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Attitudes toward HIV treatments influence unsafe sexual and injection practices among injecting drug users.
AIDS 2003; 17(13):1953-1962.
Tun W, Celentano DD, Vlahov D, Strathdee SA.
Abstract
OBJECTIVE: To determine if HIV treatment-related attitudes are associated with
unprotected sex and needle sharing among HIV-seropositive and -seronegative
injecting drug users (IDU) in Baltimore, Maryland. DESIGN AND METHODS: IDU
participating in a cohort study seen between December 2000 and July 2001
completed an interviewer-administered questionnaire on attitudes toward HIV
treatment and risk behaviors (593 HIV-seronegative, 338 HIV-seropositive),
including: perceived HIV transmissibility through unprotected sex and needle
sharing, and safer sex and injection fatigue. Logistic regression was used
to examine the role of attitudinal factors on needle sharing and unsafe sex.
RESULTS: Almost two-thirds of sexually active participants engaged in unprotected
sex and approximately half of those injecting drugs shared needles. Among
HIV-seropositive IDU, perception of reduced HIV transmissibility through
unprotected sex was significantly associated with unprotected sex [adjusted
odds ratio (AOR), 3.33; 95% confidence interval (CI), 1.05-10.55). Safer
injection fatigue was independently associated with needle sharing among
HIV-seropositive IDU (AOR, 6.55; 95% CI, 1.69-25.39). Among HIV-seronegative
IDU, safer sex fatigue and safer injection fatigue were independently associated
with unprotected sex (AOR, 3.12; 95% CI, 1.17-8.35) and needle sharing (AOR,
5.15; 95% CI, 2.33-11.37), respectively. CONCLUSION: Among HIV-seropositive
IDU, perceiving that HIV treatments reduce HIV transmission was significantly
associated with unprotected sex. Risk reduction fatigue was strongly associated
with unsafe sexual and injection behaviors among HIV-seronegative individuals.
HIV prevention interventions must consider the unintended impact of HIV treatments
on attitudes and risk behaviors among IDU.