Skip to main content
PMC home page
Public Health Reports logoLink to Public Health Reports
. 2003 Sep-Oct;118(5):415–424. doi: 10.1093/phr/118.5.415

Factors associated with positive HIV serostatus among women who use drugs: continued evidence for expanding factors of influence.

Katherine P Theall 1, Claire E Sterk 1, Kirk W Elifson 1, Daniel Kidder 1
PMCID: PMC1497583  PMID: 12941854

Abstract

OBJECTIVE: To identify risk factors associated with positive HIV serostatus among African American women who smoke crack and/or inject drugs and who are not enrolled in drug treatment or another institutional setting. METHODS: Baseline interviews were conducted from June 1998 to June 2000 with 379 heterosexually active women (ages 18 to 59) who had been recruited for potential enrollment into an HIV intervention trial. RESULTS: Adjusted for age and drug using status, women who expressed more difficulty saying no to sex with male partners were more likely to be HIV-positive (adjusted odds ratio [aOR]=3.08, 95% confidence interval [CI] 2.02, 4.83). Similarly, those who indicated greater communication with casual sex partner(s) were less likely to test positive (aOR=0.29, 95% CI 0.10, 0.89). Lower HIV internal control and a history of cuts or burns on lips due to crack smoking were also associated with positive serostatus, and were important confounders in the final multivariate model. A higher level of internal control was associated with a decreased likelihood of positive serostatus, while a history of cuts or burns on the lips was associated with an increased likelihood of HIV antibodies, even after controlling for the amount of oral sex. CONCLUSIONS: A broad array of factors may promote or avert infection with HIV. The degree to which personal attributes and beliefs, and relationship characteristics contribute to the likelihood of infection must continue to be addressed. The importance of oral sex and presence of oral sores and their potential role in transmission was suggested.

Full Text

The Full Text of this article is available as a PDF (94.4 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Brafford L. J., Beck K. H. Development and validation of a condom self-efficacy scale for college students. J Am Coll Health. 1991 Mar;39(5):219–225. doi: 10.1080/07448481.1991.9936238. [DOI] [PubMed] [Google Scholar]
  2. Brown E. J. Female injecting drug users: human immunodeficiency virus risk behavior and intervention needs. J Prof Nurs. 1998 Nov-Dec;14(6):361–369. doi: 10.1016/s8755-7223(98)80078-1. [DOI] [PubMed] [Google Scholar]
  3. Compton W. M., Cottler L. B., Ben-Abdallah A., Cunningham-Williams R., Spitznagel E. L. The effects of psychiatric comorbidity on response to an HIV prevention intervention. Drug Alcohol Depend. 2000 Mar 1;58(3):247–257. [PubMed] [Google Scholar]
  4. Coyle S. L. Women's drug use and HIV risk: findings from NIDA's Cooperative Agreement for Community-Based Outreach/Intervention Research Program. Women Health. 1998;27(1-2):1–18. doi: 10.1300/J013v27n01_01. [DOI] [PubMed] [Google Scholar]
  5. Des Jarlais D. C., Friedman S. R., Perlis T., Chapman T. F., Sotheran J. L., Paone D., Monterroso E., Neaigus A. Risk behavior and HIV infection among new drug injectors in the era of AIDS in New York City. J Acquir Immune Defic Syndr Hum Retrovirol. 1999 Jan 1;20(1):67–72. doi: 10.1097/00042560-199901010-00010. [DOI] [PubMed] [Google Scholar]
  6. Ehrhardt A. A., Exner T. M. Prevention of sexual risk behavior for HIV infection with women. AIDS. 2000 Sep;14 (Suppl 2):S53–S58. [PubMed] [Google Scholar]
  7. Faruque S., Edlin B. R., McCoy C. B., Word C. O., Larsen S. A., Schmid D. S., Von Bargen J. C., Serrano Y. Crack cocaine smoking and oral sores in three inner-city neighborhoods. J Acquir Immune Defic Syndr Hum Retrovirol. 1996 Sep;13(1):87–92. doi: 10.1097/00042560-199609000-00012. [DOI] [PubMed] [Google Scholar]
  8. Gallo D., George J. R., Fitchen J. H., Goldstein A. S., Hindahl M. S. Evaluation of a system using oral mucosal transudate for HIV-1 antibody screening and confirmatory testing. OraSure HIV Clinical Trials Group. JAMA. 1997 Jan 15;277(3):254–258. [PubMed] [Google Scholar]
  9. Ickovics J. R., Yoshikawa H. Preventive interventions to reduce heterosexual HIV risk for women: current perspectives, future directions. AIDS. 1998;12 (Suppl A):S197–S208. [PubMed] [Google Scholar]
  10. Ilaria G., Jacobs J. L., Polsky B., Koll B., Baron P., MacLow C., Armstrong D., Schlegel P. N. Detection of HIV-1 DNA sequences in pre-ejaculatory fluid. Lancet. 1992 Dec 12;340(8833):1469–1469. doi: 10.1016/0140-6736(92)92658-3. [DOI] [PubMed] [Google Scholar]
  11. Inciardi J. A., Chitwood D. D., McCoy C. B. Special risks for the acquisition and transmission of HIV infection during sex in crack houses. J Acquir Immune Defic Syndr. 1992;5(9):951–952. [PubMed] [Google Scholar]
  12. Lane H. C., Holmberg S. D., Jaffe H. W. HIV seroconversion and oral intercourse. Am J Public Health. 1991 May;81(5):658–658. doi: 10.2105/ajph.81.5.658. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Levy J. A. Human immunodeficiency viruses and the pathogenesis of AIDS. JAMA. 1989 May 26;261(20):2997–3006. [PubMed] [Google Scholar]
  14. Magura S., Goldsmith D., Casriel C., Goldstein P. J., Lipton D. S. The validity of methadone clients' self-reported drug use. Int J Addict. 1987 Aug;22(8):727–749. doi: 10.3109/10826088709027454. [DOI] [PubMed] [Google Scholar]
  15. McElrath K., Chitwood D. D., Griffin D. K., Comerford M. The consistency of self-reported HIV risk behavior among injection drug users. Am J Public Health. 1994 Dec;84(12):1965–1970. doi: 10.2105/ajph.84.12.1965. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Miller M., Neaigus A. Networks, resources and risk among women who use drugs. Soc Sci Med. 2001 Mar;52(6):967–978. doi: 10.1016/s0277-9536(00)00199-4. [DOI] [PubMed] [Google Scholar]
  17. Mitchell-Lewis D. A., Phelan J. A., Kelly R. B., Bradley J. J., Lamster I. B. Identifying oral lesions associated with crack cocaine use. J Am Dent Assoc. 1994 Aug;125(8):1104-8, 1110. doi: 10.14219/jada.archive.1994.0122. [DOI] [PubMed] [Google Scholar]
  18. Morrill A. C., Kasten L., Urato M., Larson M. J. Abuse, addiction, and depression as pathways to sexual risk in women and men with a history of substance abuse. J Subst Abuse. 2001;13(1-2):169–184. doi: 10.1016/s0899-3289(01)00065-7. [DOI] [PubMed] [Google Scholar]
  19. Neaigus A., Miller M., Friedman S. R., Hagen D. L., Sifaneck S. J., Ildefonso G., des Jarlais D. C. Potential risk factors for the transition to injecting among non-injecting heroin users: a comparison of former injectors and never injectors. Addiction. 2001 Jun;96(6):847–860. doi: 10.1046/j.1360-0443.2001.9668476.x. [DOI] [PubMed] [Google Scholar]
  20. Padian N. S. Prostitute women and AIDS: epidemiology. AIDS. 1988 Dec;2(6):413–419. doi: 10.1097/00002030-198812000-00001. [DOI] [PubMed] [Google Scholar]
  21. Porter J., Bonilla L. Crack users' cracked lips: an additional HIV risk factor. Am J Public Health. 1993 Oct;83(10):1490–1491. doi: 10.2105/ajph.83.10.1490-a. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Rothenberg R. B., Scarlett M., del Rio C., Reznik D., O'Daniels C. Oral transmission of HIV. AIDS. 1998 Nov 12;12(16):2095–2105. doi: 10.1097/00002030-199816000-00004. [DOI] [PubMed] [Google Scholar]
  23. Rotter J. B. Generalized expectancies for internal versus external control of reinforcement. Psychol Monogr. 1966;80(1):1–28. [PubMed] [Google Scholar]
  24. Rozenbaum W., Gharakhanian S., Cardon B., Duval E., Coulaud J. P. HIV transmission by oral sex. Lancet. 1988 Jun 18;1(8599):1395–1395. doi: 10.1016/s0140-6736(88)92205-2. [DOI] [PubMed] [Google Scholar]
  25. St Lawrence J. S., Eldridge G. D., Brasfield T. L. Behavioral and psychosocial consequences of HIV antibody counseling and testing with African American women. Womens Health. 1998 Summer;4(2):135–153. [PubMed] [Google Scholar]
  26. Stacy A. W., Newcomb M. D., Ames S. L. Implicit cognition and HIV risk behavior. J Behav Med. 2000 Oct;23(5):475–499. doi: 10.1023/a:1005577132666. [DOI] [PubMed] [Google Scholar]
  27. Sterk C. E., Dolan K., Hatch S. Epidemiological indicators and ethnographic realities of female cocaine use. Subst Use Misuse. 1999 Dec;34(14):2057–2072. doi: 10.3109/10826089909039438. [DOI] [PubMed] [Google Scholar]
  28. Sterk Claire E., Theall Katherine P., Elifson Kirk W. Effectiveness of a risk reduction intervention among African American women who use crack cocaine. AIDS Educ Prev. 2003 Feb;15(1):15–32. doi: 10.1521/aeap.15.1.15.23843. [DOI] [PubMed] [Google Scholar]
  29. Sterk Claire E., Theall Katherine P., Elifson Kirk W., Kidder Daniel. HIV risk reduction among African-American women who inject drugs: a randomized controlled trial. AIDS Behav. 2003 Mar;7(1):73–86. doi: 10.1023/a:1022565524508. [DOI] [PubMed] [Google Scholar]
  30. Vernazza P. L., Eron J. J., Cohen M. S., van der Horst C. M., Troiani L., Fiscus S. A. Detection and biologic characterization of infectious HIV-1 in semen of seropositive men. AIDS. 1994 Sep;8(9):1325–1329. doi: 10.1097/00002030-199409000-00017. [DOI] [PubMed] [Google Scholar]
  31. Wallace J. I., Porter J., Weiner A., Steinberg A. Oral sex, crack smoking, and HIV infection among female sex workers who do not inject drugs. Am J Public Health. 1997 Mar;87(3):470–470. doi: 10.2105/ajph.87.3.470. [DOI] [PMC free article] [PubMed] [Google Scholar]
  32. Weinhardt L. S., Carey K. B., Carey M. P. HIV risk sensitization following a detailed sexual behavior interview: a preliminary investigation. J Behav Med. 2000 Aug;23(4):393–398. doi: 10.1023/a:1005505018784. [DOI] [PubMed] [Google Scholar]
  33. Wingood G. M., DiClemente R. J. Cultural, gender, and psychosocial influences on HIV-related behavior of African-American female adolescents: implications for the development of tailored prevention programs. Ethn Dis. 1992 Fall;2(4):381–388. [PubMed] [Google Scholar]

Articles from Public Health Reports are provided here courtesy of SAGE Publications

RESOURCES