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AIMS: To estimate the extent to which specific sexual behaviours (being sexually active, having multiple sex partners, casual sex, condomless casual sex, anal sex and condomless anal sex) change during periods of methamphetamine use. DESIGN: Within-person estimates for the relationship between methamphetamine use and sexual behaviour were derived from longitudinal panel data from the Methamphetamine Treatment Evaluation Study (MATES) cohort (2006-10). SETTING: Sydney and Brisbane, Australia. PARTICIPANTS: Participants (n = 319) were recruited through treatment and other health services, self-identified as heterosexual, were aged 17-51 years, 74% were male and all were dependent on methamphetamine on study entry. MEASUREMENTS: Days of methamphetamine use in the past month and sexual behaviour in the past month were both assessed using the Opiate Treatment Index. FINDINGS: When using methamphetamine, participants had double the odds of being sexually active compared with when they were not using, after adjustment for demographics and other substance use [adjusted odds ratio (aOR) = 1.9, P = 0.010]. When participants were sexually active, they were more likely to have multiple sex partners (aOR = 3.3, P = 0.001), casual sex partners (aOR = 3.9, P

BACKGROUND AND AIMS: Substance use has been implicated in the onset and maintenance of risky sexual behaviors, which have particularly devastating consequences in young women. This study examined whether (i) adolescent onset of cannabis use is associated with repeated voluntary unprotected sex in women and (ii) whether this association persists after accounting for correlated familial influences. DESIGN: General population sample of female twins. SETTING: Midwestern United States. PARTICIPANTS: 2,784 sexually active twin women (15.5% African-American) aged 18-27 years (assessed 2002-2005), including 119 dizygotic (DZ) and 115 monozygotic (MZ) discordant pairs. MEASUREMENTS: Self-report interview data on cannabis use that first occurred prior to age 17 (27.1%) and repeated voluntary unprotected sex (27.2%). Key covariates included early onset of drinking, regular smoking, sexual debut and menstruation as well as conduct disorder symptoms and childhood sexual abuse. FINDINGS: Compared with never users and those who started using cannabis at a later age, adolescent cannabis users were more likely to report repeated voluntary unprotected sex (odds ratio [OR], 2.69; 95% Confidence Interval, CI 2.24-3.22). Genetic (rg = 0.57, 95% CI: 0.38-0.87) and non-shared environmental (re = 0.21, 95% CI: 0.02-0.38) factors contributed to the association. After accounting for correlated familial factors, there was a consistent elevation in the likelihood of repeated voluntary unprotected sex in the exposed twin relative to her genetically identical never/late-onset user co-twin (unadjusted OR 2.25, 95% CI 1.14-4.44), even after adjustment for covariates (adjusted OR 2.27, 95% CI 1.08-4.80). CONCLUSIONS: Women who start using cannabis during adolescence appear to be more likely to report voluntary engagement in repeated unprotected sex than women who never use cannabis or who initiate cannabis use after adolescence. The results appear to be independent of shared genetic influences.This article is protected by copyright. All rights reserved. Language: en

Aim To investigate the characteristics of the different club drugs and associated high-risk sexual behaviours in China. Design Multicentre cross-sectional study. Setting Drug Detoxification and Rehabilitation Centres in six provinces, China. Participants A total of 1434 eligible club drug users were included. Measurements Participants were investigated by trained interviewers using a self-designed structured questionnaire to collect information on club drug use and associated behaviours. Findings Methamphetamine was the most commonly abused drug in participants (73.92%), who used it in their or their friends' homes by non-injection for the purpose of feeling euphoria. Among participants with sexual behaviours after club drug use, 75.21% reported having engaged in sex with multiple partners after club drug use during the past year and 79.84% had unprotected sex after using club drug during the past year. A two-level logistic model showed that male gender [adjusted odds ratio (AOR) = 7.14; 95% confidence interval (CI) = 4.17–12.5], unmarried (AOR = 1.71, 95% CI = 1.04–2.79), long duration of club drug use during their life-time (AOR = 1.76, 95% CI = 1.28–2.42) and severe acute intoxication after using club drugs during the past year (AOR = 2.11, 95% CI = 1.07–4.15) were independent risk factors of multiple sex partners during the past year. Another two-level model showed that the club drug users who were female (AOR = 1.79, 95% CI = 1.03–3.11) and had polydrug use during their lifetime (AOR = 1.55, 95% CI = 1.01–2.34) had more risk for unprotected sex during the past year than without these characteristics. Conclusion High-risk sexual behaviours are common among club drug users in China. The prevention and intervention of club drug use could decrease the risk of sexual behaviours which further prevent HIV transmission and other sexually transmitted infections in China.

Aims This study assessed the effectiveness of HERMITAGE (HIV’s Evolution in Russia - Mitigating Infection Transmission and Alcoholism in a Growing Epidemic), an adapted secondary HIV prevention intervention, compared with an attention control condition in decreasing sexually transmitted infections (STIs) and sex and drug risk behaviors among Russian HIV-infected heavy drinkers.

Aims To review and analyse in experimentally controlled studies the impact of alcohol consumption on intentions to engage in unprotected sex. To draw conclusions with respect to the question of whether alcohol has an independent effect on the incidence of human immunodeficiency virus (HIV) and other sexually transmitted infections (STIs). Methods A systematic review and meta-analysis of randomized controlled studies examined the association between blood alcohol content (BAC) and self-perceived likelihood of using a condom during intercourse. The systematic review and meta-analysis were conducted according to internationally standardized protocols (Preferred Reporting Items for Systematic Reviews and Meta-Analyses: PRISMA). The meta-analysis included an estimate of the dose–response effect, tests for publication bias and sensitivity analyses. Results Of the 12 studies included in the quantitative synthesis, our pooled analysis indicated that an increase in BAC of 0.1 mg/ml resulted in an increase of 5.0% (95% CI: 2.8–7.1%) in the indicated likelihood (indicated by a Likert scale) of engaging in unprotected sex. After adjusting for potential publication bias, this estimate dropped to 2.9% (95% CI: 2.0–3.9%). Thus, the larger the alcohol intake and the subsequent level of BAC, the higher the intentions to engage in unsafe sex. The main results were homogeneous, persisted in sensitivity analyses and after correction for publication bias. Conclusions Alcohol use is an independent risk factor for intentions to engage in unprotected sex, and as risky sex intentions have been shown to be linked to actual risk behavior, the role of alcohol consumption in the transmission of HIV and other STIs may be of public health importance.

Aims To investigate the patterns of concurrent sexual partnerships among young opiate users and sexual transmissibility of human immunodeficiency virus (HIV) in concurrent sexual partnerships in drug-use and sexual networks. Design Cross-sectional design. Participants A total of 426 young opiate users in Yunnan China. Setting Young opiate users recruited from their network ties. Measurement Respondent-driven sampling (RDS) was used to recruit participants. Multiple logistic regressions were performed to analyze the relationships of concurrent sexual partnerships with egocentric social network components risky sexual behavior for HIV and drug-use practices. Findings The RDS-adjusted prevalence of concurrent sexual partners was 42.9% among opiate users. Opiate users with concurrent sexual partnerships were more likely to engage in risky HIV-related sexual behavior compared to those without. Specifically they were more likely to report having had four or more sexual partners (26.3% versus 2.0%) having had a spouse or boy/girlfriends who also had concurrent sexual partnerships (28.1% versus 8.2%) having exchanged drug for sex (12.4% versus 3.8%) having had sexual partners who were non-injection drug users (22.6% versus 10.1%) having had sexual partners who were injection drug users (25.3% versus 13.5%) and having used club drugs (26.3% versus 13.5%). There were no significant differences in consistent condom use between opiate users with sexual concurrency and those without. The same proportion (25.8%) of opiate users in the two groups reported having consistently used condoms when having sex with regular partners and 46.3% of opiate users with sexual concurrency and 36.4% of those without such concurrency consistently used condoms with non-regular partners. Conclusion The expansion of the human immunodeficiency virus epidemic from high-risk populations to the general population in China may be driven by concurrent sexual partnerships. Behavioral interventions targeting safer sex should be integrated into harm reduction programmes.

Aims To assess the effectiveness of a peer-based, personal risk network-focused HIV prevention intervention to (i) train injection drug users (IDUs) to reduce injection and sex risk behaviors, (ii) conduct outreach to behaviorally risky individuals in their personal social networks [called risk network members (RNM)], and (iii) reduce RNM HIV risk behaviors. Design Randomized controlled trial with prospective data collection at 6, 12 and 18 months. Intervention condition consisted of five group sessions, one individual session and one session with Index and the RNM. Setting This study was conducted in Baltimore, Maryland from March 2004 to March 2006. Participants (i) Index participants were aged ≥18 years and self-reported injection drug use in the prior 6 months and (ii) their RNM who were aged ≥18 years and drug users or sex partners of Index. Measurements Outcomes included: (i) injection risk based on sharing needles, cookers and cotton for injection and drug splitting, (ii) sex risk based on number of sex partners, condom use and exchanging sex and (iii) Index HIV outreach behaviors. Findings A total of 227 Index participants recruited 336 RNM. Retention of Index at 18-month follow-up exceeded 85%. Findings suggest that the experimental condition was efficacious at 18 months in reducing Index participant injection risk [odds ratio (OR) = 0.38; 95% confidence interval (CI) = 0.18–0.77), drug-splitting risk (OR = 0.46; 95% CI = 0.25–0.88) and sex risk among Index (OR = 0.53; 95% CI = 0.34–0.86). Significant intervention effect on increased condom use among female RNM was observed (OR = 0.34; 95% CI = 0.18–0.62). Conclusions Training active IDU to promote HIV prevention with behaviorally risky individuals in their networks is feasible, efficacious and sustainable.

Aims To identify correlates of active syphilis infection among female sex workers (FSWs) in Tijuana and Ciudad Juarez. Design Cross-sectional analyses of baseline interview data. Correlates of active syphilis (antibody titers >1 : 8) were identified by logistic regression. Setting Tijuana and Ciudad Juarez, two Mexican cities on the US border that are situated on major drug trafficking routes and where prostitution is quasi-legal. Participants A total of 914 FSWs aged ≥18 years without known human immunodeficiency virus (HIV) infection who had had recent unprotected sex with clients. Measurements Baseline interviews and testing for syphilis antibody using Treponema pallidum particle agglutination (TPPA) and rapid plasma reagin (RPR) tests. Findings Median age and duration in sex work were 32 and 4 years, respectively. Overall, 18.0% had ever injected drugs, 14.2% often or always used illegal drugs before or during sex in the past month, 31.4% had clients in the last 6 months who injected drugs, and 68.6% reported having clients from the United States. Prevalence of HIV and active syphilis were 5.9% and 10.3%, respectively. Factors independently associated with active syphilis included injecting drugs (AOR: 2.39; 95% CI: 1.40, 4.08), using illegal drugs before or during sex (AOR: 2.06; 95% CI: 1.16, 3.65) and having any US clients (AOR: 2.85; 95% CI: 1.43, 5.70). Conclusions Among female sex workers in Tijuana and Ciudad Juarez, drug-using behaviors were associated more closely with active syphilis than were sexual behaviors, suggesting the possibility of parenteral transmission of T. pallidum. Syphilis eradication programs should consider distributing sterile syringes to drug injectors and assisting FSWs with safer-sex negotiation in the context of drug use.

Aims To assess the effectiveness of a brief human immunodeficiency virus (HIV) testing and counseling intervention compared to a more time-consuming and expensive street-based intervention with injection drug users (IDUs). Design Cross-over experimental design in which 900 IDUs were recruited, followed by a ‘wash-out’ period with no recruitment, a reversal of intervention assignment areas and an additional recruitment of 900 IDUs with baseline and 6-month follow-up assessments. Setting Kiev, Odessa and Makeevka/Donesk Ukraine. Participants A total of 1798 IDUs. Measurements HIV testing and audio computer-assisted self-interview (ACASI) data on socio-demographics, drug use and injection and sex-related risk behaviors. Findings Participants in both conditions reduced their injection and sex risks significantly; however, there was little difference in outcomes between conditions. IDUs who knew they were HIV-infected at baseline were significantly more likely to practice safe sex than those unaware or HIV-negative; those who first learned that they were infected at baseline changed their safe sex practices significantly more than those who already knew that they were infected at baseline and those who were HIV-negative. Younger IDUs and those injecting for a shorter period of time reported higher injection and sex risk behaviors following interventions. Conclusions Awareness of HIV infection by street-recruited drug injectors is associated with reduced sex risks. Additional interventions are required for younger IDUs and those injecting for shorter periods of time.

To examine the use of crystal methamphetamine (crystal meth) and its association with high-risk sexual behaviour among gay men in London.Cross-sectional surveys using self-administered questionnaires.National Health Service (NHS) out-patient human immunodeficiency virus (HIV) treatment clinic in London; NHS HIV testing/sexual health clinics in London; central London gyms.HIV-positive gay men attending the HIV treatment clinic in 2002-03 (n = 388); HIV-negative gay men attending the HIV testing/sexual health clinics in 2002-03 (n = 266); gay men using the gyms between January and March 2003 (n = 445), 2004 (n = 653) and 2005 (n = 494).Percentage of gay men who reported: (i) using crystal meth in the previous 12 months; (ii) using other recreational drugs (e.g. cocaine, ecstasy, ketamine); (iii) high-risk sexual behaviour in the previous 3 months.The percentage of gay men who had used crystal meth in the previous year varied by sample (HIV treatment clinic, 12.6%; HIV testing/sexual health clinics, 8.3%; gyms, 19.5%; P0.001) but did not change over time in the gyms (19.8%, 20.7%, 17.8%; P = 0.5). In all samples, the majority of men used crystal meth only once or twice a year. Most crystal meth users (80%) had taken other recreational drugs. Crystal meth and other drug users were more likely to report high-risk sexual behaviour than other men, e.g. HIV treatment clinic sample: crystal meth users, 34.7%; other drug users, 18.9%, non-users, 10.6%, P0.001. Cause and effect could not be established.Among gay men in London surveyed in clinics, approximately one in 10 reported using crystal meth in the previous 12 months (HIV-positive men 12.6%; HIV-negative men 8.3%). Most men used it infrequently--only once or twice a year. There was no evidence of increasing use of crystal meth between 2003 and 2005.

Aims To determine relationships between drug use ‘hardness’ (defined in increasing order of hardness as no drug use, marijuana use, non-injected heroin or cocaine use, crack smoking and injection drug use) and prevalences of several sexually transmissible infections among young adults in a high-risk neighbourhood. Drug users, particularly injection drug users and crack smokers, may be a core group for some sexually transmitted infections. Design Cross-sectional survey and assays of young adults from (a) a household probability sample and (b) a targeted sample of youth who have used injected drugs, crack, other cocaine or heroin. Setting Bushwick, an impoverished New York City minority neighbourhood with major drug markets. Participants A total of 363 18–24-year-olds from a household probability sample; 165 Bushwick 18–24-year-olds who have used injected drugs, crack, other cocaine or heroin. Measurements Drug use by self-report; serum- and urine-based assays for HIV, hepatitis B and C, syphilis, gonorrhoea, chlamydia and herpes simplex (type 2). Findings Household-sample prevalences: HIV, hepatitis C and syphilis, 1%; gonorrhoea 3%; chlamydia 5%; past or present hepatitis B infection 8%; herpes simplex (type 2) 18%. In combined household and targeted samples, hepatitis C and HIV were concentrated among drug injectors. Herpes simplex (type 2), syphilis and hepatitis B increased among women with ‘hardest drug ever used’. Conclusions Using ‘harder’ drugs is associated with some but not all of these infections. Prevention efforts should help youth avoid unsafe sex and higher-risk drugs.

Aims. To compare the occurrence of behaviours occurring under the influence of alcohol in 16-17-year-olds and determine associated risk factors for the different behaviours. Design/setting. Cross-sectional survey administered by laptop computers in secondary schools across the state of Victoria, Australia. Measurement/findings. The participation rate was 79%. Seventy per cent of participants drank alcohol; 17% of drinkers reported alcohol-related violence (accidents or injuries) and 15% reported problems relating to sex under the influence of alcohol (having sex and later regretting it or having had unsafe sex) in the previous 12 months. Males were more likely to report alcohol-related violence (20% compared to 14% females). Almost one in 10 young people reported having sex while under the influence of alcohol and later regretting it and 10% reported having had unsafe sex. There were no significant gender differences in the reporting rates of alcohol-related sexual risk taking (prop. cum. OR 1.1, 95% CI 0.68-1.9). For alcohol-related injuries, strong independent associations were found with dose of alcohol consumed (prop. cum. OR 2.3, 95% CI 1.3-4.0), frequency of alcohol consumption (prop. cum. OR 2.7, 95% CI 0.94-7.5), antisocial behaviour (prop. cum. OR 2.4, 95% CI 1.4-4.1) and peer drinking (prop. cum. OR 3.3, 95% CI 1.4-8.1). For alcohol-related sexual risk-taking, psychiatric morbidity (prop. cum. OR 4.1, 95% CI 1.9-9.0) and high frequency of alcohol consumption (prop. cum. OR 2.0, 95% CI 0.87-4.6) had strong independent associations. Conclusions. Physical injury and high-risk sexual behaviour under the influence of alcohol are common in teenagers. Alcohol-related physical injury appears closely related to patterns of alcohol consumption whereas alcohol-related sexual risk-taking is most closely associated with symptoms of depression and anxiety.

AIMS: To establish the extent and nature of linkages between illicit drug and alcohol use and sexual behaviour in women. PARTICIPANTS AND SETTING: One hundred women attending either a Genitourinary Medicine Clinic or a Family Planning Clinic. DESIGN: Respondents were interviewed using a semi-structured interview schedule covering the effect of drink/illicit drug use on the incidence of sex, on condom use, and on specific sexual activities, and deliberate use of drink/illicit drugs to affect sex. Interviews focused on the last three new male partners, from the beginning of the sexual relationship through its development. Data analysis was primarily qualitative, quantitative analysis was conducted where appropriate. RESULTS: There were few cases in which women reported that consumption of drink/illicit drugs caused them to engage in sexual behaviour which they would not have engaged in if they had not had drink/drugs. Associations between drink and illicit drugs and sexual behaviour were, mainly, either because encounters took place in social situations where drugs or drink were being consumed or because the woman used drink or drugs instrumentally to engage in desired behaviours. There was some evidence to suggest that greater use of drugs and alcohol might be part of a wider pattern of social behaviour including more sexual partners. CONCLUSIONS: The women's self-reported behaviour suggested that illicit drug and alcohol use in itself did not usually result in unsafe or undesired sexual behaviour. Language: en

To investigate sexual behaviour under the influence of alcohol and the relationship between drinking habits and unsafe sex we carried out a postal and interview survey of 2174 students in the North East of England. Drinking habits were classified as non, light, medium and heavy, and cross-tabulated against sexual and other risk taking behaviour. Response rates of 74% and 77% were obtained in the postal and interview surveys respectively. In the postal survey, heavier drinkers were more likely to have unsafe sex such as casual sex without a condom, and sex with someone know to have many partners. Respondents associated alcohol with sexual risk taking; because of drinking too much, in the last year, 19% had not taken contraceptive precautions during sex. The interview survey largely confirmed postal survey results. There are three possible explanations of the association between drinking habits and unsafe sex: alcohol might disinhibit safer sex; young risk-takers may also drink more; or, drinking might be associated with unsafe sex by coincidence because sexual encounters often begin in licensed premises. Drinking habits should therefore be a priority issue for future HIV/AIDS related research, policy debate, and health education endeavour.

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