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Continued Sexual Risk Behavior Among HIV-Seropositive, Drug-Using Men -- Atlanta; Washington, D.C.; and San Juan, Puerto Rico, 1993

Behaviors associated with increased risk for sexual transmission of human immunodeficiency virus (HIV) by infected persons include unprotected intercourse, multiple sex partners, use of crack cocaine, failure to disclose serostatus to sex partners, and trading sex for money or drugs. Some sexually active, HIV-infected persons in the United States continue to practice risky behaviors (1-4). To characterize continued sexual risk behaviors among HIV-positive, illicit-drug-using men, in 1993 CDC analyzed data from such men recruited for a small group-intervention program in three cities -- Atlanta; Washington, D.C.; and San Juan, Puerto Rico. This report summarizes the results of that analysis, which indicate that some seropositive men continue to engage in unprotected sex.

Data were collected from interviews administered by trained, on-site interviewers of 120 men known to be HIV-seropositive and illicit-drug users. They were recruited through support groups and a day drug-treatment program for assisting HIV-infected persons; four persons were excluded because of incomplete data. The 116 men included 63 from San Juan, 38 from Atlanta, and 15 from Washington; all reported use of injected drugs or noninjection use of cocaine during the preceding year. Information obtained during the interviews included demographic data; respondents' perceptions of personal health; HIV-related services received; and sexual risk behaviors, including unprotected sexual intercourse with steady, nonsteady, and commercial sex partners (i.e., men who were male prostitutes or had had sex with prostitutes). Risk behaviors were reported for sexual activity during the preceding 30 days. To assess an association between unprotected sex and selected characteristics (i.e., race/ethnicity, age, perceptions of health status, services being received, use of crack cocaine, route of drug administration, and frequency of drug use), data on the men reporting unprotected anal or vaginal sex were analyzed by contingency table chi-square techniques.

The mean age of the 116 men was 36 years (range: 22-54 years). The men had known of their HIV seropositivity for an average of 49 months, and most (100 {86%}) were participating in two or more HIV-related services, including case management, HIV and substance-abuse-related support groups, and medical care; 60 (52%) had been admitted to residential drug treatment for at least 1 month during the preceding year. Most (83 {72%}) reported having used crack cocaine.

Of the 116 men, 35 (30%) reported engaging in sexual intercourse greater than or equal to 12 times during the preceding 30 days. A total of 39 (34%) reported two or more sex partners, 32 (28%) reported having vaginal or anal sex without a condom, and 22 (23%) reported having traded sex for drugs or money. A total of 37 (32%) had not disclosed their HIV status to all partners, and 73 (63%) were either unaware of any partners' HIV status or believed they were negative.

The 32 men who reported sex without a condom were significantly more likely than those who used condoms to report multiple sex partners, having oral sex, trading sex for money or drugs, failure to disclose HIV serostatus, and having intercourse greater than or equal to 12 times (p less than or equal to 0.05). These men were at high risk for infecting their sex partners and reported a mean of four sex partners (range: one-25) with an average of 14 sex acts without a condom for all partners during the preceding month.

Reported by: SC Kalichman, PhD, Psychology Dept, Georgia State Univ, Atlanta. Behavioral Intervention Research Br, Div of STD Prevention, National Center for Prevention Svcs, CDC.

Editorial Note

Editorial Note: The findings in this report underscore that some persons with HIV infection need ongoing assistance and support to acquire and maintain safer sex practices. For example, in this study, men who reported not using condoms were more likely than men who reported using condoms to report trading sex for money or drugs. This finding indicates the need for further characterization of the behavioral and environmental determinants of continued unsafe sexual behavior among HIV-seropositive, illicit-drug users. In addition, the findings indicate opportunities for strengthening prevention because most of these men already were linked to ongoing community programs that provide drug treatment, mental health services, health care, and psychologic support. Such programs also should educate, motivate, and assist patients in acquiring skills needed to maintain safer practices.


  1. Higgins DH, Galavotti C, O'Reilly KR, et al. Evidence for the effects of HIV antibody counseling and testing on risk behaviors. JAMA 1991; 266:2419-29.

  2. Cleary PD, VanDevanter N, Rogers TP, et al. Behavior changes after notification of HIV infection. Am J Public Health 1991;81:1586-90.

  3. Otten MW, Zaidi AA, Wroten JE, et al. Changes in sexually transmitted disease rates after HIV testing and post-test counseling, Miami, 1988 to 1989. Am J Public Health 1993;83:529-33.

  4. Singh BK, Koman JJ, Catan VM, et al. Sexual risk behavior among injection drug-using human immunodeficiency virus-positive clients. Int J Addict 1993;28:735-47.

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