RESUMEN
The objectives of this study were to determine predictors of consistent condom use in heterosexual relationships of young adults who use hard drugs in a neighbourhood with widespread drug-use-connected HIV. We interviewed 196 18-24 year olds who injected drugs or used heroin, cocaine or crack in the prior year and lived in the Bushwick neighbourhood of New York City. Interviews covered sociodemographics, substance use and sexual networks. The unit of analysis is the relationship; the dependent variable measures consistent condom use over the prior 30 days in a given relationship. Consistent condom use was reported in 26% of 377 non-commercial relationships and in all of 22 commercial relationships. Using multiple logistic regression, consistent condom use in non-commercial relationships was more likely in relationships that are not 'very close'; for men (but not women) with peers whose norms are more favourable to condom use; and for subjects who had concurrent sex partners in the last 12 months. In conclusion, we found that: (1) the lack of relationship between the peer norms of drug-using women and their condom use suggests they may have little control over condom use in their relationships-programmes should attempt to empower young women drug users and to develop ways for their peers to influence the men in their lives; (2) epidemiologically, the positive association of concurrency to consistent condom use suggests that condom use may be restricting HIV spread through the community-the presence of consistent condom use in all of the commercial sexual relationships also may restrict HIV spread; (3) prevention efforts should attempt to change peer cultures as a way to develop self-sustaining risk reduction. These changes should include changes in gender roles and power relations.
Asunto(s)
Condones/estadística & datos numéricos , Infecciones por VIH/epidemiología , Heterosexualidad/psicología , Trastornos Relacionados con Sustancias/psicología , Adulto , Femenino , Infecciones por VIH/prevención & control , Heterosexualidad/estadística & datos numéricos , Humanos , Masculino , Análisis Multivariante , Ciudad de Nueva York/epidemiología , Asunción de Riesgos , Parejas Sexuales , Trastornos Relacionados con Sustancias/epidemiologíaRESUMEN
BACKGROUND: Sex risks and drug use are related. This relation in youth is described. GOAL: To determine how stigmatized drug use is related to sexual risk behaviors and network characteristics among youth. STUDY DESIGN: In-person interviews were conducted with both a probability household sample (n = 363) and a targeted, street-recruited sample of cocaine, heroin, crack, or injected drug users (n - 165) comprising 18- to 24-year-olds in an inner city neighborhood. Drug use in the preceding 12 months was scaled hierarchically, lowest to highest social stigma, as none, marijuana, noninjected cocaine, noninjected heroin, crack, and injected drugs. RESULTS: Users of the more stigmatized drugs had more sex partners. They were more likely to report a history of concurrent sex partners, sex with someone who also had engaged in sex with a network member, commercial sex work, and unprotected sex. Findings showed crack use and drug injection to be associated more strongly with increased sex risk among women than among men. CONCLUSIONS: Young users of the more stigmatized drugs are at much greater network and behavior risk for sexually transmitted diseases. Drug use prevention, harm reduction interventions, or both may lower this risk.
Asunto(s)
Asunción de Riesgos , Conducta Sexual , Enfermedades de Transmisión Sexual/epidemiología , Trastornos Relacionados con Sustancias/epidemiología , Adolescente , Adulto , Condones , Femenino , Infecciones por VIH/epidemiología , Infecciones por VIH/transmisión , Humanos , Entrevistas como Asunto , Masculino , Áreas de Pobreza , Factores de Riesgo , Factores Sexuales , Trabajo Sexual , Parejas Sexuales , Enfermedades de Transmisión Sexual/transmisión , Abuso de Sustancias por Vía Intravenosa/epidemiologíaRESUMEN
In a population-representative sample of 202 18-24-year-old women in a neighborhood with widespread injection of drugs and HIV, 14% reported unprotected anal sex with men in the past year. Independent significant predictors were illegal drug use, having a main partner who takes the lead in deciding what to do during sex, and less self-deception. Having ever had anal sex was associated with having ever been infected with hepatitis B.
Asunto(s)
Conducta Sexual , Enfermedades de Transmisión Sexual/epidemiología , Población Urbana , Adolescente , Adulto , Recolección de Datos , Femenino , Hispánicos o Latinos , Humanos , Masculino , Grupos Minoritarios , New York/epidemiología , Prevalencia , Medición de Riesgo , Asunción de Riesgos , Conducta Sexual/estadística & datos numéricos , Enfermedades de Transmisión Sexual/transmisiónRESUMEN
This study was set up to determine the predictors of condom use in the heterosexual non-commercial sexual relationships of young adults who neither inject drugs nor use cocaine, heroin or crack, in a neighbourhood with widespread drug-use-connected HIV. The analytic sample is 279 young adults, aged 18-24, who have never injected drugs and who have not used heroin, cocaine or crack in the last year. They were recruited in the Bushwick neighbourhood of New York City, July 1997 to September 1999. A face-to-face interview included items about their sociodemographic background, substance use and sexual networks. Sexual relationship and self-reported consistent (100%) condom use over the prior year with the partner in a given relationship was examined. Subjects had 337 heterosexual non-commercial relationships. Consistent condom use was reported in 32% of these relationships. In multiple logistic regression, consistent condom use was more likely in relationships that are not 'very close' (odds ratio = 3.92; 95% confidence interval = 2.08, 7.52); in the relationships of subjects whose peer norms support condom use (OR = 1.94; 95% CI = 1.43, 2.69), who are not problem drinkers (OR = 8.70; 95% CI = 2.22, 58.8), and (perhaps as a result of measurement issues) who are men (OR = 1.95; 95% CI = 1.04, 3.68). In conclusion, consistent condom use remains uncommon among youth in this high-risk neighbourhood. It is thus important to keep HIV from entering the sexual networks of youth in communities like this through programmes aimed at drug injectors and their sexual partners. Programmes to increase condom use among young adults should focus on strengthening norms that promote safer sex to protect oneself and others. In addition, assistance should be provided to youth who are problem drinkers.
Asunto(s)
Condones/estadística & datos numéricos , Infecciones por VIH/prevención & control , Heterosexualidad/psicología , Adolescente , Adulto , Femenino , Humanos , Masculino , Ciudad de Nueva York , Análisis de Regresión , Factores de Riesgo , Salud UrbanaRESUMEN
In many cities, human immunodeficiency virus (HIV)-1 seroprevalence among drug injectors stabilizes at 30-70% for many years without secondary outbreaks that increase seroprevalence by 15% or more. The authors considered how HIV-1 incidence can remain moderate at seroprevalence levels that would give maximum incidence. Previously suggested answers include behavioral risk reduction and network saturation within high-risk subgroups. Among 767 drug injectors studied in 1991-1993, during a period of stable high seroprevalence in New York City, risk behaviors remained common, and networks were far from saturated. The authors suggest a different network-based mechanism: in stable high-prevalence situations, the relatively small sizes of subnetworks of linked seronegatives (within larger networks containing both infected and uninfected persons) may limit infectious outbreaks. Any primary infection outbreak would probably be limited to members of connected subcomponents of seronegatives, and the largest such subcomponent in the study contained only 18 members (of 415 seronegatives). Research and mathematical modeling should study conditions that may affect the size and stability of subcomponents of seronegatives. Finally, if the existence of small, connected components of seronegatives prevents secondary outbreaks, this protection may weaken, and vulnerability to new outbreaks increase, if HIV-1 seroprevalence falls. Thus, in situations of declining prevalence, prevention programs should be maintained or strengthened.