HHS Public Access Author manuscript Author Manuscript
Alcohol Clin Exp Res. Author manuscript; available in PMC 2017 November 01. Published in final edited form as: Alcohol Clin Exp Res. 2016 November ; 40(11): 2394–2400. doi:10.1111/acer.13216.
Hazardous Alcohol Use Associated with Increased Sexual Risk Behaviours among People who Inject Drugs Nadia Fairbairn, MD1, Kanna Hayashi, PhD1,2, M-J Milloy, PhD1,2, Seonaid Nolan, MD1,2, Paul Nguyen, MSc1,2, Evan Wood, MD, PhD1,2, and Thomas Kerr, PhD1,2 1
Urban Health Research Initiative, British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, 608 - 1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
Author Manuscript
2
Department of Medicine, University of British Columbia, 608 - 1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
Abstract Background—Alcohol is associated with a multitude of severe health consequences. While risk behaviours related to illicit drug use are commonly studied among people who inject drugs (PWID), the role of alcohol use has received substantially less attention in this population. We explored whether drug and sexual risk behaviours as well as experiences of violence were associated with hazardous alcohol use in a cohort of PWID.
Author Manuscript
Methods—Analyses were conducted using observational data from a prospective cohort of community-recruited HIV-negative PWID in Vancouver, Canada. We used the US National Institute on Alcohol Abuse and Alcoholism definition of hazardous alcohol use (i.e., > 14 drinks/ week or > 4 drinks on one occasion for men, and > 7 drinks/week or > 3 drinks on one occasion for women.) We used multivariable generalized estimating equations to identify factors associated with hazardous alcohol use.
Author Manuscript
Results—Between 2006 and 2012, 1114 HIV-negative individuals were recruited, and 186 (16.7%) reported hazardous alcohol use in the previous six months at baseline. In multivariable GEE analyses, having multiple sex partners (Adjusted Odds Ratio [AOR] = 1.25), history of sexually transmitted infection (AOR = 1.50), experiencing violence (AOR = 1.36) and incarceration (AOR = 1.29) were each independently associated with hazardous alcohol use. Caucasian ethnicity (AOR = 0.56), ≥ daily heroin injection (AOR = 0.81) and engagement in addiction treatment (AOR = 0.84) were negatively associated with hazardous alcohol use (all p 14 drinks/week or >4 drinks on one occasion for men 7 drinks/week or >3 drinks on one occasion for all women and men ≥ 65 years of age (2007). A standard drink is defined as one 12-ounce bottle of beer, one 5-ounce glass of wine, or 1.5 ounces of distilled spirits (2007).
Author Manuscript
Socio-demographic explanatory variables of interest included age (treated as a continuous variable), gender (female vs. male), Caucasian ethnicity (yes vs. no), and currently living in unstable housing, defined as staying in a hotel room, shelter/hostel or treatment/recovery house, having no fixed address/sleeping on the street, or residing in jail (yes vs. no). Drug use variables of interest referring to behaviours in the previous six months included non-fatal overdose (yes vs. no), ≥ daily crack cocaine smoking (yes vs. no), ≥ daily cocaine injection (yes vs. no), ≥ daily heroin injection (yes vs. no), and receptive syringe sharing (yes vs. no). Sexual behaviours of interest included self-reported history of any diagnosed sexually transmitted infection (STI) ever in the past (yes vs. no), number of sex partners in the past six months (≤ 1 vs. 2-10 vs. >10), having sex with the same gender in the past six months (yes vs. no), and involvement in sex work in the past six months (yes vs. no). Other variables of interest included being a victim of violence, defined as having been attacked or assaulted in the previous six months (yes vs. no), incarceration, defined as being in detention, prison, drunk tank, or jail overnight or longer in the previous six months (yes vs. no), accessing any
Alcohol Clin Exp Res. Author manuscript; available in PMC 2017 November 01.
Fairbairn et al.
Page 4
Author Manuscript
kind of alcohol or drug treatment in the previous six months (yes vs. no), and depression at baseline (Center for Epidemiologic Studies Depression Scale [CES-D] score of ≥16 vs. 10
11 (5.9)
32 (3.4)
1.92 (0.95 – 3.92)
0.071
2-10
47 (25.3)
169 (18.2)
1.56 (1.07 – 2.26)
0.020
127 (68.3)
711 (84.8)
1.93 (0.98 – 3.82)
0.059
1.44 (0.94 – 2.19)
0.091
0.71 (0.50 – 1.02)
0.065
1.32 (0.80 – 2.16)
0.280
0.99 (0.72 – 1.36)
0.946
1.32 (0.78 – 2.21)
0.300
≤1 Sex with same gender
a
Author Manuscript
Yes
12 (6.5)
32 (3.5)
No
174 (93.5)
896 (96.5)
33 (17.7)
121 (13.0)
153 (82.3)
807 (87.0)
Yes
47 (25.3)
297 (32.0)
No
139 (74.7)
627 (67.6)
22 (11.8)
86 (9.3)
163 (87.6)
838 (90.3)
77 (41.4)
385 (41.5)
109 (58.6)
539 (58.1)
20 (10.8)
79 (8.5)
a
Sex work involvement Yes No Daily heroin injection
a
Daily cocaine injection
a
Yes No
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Daily crack smoking
a
Yes No Receptive syringe sharing Yes
a
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Fairbairn et al.
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a
Hazardous alcohol use
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Characteristic
Yes n (%) 186 (16.7)
No n (%) 928 (83.3)
155 (84.4)
816 (83.9)
16 (8.6)
63 (6.8)
168 (90.3)
854 (92.0)
39 (21.0)
164 (17.7)
145 (78.0)
749 (80.7)
Yes
67 (36.0)
459 (49.5)
No
118 (63.4)
454 (48.9)
59 (31.7)
195 (21.0)
126 (67.7)
713 (76.8)
CES-D score ≥ 16
105 (56.5)
529 (57.0)
CES-D score < 16
48 (25.8)
280 (30.2)
No Non-fatal overdose
No
No Addiction treatment
Author Manuscript
1.29 (0.73 – 2.29)
0.382
1.23 (0.83 – 1.82)
0.304
0.56 (0.41 – 0.78)
0.001
1.71 (1.21 – 2.42)
0.002
1.16 (0.80 – 1.68)
0.439
a
Yes
Victim of violence
a
a
Yes No Depression
p-value
a
Yes
Incarceration
b c OR (95% CI )
a
Note: Column percentages may not necessarily sum to 100% due to missing data or rounding error;
a
Denotes activities in the previous six months;
b
OR = Odds Ratio;
c
Author Manuscript
CI = Confidence Interval;
d
IQR = interquartile range
Author Manuscript Alcohol Clin Exp Res. Author manuscript; available in PMC 2017 November 01.
Fairbairn et al.
Page 14
Table II a
b
Author Manuscript
Univariable and multivariable GEE analyses of factors associated with hazardous alcohol use among VIDUS participants (n = 1114). Adjusted Odds Ratio c (95% CI )
p - value
0.59 (0.47 – 0.75)
< 0.001
0.001
1.41 (1.11 – 1.80)
0.005
1.35 (1.12 – 1.62)
0.001
1.25 (1.04 – 1.51)
0.019
1.54 (0.95 – 2.47)
0.078
1.41 (0.85 – 2.33)
0.181
1.46 (1.03 – 2.07)
0.034
1.30 (0.92 – 1.82)
0.136
1.15 (0.88 – 1.50)
0.308
0.81 (0.67 – 0.98)
0.026
0.72 (0.59 – 0.88)
0.001
0.96 (0.74 – 1.24)
0.751
1.10 (0.95 – 1.26)
0.216
1.31 (0.98 – 1.77)
0.073
1.30 (0.96 – 1.77)
0.095
1.10 (0.87 – 1.39)
0.421
1.30 (1.09 – 1.54)
0.004
1.24 (1.04 – 1.49)
0.019
0.84 (0.72 – 0.98)
0.028
0.83 (0.71 – 0.97)
0.021
1.36 (1.16 – 1.58)
< 0.001
1.33 (1.13 – 1.55)
0.001
Odds Ratio c (95% CI )
p - value
0.99 (0.98 – 1.00)
0.176
0.56 (0.45 – 0.71)
< 0.001
1.17 (0.92 – 1.51)
0.203
1.02 (0.87 – 1.19)
0.838
1.50 (1.18 – 1.91)
(2-10 vs. ≤ 1) (> 10 vs. ≤ 1)
Characteristic Age Per year older Caucasian ethnicity (yes vs. no) Gender (female vs. male) Currently in unstable housing
Author Manuscript
(yes vs. no) STI (yes vs. no) Number of sex partners
e
e
Sex with same gender (yes vs. no) Sex work involvement
e
(yes vs. no) e
Daily heroin injection
Author Manuscript
(yes vs. no) Daily cocaine injection
e
(yes vs. no) Daily crack smoking
e
(yes vs. no) Receptive syringe sharing (yes vs. no) Non-fatal overdose
e
e
(yes vs. no) e
Incarceration
Author Manuscript
(yes vs. no) e
Addiction treatment (yes vs. no) e
Victim of violence (yes vs. no)
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Characteristic
Author Manuscript
Odds Ratio c (95% CI )
p - value
1.15 (0.88 – 1.51)
0.303
Adjusted Odds Ratio c (95% CI )
p - value
e
Depression
CES-D score ≥ 16 vs. < 16 Note:
a
GEE = Generalized Estimating Equations;
b
hazardous alcohol use = > 14 drinks/week or > 4 drinks on one occasion for men, and > 7 drinks/week or > 3 drinks on one occasion for women;
c
CI = Confidence Interval;
e
Denotes activities in the previous 6 months.
Author Manuscript Author Manuscript Author Manuscript Alcohol Clin Exp Res. Author manuscript; available in PMC 2017 November 01.
Fairbairn et al.
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Table III
Author Manuscript
Relationship to perpetrator among participants who reported being victims of violence and hazardous alcohol use (n = 270). Relationship to perpetrator Stranger
N (%) 109 (40.4)
a
78 (28.9)
Acquaintance
Police or security guard
41 (15.2)
Drug dealer
26 (9.6)
b
21 (7.8)
Sex work client
8 (3.0)
Partner
Note:
a
Acquaintance includes friend, casual sex partner, family member, inmate or neighbour;
Author Manuscript
b
Partner includes husband/wife, boyfriend/girlfriend, common-law partner or regular sex partner.
Author Manuscript Author Manuscript Alcohol Clin Exp Res. Author manuscript; available in PMC 2017 November 01.
Alcohol Clin Exp Res. Author manuscript; available in PMC 2017 November 01. Published in final edited form as: Alcohol Clin Exp Res. 2016 November ; 40(11): 2394–2400. doi:10.1111/acer.13216.
Hazardous Alcohol Use Associated with Increased Sexual Risk Behaviours among People who Inject Drugs Nadia Fairbairn, MD1, Kanna Hayashi, PhD1,2, M-J Milloy, PhD1,2, Seonaid Nolan, MD1,2, Paul Nguyen, MSc1,2, Evan Wood, MD, PhD1,2, and Thomas Kerr, PhD1,2 1
Urban Health Research Initiative, British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, 608 - 1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
Author Manuscript
2
Department of Medicine, University of British Columbia, 608 - 1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
Abstract Background—Alcohol is associated with a multitude of severe health consequences. While risk behaviours related to illicit drug use are commonly studied among people who inject drugs (PWID), the role of alcohol use has received substantially less attention in this population. We explored whether drug and sexual risk behaviours as well as experiences of violence were associated with hazardous alcohol use in a cohort of PWID.
Author Manuscript
Methods—Analyses were conducted using observational data from a prospective cohort of community-recruited HIV-negative PWID in Vancouver, Canada. We used the US National Institute on Alcohol Abuse and Alcoholism definition of hazardous alcohol use (i.e., > 14 drinks/ week or > 4 drinks on one occasion for men, and > 7 drinks/week or > 3 drinks on one occasion for women.) We used multivariable generalized estimating equations to identify factors associated with hazardous alcohol use.
Author Manuscript
Results—Between 2006 and 2012, 1114 HIV-negative individuals were recruited, and 186 (16.7%) reported hazardous alcohol use in the previous six months at baseline. In multivariable GEE analyses, having multiple sex partners (Adjusted Odds Ratio [AOR] = 1.25), history of sexually transmitted infection (AOR = 1.50), experiencing violence (AOR = 1.36) and incarceration (AOR = 1.29) were each independently associated with hazardous alcohol use. Caucasian ethnicity (AOR = 0.56), ≥ daily heroin injection (AOR = 0.81) and engagement in addiction treatment (AOR = 0.84) were negatively associated with hazardous alcohol use (all p 14 drinks/week or >4 drinks on one occasion for men 7 drinks/week or >3 drinks on one occasion for all women and men ≥ 65 years of age (2007). A standard drink is defined as one 12-ounce bottle of beer, one 5-ounce glass of wine, or 1.5 ounces of distilled spirits (2007).
Author Manuscript
Socio-demographic explanatory variables of interest included age (treated as a continuous variable), gender (female vs. male), Caucasian ethnicity (yes vs. no), and currently living in unstable housing, defined as staying in a hotel room, shelter/hostel or treatment/recovery house, having no fixed address/sleeping on the street, or residing in jail (yes vs. no). Drug use variables of interest referring to behaviours in the previous six months included non-fatal overdose (yes vs. no), ≥ daily crack cocaine smoking (yes vs. no), ≥ daily cocaine injection (yes vs. no), ≥ daily heroin injection (yes vs. no), and receptive syringe sharing (yes vs. no). Sexual behaviours of interest included self-reported history of any diagnosed sexually transmitted infection (STI) ever in the past (yes vs. no), number of sex partners in the past six months (≤ 1 vs. 2-10 vs. >10), having sex with the same gender in the past six months (yes vs. no), and involvement in sex work in the past six months (yes vs. no). Other variables of interest included being a victim of violence, defined as having been attacked or assaulted in the previous six months (yes vs. no), incarceration, defined as being in detention, prison, drunk tank, or jail overnight or longer in the previous six months (yes vs. no), accessing any
Alcohol Clin Exp Res. Author manuscript; available in PMC 2017 November 01.
Fairbairn et al.
Page 4
Author Manuscript
kind of alcohol or drug treatment in the previous six months (yes vs. no), and depression at baseline (Center for Epidemiologic Studies Depression Scale [CES-D] score of ≥16 vs. 10
11 (5.9)
32 (3.4)
1.92 (0.95 – 3.92)
0.071
2-10
47 (25.3)
169 (18.2)
1.56 (1.07 – 2.26)
0.020
127 (68.3)
711 (84.8)
1.93 (0.98 – 3.82)
0.059
1.44 (0.94 – 2.19)
0.091
0.71 (0.50 – 1.02)
0.065
1.32 (0.80 – 2.16)
0.280
0.99 (0.72 – 1.36)
0.946
1.32 (0.78 – 2.21)
0.300
≤1 Sex with same gender
a
Author Manuscript
Yes
12 (6.5)
32 (3.5)
No
174 (93.5)
896 (96.5)
33 (17.7)
121 (13.0)
153 (82.3)
807 (87.0)
Yes
47 (25.3)
297 (32.0)
No
139 (74.7)
627 (67.6)
22 (11.8)
86 (9.3)
163 (87.6)
838 (90.3)
77 (41.4)
385 (41.5)
109 (58.6)
539 (58.1)
20 (10.8)
79 (8.5)
a
Sex work involvement Yes No Daily heroin injection
a
Daily cocaine injection
a
Yes No
Author Manuscript
Daily crack smoking
a
Yes No Receptive syringe sharing Yes
a
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Fairbairn et al.
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a
Hazardous alcohol use
Author Manuscript
Characteristic
Yes n (%) 186 (16.7)
No n (%) 928 (83.3)
155 (84.4)
816 (83.9)
16 (8.6)
63 (6.8)
168 (90.3)
854 (92.0)
39 (21.0)
164 (17.7)
145 (78.0)
749 (80.7)
Yes
67 (36.0)
459 (49.5)
No
118 (63.4)
454 (48.9)
59 (31.7)
195 (21.0)
126 (67.7)
713 (76.8)
CES-D score ≥ 16
105 (56.5)
529 (57.0)
CES-D score < 16
48 (25.8)
280 (30.2)
No Non-fatal overdose
No
No Addiction treatment
Author Manuscript
1.29 (0.73 – 2.29)
0.382
1.23 (0.83 – 1.82)
0.304
0.56 (0.41 – 0.78)
0.001
1.71 (1.21 – 2.42)
0.002
1.16 (0.80 – 1.68)
0.439
a
Yes
Victim of violence
a
a
Yes No Depression
p-value
a
Yes
Incarceration
b c OR (95% CI )
a
Note: Column percentages may not necessarily sum to 100% due to missing data or rounding error;
a
Denotes activities in the previous six months;
b
OR = Odds Ratio;
c
Author Manuscript
CI = Confidence Interval;
d
IQR = interquartile range
Author Manuscript Alcohol Clin Exp Res. Author manuscript; available in PMC 2017 November 01.
Fairbairn et al.
Page 14
Table II a
b
Author Manuscript
Univariable and multivariable GEE analyses of factors associated with hazardous alcohol use among VIDUS participants (n = 1114). Adjusted Odds Ratio c (95% CI )
p - value
0.59 (0.47 – 0.75)
< 0.001
0.001
1.41 (1.11 – 1.80)
0.005
1.35 (1.12 – 1.62)
0.001
1.25 (1.04 – 1.51)
0.019
1.54 (0.95 – 2.47)
0.078
1.41 (0.85 – 2.33)
0.181
1.46 (1.03 – 2.07)
0.034
1.30 (0.92 – 1.82)
0.136
1.15 (0.88 – 1.50)
0.308
0.81 (0.67 – 0.98)
0.026
0.72 (0.59 – 0.88)
0.001
0.96 (0.74 – 1.24)
0.751
1.10 (0.95 – 1.26)
0.216
1.31 (0.98 – 1.77)
0.073
1.30 (0.96 – 1.77)
0.095
1.10 (0.87 – 1.39)
0.421
1.30 (1.09 – 1.54)
0.004
1.24 (1.04 – 1.49)
0.019
0.84 (0.72 – 0.98)
0.028
0.83 (0.71 – 0.97)
0.021
1.36 (1.16 – 1.58)
< 0.001
1.33 (1.13 – 1.55)
0.001
Odds Ratio c (95% CI )
p - value
0.99 (0.98 – 1.00)
0.176
0.56 (0.45 – 0.71)
< 0.001
1.17 (0.92 – 1.51)
0.203
1.02 (0.87 – 1.19)
0.838
1.50 (1.18 – 1.91)
(2-10 vs. ≤ 1) (> 10 vs. ≤ 1)
Characteristic Age Per year older Caucasian ethnicity (yes vs. no) Gender (female vs. male) Currently in unstable housing
Author Manuscript
(yes vs. no) STI (yes vs. no) Number of sex partners
e
e
Sex with same gender (yes vs. no) Sex work involvement
e
(yes vs. no) e
Daily heroin injection
Author Manuscript
(yes vs. no) Daily cocaine injection
e
(yes vs. no) Daily crack smoking
e
(yes vs. no) Receptive syringe sharing (yes vs. no) Non-fatal overdose
e
e
(yes vs. no) e
Incarceration
Author Manuscript
(yes vs. no) e
Addiction treatment (yes vs. no) e
Victim of violence (yes vs. no)
Alcohol Clin Exp Res. Author manuscript; available in PMC 2017 November 01.
Fairbairn et al.
Page 15
Characteristic
Author Manuscript
Odds Ratio c (95% CI )
p - value
1.15 (0.88 – 1.51)
0.303
Adjusted Odds Ratio c (95% CI )
p - value
e
Depression
CES-D score ≥ 16 vs. < 16 Note:
a
GEE = Generalized Estimating Equations;
b
hazardous alcohol use = > 14 drinks/week or > 4 drinks on one occasion for men, and > 7 drinks/week or > 3 drinks on one occasion for women;
c
CI = Confidence Interval;
e
Denotes activities in the previous 6 months.
Author Manuscript Author Manuscript Author Manuscript Alcohol Clin Exp Res. Author manuscript; available in PMC 2017 November 01.
Fairbairn et al.
Page 16
Table III
Author Manuscript
Relationship to perpetrator among participants who reported being victims of violence and hazardous alcohol use (n = 270). Relationship to perpetrator Stranger
N (%) 109 (40.4)
a
78 (28.9)
Acquaintance
Police or security guard
41 (15.2)
Drug dealer
26 (9.6)
b
21 (7.8)
Sex work client
8 (3.0)
Partner
Note:
a
Acquaintance includes friend, casual sex partner, family member, inmate or neighbour;
Author Manuscript
b
Partner includes husband/wife, boyfriend/girlfriend, common-law partner or regular sex partner.
Author Manuscript Author Manuscript Alcohol Clin Exp Res. Author manuscript; available in PMC 2017 November 01.
