mental health AIDS

Winter 2006 Newsletter / Volume 7, Issue 2

HIV Prevention News

About Persons Who Use Substances

Ninety-three heterosexually active college men provided LaBrie, Earleywine, Schiffman, Pedersen, and Marriot (2005) with data on more than 1,500 sexual events across a 3-month period. The investigators found that "[t]he men consumed significantly more alcohol with new partners, followed by casual partners, and then by regular partners. In contrast, they were more likely to use condoms with new partners than with casual or regular partners. Drinking alcohol decreased condom use, but only with casual partners. Expectancies about alcohol's disinhibiting sexual effects decreased condom use as well" (p. 259). Drawing on these data, LaBrie and colleagues observe that "alcohol consumption does decrease condom use, particularly with casual partners and when drinkers believe alcohol alters sexual disinhibition" (p. 259). They suggest that "[i]mproving knowledge about [the potential for] HIV and other [sexually transmitted disease (STD)] transmission ... [with] casual partners and challenging expectancies about alcohol as a sexual disinhibitor could help decrease the spread of HIV and other STDs" (p. 259). With regard to casual partners, "[e]ncouraging men to treat casual partners as new partners may promote safer-sex behaviors. If participants are capable of using a condom after drinking with a new partner, the same skills should apply with a casual partner" (p. 264).

Stein et al. (2005) conducted a randomized controlled trial involving 109 active drug injectors (64% male, 82% white) with a DSM-IV diagnosis of major depression only (63%), substance-induced mood disorder with depressive features persisting for at least 3 months (17%), or major depression plus dysthymia ("double depression"; 17%). Study participants were assigned to one of two conditions: eight sessions of outpatient cognitive behavioral psychotherapy plus pharmacotherapy over a 3-month period, or an assessment-only condition. HIV drug risk and depression remission were evaluated at 3, 6, and 9 months.

The investigators found that "[r]eported HIV drug risk scores decreased sharply over the first 3 months and continued to decline throughout the follow-up period. ... However, highly adherent participants had significantly lower HIV drug risk scores at 3 months ..., but not 6 and 9 months. Depression remission was significantly associated with lower HIV drug risk scores at follow-ups" (p. 418). Stein and colleagues conclude that "[c]ombined psychotherapy and pharmacotherapy did not produce a significant reduction in HIV drug risk beyond that seen in an assessment-only control group. The greatest declines in HIV drug risk were found among participants with high protocol adherence and those with depression remission" (p. 418), but relatively few participants reported the remission of their depressive symptoms when follow-up measures were taken. It should, however, be noted that "[a] persistent treatment effect on HIV drug risk behavior did exist for women. There was a treatment by gender interaction effect through the follow-up periods" (p. 429).

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