Intimate relationship characteristics associated with condom use among drug users and their sex partners: a multilevel analysis

Few studies have examined sexual risk behaviors among drug users in the con text of their primary sexual relationships. The aim of this study is to exa mine characteristics of sexual partners associated with inconsistent condom use among a sample of 703 cocaine and opiate users from Baltimore, MD who participated in a network oriented intervention study of human immunodefici ency syndrome (HIV) risk behaviors among drug users. The current study exam ines relationship characteristics between drug users and their sexual partn ers (n = 1003). Some of the study participants had more than one sexual par tner, accounting for the greater number of sexual pairs than study particip ants. Study participants reported using multiple drugs (56% injected, 48% s niffed heroin, and 48%, smoked crack) and that 70% of their sexual partners also used heroin and/or cocaine. Forty percent reported consistent condom use in the past 3 months. In multiple logistic regression, characteristics associated with consistent condom use were, the drug user being HIV infecte d: not living with their sexual partners; and not being financially interde pendent. Previous research has demonstrated lower rates of condom use with main compared with casual and exchange partners. Primary sexual partners pr ovide a sense of stability and introducing condoms may not be desirable or realistic. HIV prevention programs that target drug users should focus on t he benefits, such as trust and a sense of security, and risks of not using condoms in primary relationships. Programs should also focus on enhancing c ommunication and negotiation skills through targeting individuals as well a s couples. (C) 2001 Elsevier Science Ireland Ltd. All rights reserved.