Alcohol and HIV risk taking among intravenous drug users

Purpose: To determine if drug risk days are also alcohol use days for active injection drug users (IDUs). Methods: Cross-sectional interview of 187 AUDIT-positive (≥8) active IDUs recruited between 2/98 and 10/99 from a needle exchange program (NEP) in Providence, RI. A drug risk day is defined as 'using needles, cotton, or cookers after someone else had used it,' measured using a 30-day Timeline Follow-Back procedure. Results: The sample was 64% male, 87% white, with 85% meeting DSM-IV criteria for alcohol abuse/dependence. Of the total days analyzed (n=5610), 25% were drug risk days; on 40% of these days, drinking also occurred. Using a generalized estimating equation (GEE) model to cluster by subject, alcohol use was associated with drug risk days (OR 1.53; 95% CI 1.2-1.9; P<.001), controlling for gender, age, race, cocaine use, number of daily injections, methadone treatment, and partner drug use. Conclusions: Using a data analytic strategy that allows examination of self-reports of behaviors on a day-to-day basis, we found that alcohol use is associated with drug risk taking behavior among IDUs. Whether alcohol use precedes or is subsequent to risky HIV behaviors remains to be determined.