AIDS Education And Prevention

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AIDS Education and Prevention, 20(3), 325–337, 2008 © 2008 The Guilford Press

Sherry Deren, Shiela Strauss, Sung–Yeon Kang, Hector M. Colón, and Rafaela R. Robles

Reducing sex risk behaviors among high–risk injection drug users (IDUs) and crack smokers is a continuing challenge for HIV prevention. Based on a longitudinal study of sexually active Puerto Rican IDUs and crack smokers in New York (n = 573) and Puerto Rico (n = 264), baseline predictors of changes in sex risk (number of unprotected sex acts) at 6- and 36-month follow–up interviews were examined. In New York, predictors of higher sex risk were being younger, having primary partners, having more other sex partners, never exchanging sex, having lower self–efficacy for reducing sex risk behaviors and being HIV–negative, and these predictors were significant at both postbaseline periods. In Puerto Rico, short–term predictors included being male, having primary partners, never exchanging sex, lower sex risk norms and lower self–efficacy. However, only having primary partners was significant in longer–term behaviors. Results indicated the need for enhancing self–efficacy and for developing risk reduction strategies related to community differences.

Although some success has been achieved in reducing injection–related HIV risk behaviors among injection drug users (IDUs), interventions to impact sex risk behaviors have remained a challenge (McCoy et al., 2005). Other types of drug use (e.g., crack cocaine) have also been associated with HIV and other sexually transmitted infections, related to high levels of unprotected sex (Logan & Leukefeld, 2000; Sánchez, Comerford, Chitwood, Fernandez, & McCoy, 2002). The importance of enhancing sexual risk reduction among drug users has been identified by many investigators (Des Jarlais & Semaan, 2005; Strathdee & Sherman, 2003). Intervention efforts focusing on reducing sex risks primarily address increasing safe sex, defined as sex with condoms. The importance of distinguishing between risk behaviors with primary and other sex partners has been emphasized by repeated findings of increased risk (less condom use) reported for sex with primary partners (Bird, Harvey, Beckman, Johnson, & the Partners Project, 2001; Rosengard, Anderson, &

Sherry Deren, Shiela Strauss, and Sung–Yeon Kang are with the National Development & Research Institutes, Inc., Center for Drug Use & HIV Research, New York. Hector M. Colón, and Rafaela R. Robles are with the Universidad Central Del Caribe, Center for Addiction Studies, Bayamón, Puerto Rico. This research was funded by the National Institute on Drug Abuse, Grants R01DA010425 and P30 DA011041. Address correspondence to Sherry Deren, PhD, NDRI, Center for Drug Use & HIV Research, 71 West 23rd St., 8th Floor, New York, NY 10010; e–mail:




Stein, 2004). Other variables that have been found to be associated with condom use among drug users include drug–related factors (e.g., involvement in drug treatment) and sex–related factors (e.g., sex risk norms and self–efficacy for sex risk reduction) (Gossop, Marsden, Steward, & Treacy, 2002; Zamboni, Crawford, & Williams, 2000). Studies examining predictors of condom use often focus on a single point in time. There is a need to examine whether predictors of risk at a given point in time retain their ability to explain variability in risk behaviors at a later time period. This can be helpful to inform the development of interventions with both short and longer term success. Among Hispanics, Puerto Ricans have been identified as having significantly higher HIV risk behaviors, and significantly higher rates of HIV disease (Colón et al., 2006). Puerto Rican drug users have been identified as being at high risk for HIV transmission, both through injection– and sex–related risk behaviors