Alcohol use and sexual risk taking among hazardously drinking drug injectors who attend needle exchange

Background: To determine if sex-risk days are also alcohol use days for act ive injection drug users. Methods: Cross-sectional interview of 187 active injection drug users who s cored positively (greater than or equal to8) on the Alcohol Use Disorders I dentification Test who were recruited between February 1998 and October 199 9 from a needle exchange program in Providence, Rhode Island. A sex-risk da y was defined as "vaginal sex, anal sex or oral sex without a condom," meas ured by using a 30 day timeline follow-back procedure. Results: The sample was 64% male and 87% white, and 85% met DSM-IV criteria for alcohol abuse/dependence. Of the total days analyzed (n=5610), 19% wer e sex-risk days; on 52% of these days drinking also occurred. By using a ge neralized estimating equation model to cluster by subject, alcohol use was associated with sex-risk days (odds ratio, 1.76; 95% confidence interval, 1 .35-2.29; p<0.001), when we controlled for gender, age, race, education, co caine use, injection frequency, exchanging sex for money or drugs, number o f sexual partners, and perceived sexual risk of acquiring human immunodefic iency virus from partners. Conclusions: Alcohol use is associated with sex risk-taking behavior among injection drug users. A substantial majority of participants reported using alcohol before or during sexual relations, which temporally links alcohol use with human immunodeficiency virus injection risk.