Transitions in Latent Classes of Sexual Risk Behavior Among Young Injection Drug Users Following HIV Prevention Intervention

Mary Ellen Mackesy-Amiti,Richard S Garfein,Lawrence J Ouellet,Mary Latka,Karla Wagner,Elizabeth Golub,Lorna Finnegan,Holly Hagan

doi:10.1007/s10461-013-0601-2

Abstract

We analyzed data from a large randomized HIV/HCV prevention intervention trial with young injection drug users (IDUs). Using categorical latent variable analysis, we identified distinct classes of sexual behavior for men and women. We conducted a latent transition analysis to test the effect of the intervention on transitions from higher to lower risk classes. Men who were in a high-risk class at baseline who received the intervention were 86 % more likely to be in a low-risk class at follow-up compared to those in the control group (p = 0.025). High-risk intervention participants were significantly more likely to transition to the class characterized by unprotected sex with a main partner only, while low-risk intervention participants were significantly less likely to transition to that class. No intervention effect was detected on the sexual risk behavior of women, or of men who at baseline were having unprotected sex with a main partner only.Electronic supplementary materialThe online version of this article (doi:10.1007/s10461-013-0601-2) contains supplementary material, which is available to authorized users.

Highlights

As HIV prevention efforts have achieved significant reductions in syringe-sharing among injection drug users (IDUs), attention has turned to the importance of addressing sexual transmission of HIV in this population [1,2,3,4,5,6,7,8,9]
In the latent class analyses of baseline data, the Bayesian Information Criterion (BIC) pointed to a model with five classes, and the bootstrap likelihood ratio tests (BLRT) indicated significant improvement in fit compared to the four class model (BLRT(12) = 79.91, p \ 0.0001)
The five classes included (1) a low risk group comprised of men who reported no unprotected sex (28 %); (2) men who had unprotected sex with a main female partner only (30 %); (3) men who had unprotected sex with main and other female partners (29 %); (4) a high-risk group including men who have sex with men and women, and men who engaged in sex trade (6 %); and (5) men who have sex with men or engage in sex trade, and have low probability of unprotected sex with women (7 %)

Summary

Introduction

As HIV prevention efforts have achieved significant reductions in syringe-sharing among injection drug users (IDUs), attention has turned to the importance of addressing sexual transmission of HIV in this population [1,2,3,4,5,6,7,8,9]. Interventions with IDUs have often been less effective in reducing sexual risk behavior than injection risk behavior [21, 22]. The DUIT enhanced intervention demonstrated an overall greater decrease in injection-related HIV risk behavior compared to the control [23, 24]; it did not appear to have any greater effect on sexual risk behavior than the control

Methods

Results

Discussion

Conclusion