drug use behavior. This multidisciplinary study (without an intervention component) assesses changes in sexual risk behavior as a function of time, HIV status, and disease progression in a cohort of HIV+ and HIV- male IDUs (N = 144) for 4 years.


RESULTS
For HIV+ and HIV- men, there were increases in abstinence and monogamy, with decreases in the frequency of unprotected vaginal/anal sex and sexual risk index scores. With the exception of monogamy, HIV+ men reported lower levels of risk. Although there was also a decline in substance use, this accounted for only some of the decline in sexual risk behavior. Among the HIV+ men, a CD4 level below 200 was associated with more abstinence and monogamy. HIV-related medical symptoms were associated with increased abstinence, less unprotected sex, and lower sexual risk index scores. Lower neuropsychological memory test scores were associated with increased abstinence and lower sexual risk index scores. Neurological impairment and depression were not associated with sexual risk behavior.


CONCLUSIONS
IDU men in New York City have modified their sexual behavior toward safer practices. Lower levels of risk are found among HIV+ men, particularly those with more progressed HIV illness. Nevertheless, a substantial amount of sexual risk behavior remained in this cohort, indicating the continued need for education and intervention.
HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York 10032, USA.
C
C
Dolezal
H F
HF
Meyer-Bahlburg
X
X
Liu
A A
AA
Ehrhardt
T M
TM
Exner
J G
JG
Rabkin
J M
JM
Gorman
K
K
Marder
Y
Y
Stern
D000328:Adult; D015704:CD4 Antigens / Q000097:blood; D015331:Cohort Studies; D018450:Disease Progression; D018023:HIV Seronegativity / Q000502:physiology*; D006679:HIV Seropositivity / Q000150:complications / Q000523:psychology*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008569:Memory Disorders / Q000150:complications / Q000175:diagnosis; D009483:Neuropsychological Tests; D012309:Risk-Taking; D012720:Severity of Illness Index; D012725:Sexual Behavior / Q000523:psychology*; D015819:Substance Abuse, Intravenous / Q000150:complications / Q000523:psychology*; D014505:Urban Population
D015704:CD4 Antigens