SEX, DRUGS AND HIV COUNSELING AND TESTING - A PROSPECTIVE-STUDY OF BEHAVIOR-CHANGE AMONG METHADONE-MAINTENANCE CLIENTS IN NEW-ENGLAND

Objectives: To determine whether changes in injecting drug use and sex ual behavior over a 12-month follow-up are associated with HIV counsel ing and testing (C and T) of injecting drug users in methadone mainten ance treatment programs (MMTP) in Massachusetts and Connecticut. Metho ds: Clients were invited to participate in a longitudinal study involv ing five interviews. Data were also obtained by ethnographers and from clinical records. Behavioral outcomes of interest were numb;er pf dru g injections, sharing of unclean 'works' (injecting equipment), number of unprotected sex partners, and number of unprotected sexual episode s. Data analyses included multiple regression, odds ratios, and quanti tative analysis of text-based data. Results: Subjects reported reducti ons in both injecting drug use and sexual behavior. Primary associatio ns with reduced injecting drug use were remaining in the MMTP and atte nding HIV-positive support groups. A reduction in high-risk sexual beh avior was associated with an HIV-positive test result and duration of HIV counseling in the MMTP. Increase in drug injecting use was associa ted with an HIV-positive test result. Inconsistent condom use was asso ciated with enrollment in the MMTP where condoms were available only u pon request and abstinence and monogamy between uninfected partners we re promoted. Conclusions: Injecting drug users who self-select to part icipate in MMTP and HIV C and T, two public health HIV-prevention inte rventions, reduce their HIV-risk behaviors. Clients should be encourag ed to remain in MMTP and HIV-infected clients should attend support gr oups for HIV-positive persons. MMTP staff should promote a variety of safer sex behaviors and provide condoms without request.