Gender difference in HIV sexual risk behavior among substance use program patients in US

Although sexual risk behavior among drug users is highly associated with HIV transmission, gender-specific patterns in sexual risk have previously received less systematic study among this particular population. This study examined gender differences in a variety of sexual risk behaviors, such as multiple partners, type of partner (primary or non-primary), site of penetration (vaginal or anal), protection (condom use or no condom use), substance use prior to sex and partners' HIV status (HIV-positive, negative, and unknown). Participants were 777 male and 504 female clients from 12 US community-based substance use disorder treatment programs participating in the National Drug Abuse Treatment Clinical Trials Network protocol CTN0032. Chi-sq test and negative binomial regression via generalized estimating equations (GEE) model were used in the statistical analysis. Results showed that female clients reported more unprotected sex with their primary partner (OR=1.27, 95%CI 1.01-1.59, p=0.04), unprotected sex while using drugs or alcohol (OR=1.41, 95%CI 1.03-1.92, p=0.03), unprotected sex with HIV-positive partners (OR=4.55, 95%CI 1.15-16.67, p=0.03) and partners with unknown serostatus (OR=2.13, 95%CI 1.47-3.13, p<0.0001) than male clients, adjusted for time, ethnicity, age, education, marital status, income and if ever in jail. Male clients reported significantly more anal sex (OR=1.66, 95%CI 1.13-2.43, p=0.01) than did female clients. Men also reported more unprotected sex with their non-primary partners (OR=1.89, 95%CI 1.19-2.99, p=0.01) when only adjusted for time. No significant gender differences were identified in number of sexual partners, vaginal sex or sex with HIV-negative partners. Gender specific intervention approaches may be indicated and are discussed.