Interrelationship of alcohol misuse, HIV sexual risk and HIV screening uptake among emergency department patients

Abstract

BackgroundEmergency department (ED) patients comprise a high-risk population for alcohol misuse and sexual risk for HIV. In order to design future interventions to increase HIV screening uptake, we examined the interrelationship among alcohol misuse, sexual risk for HIV and HIV screening uptake among these patients.MethodsA random sample of 18-64-year-old English- or Spanish-speaking patients at two EDs during July-August 2009 completed a self-administered questionnaire about their alcohol use using the Alcohol Use Questionnaire, the Alcohol Use Disorders Identification Test (AUDIT), and the HIV Sexual Risk Questionnaire. Study participants were offered a rapid HIV test after completing the questionnaires. Binging (≥ five drinks/occasion for men, ≥ four drinks for women) was assessed and sex-specific alcohol misuse severity levels (low-risk, harmful, hazardous, dependence) were calculated using AUDIT scores. Analyses were limited to participants who had sexual intercourse in the past 12 months. Multivariable logistic regression was used to assess the associations between HIV screening uptake and (1) alcohol misuse, (2) sexual risk for HIV, and (3) the intersection of HIV sexual risk and alcohol misuse. Adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were estimated. All models were adjusted for patient demographic characteristics and separate models for men and women were constructed.ResultsOf 524 participants (55.0% female), 58.4% identified as white, non-Hispanic, and 72% reported previous HIV testing. Approximately 75% of participants reported drinking alcohol within the past 30 days and 74.5% of men and 59.6% of women reported binge drinking. A relationship was found between reported sexual risk for HIV and alcohol use among men (AOR 3.31 [CI 1.51-7.24]) and women (AOR 2.78 [CI 1.48-5.23]). Women who reported binge drinking were more likely to have higher reported sexual risk for HIV (AOR 2.55 [CI 1.40-4.64]) compared to women who do not report binge drinking. HIV screening uptake was not higher among those with greater alcohol misuse and sexual risk among men or women.ConclusionsThe apparent disconnection between HIV screening uptake and alcohol misuse and sexual risk for HIV among ED patients in this study is concerning. Brief interventions emphasizing these associations should be evaluated to reduce alcohol misuse and sexual risk and increase the uptake of ED HIV screening.

Profiles of substance use disorders in patients of therapeutic communities: Link to social, medical and psychiatric characteristics

“…This finding is coherent with studies showing that alcohol-dependent individuals have a higher prevalence of HCV than those who are not (Siu et al, 2009). This could be related to the high incidence of sexual risk behavior in alcohol users (Trillo et al, 2013) and the immunosuppressive effect of alcohol (Carrière et al, 2006;Geissler et al, 1997). Moreover, the older mean age of ALC patients is a characteristic associated with higher risk of hepatitis (Stein et al, 2012), probably because an older age may involve a longer exposure period to drug-related risks, including risk behaviors such as those associated to HCV and HBV infection.…”

Brief Intervention to Increase Emergency Department Uptake of Combined Rapid Human Immunodeficiency Virus and Hepatitis C Screening Among a Drug Misusing Population

“…Based on our previous studies, 61,62 we calculated an HIV/HCV sexual risk behavior score using the relevant items from the HIV/HCV risk behavior questionnaire. The score was the sum of the risk behaviors.…”

Prevalence of Heavy Drinking and Risky Sexual Behaviors in Adult Emergency Department Patients

“…Independent studies have identified ED patients as being at relatively high risk of both heavy alcohol use (Cohen et al, 2007) and HIV infection (Alpert et al, 1996; Trillo et al, 2013). With approximately 56,000 new HIV cases per year (CDC, 2012), it is important to identify the associations between alcohol use and increased risks of HIV infection.…”

“…Further, individuals consuming alcohol prior to or at the time of sex were at a 87% increased risk, and individuals engaging in binge drinking (5 or more drinks in 1 sitting for men, 4 for women) had twice the risk of nonbinge drinkers for HIV-incident infection (Baliunas et al, 2010). Specific to ED populations, 1 investigation found evidence of a significant positive relationship between reported sexual risk of HIV and alcohol use among men and women patients, with women who reported binge drinking more likely to have higher reported sexual risk of HIV compared to women who did not report binge drinking (Trillo et al, 2013). In addition, Fenton (2007) reports that more new HIV cases are diagnosed among ED patients compared to patients in any other clinic setting.…”

“…EDs may serve as a primary site of health care for individuals at risk of HIV (Rothman, 2004), and the Centers for Disease Control and Prevention (CDC) and other national organizations have identified EDs as strategic settings for delivering HIV prevention interventions including HIV testing and counseling (Branson et al, 2006; Dowdy et al, 2011; Haukoos et al, 2011; Trillo et al, 2013). Thus, hazardous alcohol use and sex-risk behaviors have been established as 2 prevalent behavioral risks among ED patients.…”