The Role of Drinking Severity on Sex Risk Behavior and HIV Exposure among Illicit Drug Users


Address correspondence to Dr. Scherer, Department of Mental Health, Johns Hopkins University, Bloomberg School of Public Health, 624 N. Broadway, 8th floor, 895, Baltimore, MD 21205. E-mail:



The current study examined how drinking severity among injection and non-injection drug users is associated with sex risk behaviors and risk of HIV exposure.


The study is a secondary analysis of an investigation of risk factors among drug users in Baltimore known as the NEURO-HIV epidemiologic study. Participants (N = 557) completed an interview, self-reported 30-day alcohol use, lifetime injection and non-injection drug use, and provided blood samples to screen for HIV. Participants were grouped into one of three drinking severity conditions: abstinent (no reported alcohol use in prior 30 days), moderate alcohol use (≤30 drinks for females, or ≤60 drinks for males), or problematic alcohol use (>30 drinks for females, or >60 drinks for males). Drinking severity groups were significantly different on lifetime injection drug use, heroin injection, snorting/sniffing cocaine, and smoking crack.


Logistic regression analyses found problematic alcohol users to be more likely than alcohol abstainers to inject drugs before or during sex (AOR = 5.78; 95% CI = 2.07–16.10), and more likely than moderate alcohol users to use alcohol before/during sex (AOR = 4.96; 95% CI = 2.09–11.81), inject drugs before/during sex (AOR = 2.96; 95% CI = 1.29–6.80), and to be HIV+ among Black participants (AOR = 2.72; 95% CI = 1.14–6.49).


These results outline the necessity for research and clinical intervention among this population to reduce sex risk behaviors and potential HIV exposure, while highlighting the need to examine drinking severity as a predictor of sex risk behaviors. (Am J Addict 2013; 22:239–245)