Audrey J. Brooks, PhD University of Arizona CA-AZ node

1. Gender Differences in the Rates and Correlates of HIV Risk Behaviors Among Drug Dependent Individuals Audrey J. Brooks, PhD University of Arizona CA-AZ node

2. Gender SIG Collaborators • Christina S. Meade, Ph.D., NNE node • Jennifer Sharpe Potter, Ph.D., M.P.H., NNE node • Yuliya Lokhnygina, Ph.D. , DCRI • Donald A. Calsyn, Ph.D. , PNW node • Shelly Greenfield, M.D., M.P.H., NNE node • Paul Wakim, PhD, NIDA representative

3. Background • Rising rates of HIV in women highlight the need to identify unique factors associated with risk behaviors in women to help inform risk reduction interventions. • Evidence of gender differences in frequency of HIV risk behaviors. • Multiple risk factors associated with HIV risk behaviors have been identified in the literature. • Few studies have examined whether risk factors vary by gender.

4. Purpose • To examine gender differences in the rates and correlates of HIV sexual and drug risk behaviors in a sample of clients participating in 5 multi-site trials of the NIDA Clinical Trials Network. • To test whether multiple risk factors for HIV risk behaviors differ by gender. • Does gender moderate the impact of stimulant use, alcohol and drug severity, psychiatric severity, abuse history, family/social relationships, legal status and housing stability?

5. Methods • Secondary data analysis of baseline CAB data from www.ctndatashare.org • CTN-0001/ CTN-0002 - Buprenorphine/Naloxone versus Clonidine for Inpatient/ Outpatient Opiate Detoxification (Ling et al., 2005) • CTN-0005 – Motivational Interviewing to Improve Treatment Engagement and Outcome in Outpatient Substance Users (Carroll et al., 2006) • CTN-0006 / CTN-0007 - Motivational Incentives for Enhanced Recovery in Stimulant Users in Drug Free Methadone Maintenance Clinics (Petry et al., 2005; Pierce et al., 2006)

6. Measures • HIV Risk Behavior Scale (HRBS) • Sex and Drug Risk Behaviors Composites • Individual sex and drug risk items • ASI-Lite Composites • Alcohol, Drug, and Psychiatric Symptom Severity, Family/Social Relationships, Legal Problems • ASI-Lite derived variables • Demographics • Housing Stability (length at address) • Stimulant use: • stimulant only, stimulants + opioids, opioids only, other drug use • Lifetime abuse: • physical only, sexual only, both physical + sexual

7. Statistical Analysis • Gender differences in sociodemographic characteristics and HIV risk behaviors • Chi-square tests for categorical variables and Wilcoxon two-sample tests for continuous variables • Gender differences in risk factors associated with HIV risk behaviors • Ordinal logistic regression analysis using partial proportional odds model were conducted to identify variables associated with HIV sex risk composite • Linear regression models were conducted to identify variables associated with HIV drug risk composite • Models adjusted for age, gender, education, ethnicity, living arrangements • Gender interaction tested first • The ASI composite results are described using a clinically meaningful difference unit (0.1) as the measurement unit

8. Participant Characteristics *p<.0001

9. Participant Characteristics *p<.0001; +p<.01

10. HIV Sex Risk Behaviors Past 30-days N=790 N=639 N=388 N=504 *p<.008

11. Unprotected Sex * * N=484 N=31 N=39 N=357 N=83 N=31 N=41 N=82 *p<.016

12. HIV Drug Risk Behaviors Past 30-days N=250 N=227 * N=151 * N=132 N=221 N=790 N=639 N=129 *p<.0008

13. HIV Risk Composites * N=208 * N=488 N=124 N=379 *p<.043

14. Sex Risk Behavior Gender Effects

15. Drug Risk Behavior Gender Effects

16. Main Effects • Sex Risk Behaviors • Stimulant use • Drug use severity • Sexual abuse history only • Sexual and physical abuse history • Legal problems • Drug Risk Behaviors • Drug use severity • Sexual abuse history negatively related

17. Summary of Findings • Women engaged in higher risk sexual behavior overall, were more likely to have multiple partners, and have unprotected sex with regular partners. • Alcohol and psychiatric severity were associated with engaging in higher risk sexual behaviors for women. • Alcohol use severity associated with engaging in higher risk drug behaviors for women. • Men with impaired family/social relationships were less likely to engage in high risk sexual behavior. • Men more likely to inject drugs. • Confirmed relationship between stimulant use, drug severity, abuse history, and legal severity and risk behaviors in treatment-seeking sample.

18. Conclusions • Findings consistent with other studies reporting higher rates of high risk sexual behavior for women. • Studies incorporating gender into the analyses have found similar relationships between gender and HIV risk factors. • Underscores the importance of examining the role of gender in studies of HIV risk behavior. • Comprehensive assessment of HIV risk behaviors needs to occur at treatment entry. • In addition to targeting women and men separately, the content of the intervention may need to reflect the unique risk factors.