# Presentation: 236103

## Do Sex and Drug Behavior Patterns Account for HIV/STD Racial Disparities?

**Do Sex and Drug Behavior Patterns Account for HIV/STD Racial Disparities?**

**May 8, 2007**

**Denise Hallfors, Ph.D.**
**Bonita Iritani, M.A.**

## Acknowledgements

- Based on: Hallfors, D.D., Iritani, B., Miller, W.C., Bauer, D. (2007) Sexual and Drug Behavior Patterns and HIV/STD Racial Disparities: The Need for New Directions. *American Journal of Public Health*, 97(1):125-132.
- Research presented was supported by grant R01-DA14496 from the National Institute on Drug Abuse
- This research uses data from Add Health, a program project designed by J. Richard Udry, Peter S. Bearman, and Kathleen Mullan Harris, and funded by a grant P01-HD31921 from the National Institute of Child Health and Human Development, with cooperative funding from 17 other agencies.  Special acknowledgment is due Ronald R. Rindfuss and Barbara Entwisle for assistance in the original design.  Persons interested in obtaining data files from Add Health should contact Add Health, Carolina Population Center, 123 W. Franklin Street, Chapel Hill, NC  27516-2524 (_[www.cpc.unc.edu/addhealth/contract.html](http://www.cpc.unc.edu/addhealth/contract.html)_).

## Population-Based Sample of Adolescents and Young Adults

- National Longitudinal Study of Adolescent Health (Add Health)
- Cluster analyses (K-Means) on self-reported sex and drug behaviors
- 4 a priori clusters: lifetime abstention from sex & drugs, sex for money, IV drug use, MSM
- Total of 16 clusters, each person assigned to one cluster (handout)
- Analyses at Wave 3 (limited to non-Hispanic blacks and whites, with no missing STD data)
- Associations between risk behaviors (survey) and STD/HIV (bio-specimens), by race & gender

## Wave III Ages 18-26   Non-Hispanic Blacks and WhitesN=8,706

## Table 1.  Prevalence of Add Health Tested STD/HIV Infections by Race

|  | White |  | Black |  |
| --- | --- | --- | --- | --- |
|  | Prevalence | (95%CI) | Prevalence | (95%CI) |
| Chlamydial infection | 1.9 | (1.5-2.5) | 12.5 | (10.2-15.3) |
| Trichomoniasis | 1.2 | (0.9-1.5) | 6.9 | (5.4-8.8) |
| Gonorrhea | 0.1 | (0.0-0.3) | 2.1 | (1.5-3.1) |
| HIV | -- | -- | 0.5 | (0.2-1.0) |
| STD/HIV Combined | 3.1 | (2.6-3.8) | 18.8 | (16.1-21.8) |

## STD/HIV Infection by race and gender

-  Black women: 22.8%
- Black men: 14.6%
- White women: 3.7%
- White men: 2.6%

## STD/HIV Infection By Covariates

**STD/HIV Infection By Covariates**

- *p < .01, **p < .001

|  |  | % positive for STD/HIV |
| --- | --- | --- |
| Marital Status | Not Married | 6.6* |
|  | Married | 3.8 |
| Dropped Out of High School | 
Dropout | 
9.9** |
|  | Not dropout | 5.5 |
| 
Functional Poverty | 
Poverty | 
8.8 ** |
|  | No poverty | 5.7 |
| Condom Use Last Intercourse | 
Not used | 
6.2 |
|  | Used | 7.6 |
| 
Age First Intercourse | 
Age 14 or younger | 
9.7** |
|  | > Age 14 | 5.8 |

## Percent Covariate Characteristics By Race and Gender

**Percent Covariate Characteristics By Race and Gender**

|  | Blacks
M   F
% | Whites
M  F
% |
| --- | --- | --- |
| 
Married | 
10  13 | 
13  23 |
| 
Dropped out of high school | 
23  16 | 
14  12 |
| 
In functional poverty | 
17  24 | 
11  15 |
| 
Condom used last intercourse | 
   48 | 
43   32 |
| 
Age 14 or younger | 
32  23 | 
15  19 |

## Handout:Sex and DrugBehavior Clusters

## Slide 10

## Slide 11

## Slide 12

## (Red clusters = infection rates >.06)

**Users**

**STD/HIV Infection**

**Sexually**
**Active,**
**Few **
**Partners,**
**Low ATOD**

**Light**
**Alcohol**
**& Sex**

**Smokers**
**& Sex**

**Heavy**
**Dabblers**

**Regret**
**AOD w/**
**Sex,**
**High AOD**

**Regret**
**AOD w/**
**Sex,**
**Mod. AOD**

**High**
**Marijuana**
**& Sex**

**Sex for**
**Money**

**Multiple**
**Partners**

**IV Drug**
**Users**

**MSM**

**Marijuana**
**& Other**
**Drugs**

- .03

- .03

- .03

- .03

- .04

- .05

- .04

- .05

- .09

- .03

- .08

- .08

- .07

**Whites**
**(Red clusters = infection rates ****>.06**)

**WAVE3**
**(Young Adults Ages 18-26)**

## (Red clusters = infection rates > .06)

**Users**

**STD/HIV Infection**

**Sexually**
**Active,**
**Few **
**Partners,**
**Low ATOD**

**Light**
**Alcohol**
**& Sex**

**Smokers**
**& Sex**

**Heavy **
**Dabblers**

**Regret**
**AOD w/**
**Sex,**
**High AOD**

**Regret**
**AOD w/**
**Sex,**
**Mod. AOD**

**High**
**Marijuana**
**& Sex**

**Sex for**
**Money**

**Multiple**
**Partners**

**IV Drug**
**Users**

**MSM**

**Marijuana**
**& Other**
**Drugs**

- .20

- .17

- .25

- .22

- .19

- .14

- .20

- .23

- .23

- .10

- .23

- .29

- .34

**Blacks **
**(Red clusters = infection rates >** **.06****)**

**WAVE3**
**(Young Adults Ages 18-26)**

## Table 4. Prevalence odds ratios for blacks relative to whites from logistic regression models of STD/HIV infection 

|  | Unadjusted OR | (95% CI) | Adjusted* OR | (95% CI) |
| --- | --- | --- | --- | --- |
| Few Partners, Low ATOD (n=1613) | 7.8 (4.5-13.4) |  | 7.1 (4.1-12.3) |  |
| Light Alcohol & Sex (n=1368) | 6.3 (3.5-11.4) |  | 5.8 (3.2-10.6) |  |
| Low Risk Behavior (n=1016) | 28.9 (7.8-107.0) |  | 24.9 (7.1-87.2) |  |
| Smokers & Sex (n=864) | 9.1 (3.7-22.7) |  | 9.1 (3.8-21.6) |  |
| Binge Drinkers (n=648) | 8.0 (3.0-21.0) |  | 6.4 (2.0-20.6) |  |
| Substance Use and Sex (n=556) | 9.7 (2.6-36.0) |  | 8.7 (2.1-35.2) |  |
| Regret AOD with Sex, High AOD   (n=487) | 7.8 (2.3-25.7) |  | 7.2 (1.7-30.2) |  |
| Regret AOD with Sex, Moderate AOD (n=458) | 3.9 (1.5-10.1) |  | 4.0 (1.6-9.9) |  |

**Table 4.** **Prevalence odds ratios for blacks relative to whites from logistic regression models of STD/HIV infection **

- *Adjusted for gender, marital status, dropped out of school, functional poverty, age at first intercourse.

## *Adjusted for gender, marital status, dropped out of school, functional poverty, age at first intercourse.

|  | Unadjusted OR | (95% CI) | Adjusted* OR | (95% CI) |
| --- | --- | --- | --- | --- |
| Marijuana (n=387) | 3.3 (1.1-10.0) |  | 3.4 (1.2-9.6) |  |
| Multiple Partners (n=285) | 3.0 (0.9-9.9) |  | 2.7 (0.8-9.3) |  |
| High Marijuana and Sex (n=208) | 6.2 (1.3-29.7) |  | 6.8 (1.9-24.7) |  |
| Sex for Money (n=196) | 2.8 (0.9-9.2) |  | 2.7 (0.8-9.4) |  |
| IV Drug Users (n=72) | 7.0 (0.8-64.3) |  | 18.7 (0.1-5647.3) |  |
| MSM (n=82) | 7.1 (1.5-33.5) |  | 9.8 (1.8-52.8) |  |
| Marijuana and Other Drugs (n=54) | 4.8 (0.7-31.2) |  | 7.4 (1.4-38.5) |  |

**Table 4.** **Prevalence odds ratios for blacks relative to whites from logistic regression models of STD/HIV infection** (Cont’d)

## Conclusions

**Conclusions**

**Whites show the expected relationship between higher risk behaviors and greater risk for HIV/STD, but African American young adults do not.**
**African American young adult women are the least likely to engage in alcohol, tobacco, and other drug use behaviors but the most likely to acquire STDs. **
**HIV/STD racial disparities** **may be influenced by complex structural and contextual factors.  For example, other studies suggest that sexual partnerships are segregated by race, and that crossover between high and low risk groups is more likely among blacks than whites.**
**Current findings show large differences: in school dropout and sexual debut **_**among men**_** by race; in marriage rates **_**among women**_** by race;** **and in functional poverty by race.**
**School dropout may be an especially critical factor to consider, since it is related to increased incarceration, decreased marriage, and increased poverty, and may help drive risk group crossover.**