Unsafe sexual behaviour associated with hazardous alcohol use among street-involved youth

Abstract

While risky sexual behaviours related to illicit drug use among street youth have been explored, the impacts of alcohol use have received less attention. This longitudinal study examined hazardous alcohol use among a population of street-involved youth, with particular attention to sexual and drug-related risk behaviours. Data were derived from the At-Risk Youth Study, a prospective cohort of street-involved youth in Vancouver, Canada. The outcome of interest was hazardous alcohol use defined by the US National Institute on Alcohol Abuse and Alcoholism. We used generalized estimating equations (GEEs) analyses to identify factors associated with hazardous alcohol use. Between 2005 and 2014, 1149 drug-using youth were recruited and 629 (55%) reported hazardous alcohol use in the previous 6 months during study follow-up. In multivariable GEE analyses, unprotected sex (adjusted odds ratio [AOR] = 1.28, 95% confidence interval [95% CI] = 1.12-1.46) and homelessness (AOR = 1.35, 95% CI = 1.19-1.54) were independently associated with hazardous alcohol use (all p < .001). Older age (AOR = 0.95, 95% CI = 0.92-0.99), Caucasian ethnicity (AOR = 0.74, 95% CI = 0.61-0.90), daily heroin use (AOR = 0.53, 95% CI = 0.42-0.67), daily crack cocaine smoking (AOR = 0.73, 95% CI = 0.59-0.91), and daily crystal methamphetamine use (AOR = 0.52, 95% CI = 0.42-0.64) were negatively associated with hazardous alcohol use (all p < .05). In sub-analysis, consistent dose-response patterns were observed between levels of alcohol use and unprotected sex, homelessness, and daily heroin injection. In sum, hazardous alcohol use was positively associated with unsafe sexual behaviour and negatively associated with high-intensity drug use. Interventions to address hazardous alcohol use should be central to HIV prevention efforts for street-involved youth.

Keywords: HIV; Hazardous drinking; homelessness; injection drug use; youth.

Figure 1

Dose–response relationship for intensity of alcohol use. All above estimates used the reference category of “light drinking” that included all individuals who did not fulfil criteria for hazardous alcohol use and also reported a daily drinking average during the last week of ≤2 drinks for women or ≤3 drinks for men. “Moderate drinking” included individuals who did not fulfil criteria for hazardous alcohol use and also reported a daily drinking average during the last week of >2 drinks for women of >3 drinks for men. “Heavy drinking” included individuals who did fulfil criteria for hazardous alcohol use and also reported a daily drinking average during the last week <8 for women or <10 for men. “Very heavy drinking” included individuals who reported hazardous alcohol use and also reported a daily drinking average during the last week ≥8 for women OR ≥10 for men. Explanatory variables of interest included: age, gender, ethnicity, homelessness, daily cocaine use, daily crack cocaine use, daily heroin use, daily crystal methamphetamine use, syringe sharing, incarceration, non-fatal overdose, same sex activity in men, unprotected sex, engagement in sex work, and STIs. Variables significant at the p < .10 threshold in bivariable analyses for each exposure group were included in the fixed multivariable models.