Inconsistent condom use among HIV-infected patients with alcohol problems

Background: Unsafe sexual behavior is common among persons with negative or unknown HIV status and it is augmented by alcohol use in some populations. We examined the association between alcohol consumption level (abstinent, moderate, at-risk) and inconsistent condom use in a cohort of HIV-infected individuals with a history of alcohol problems. Methods: Subjects (n = 345) had up to seven structured interviews over 36 months. Identical questions on alcohol consumption and inconsistent condom use were asked at each interview. We used generalized estimating equations (GEE) multivariate logistic regression for repeated measurements analysis. We adjusted for potential confounding factors and explored possible interactions. Results: At baseline, 132 (38%) participants reported inconsistent condom use. We detected a significant (P = 0.0002) interaction between alcohol consumption and injection drug use (IDU) variables. Among active injection drug users, at-risk drinking was associated with inconsistent condom use, adjusted odds ratio (OR; 95% confidence interval) 4.3 (1.5, 12.2). Among those who did not inject drugs, at-risk drinking and inconsistent condom use were not associated, 0.7 (0.4, 1.3). Inconsistent condom use was more common among women, those believing condoms to be 'a hassle', and persons living with a partner. Conclusion: In HIV-infected drug-injecting individuals, excessive use of alcohol is associated with unsafe sexual practices. (C) 2003 Elsevier Ireland Ltd. All rights reserved.