The best of intentions: Using the Transtheoretical Model to explore substance use patterns and HIV risk behaviors in a suburban sample

Abstract

The human immunodeficiency virus (HIV) continues to pose significant challenges to public health in the United States and abroad. Despite modest treatment gains in the last decade, HIV infection remains incurable and invariably fatal. The modification of high risk behaviors is the only available means for preventing the spread of HIV. The behaviors associated with HIV transmission—unprotected sexual activity and the sharing of contaminated drug injection equipment—are complex and often difficult to alter given individual, social and cultural dynamics. Understanding how people change and the variables associated with behavior modification can enhance HIV prevention interventions and ultimately reduce the spread of HIV. The study sample includes 440 active substance users interviewed as part of a federally-funded community outreach program on Long Island.

Subjects were interviewed at baseline and again six months later regarding actual and intended sexual behaviors and substance use. Using the Transtheoretical Model (TTM) of behavior change as a lens, this study describes substance use patterns and sexual behaviors among a sample of suburban substance users and identifies predictors of behavior change. Predominant drugs of choice among subjects were alcohol, marijuana, crack/cocaine and heroin. Intent to stop using substances was reported by 81% of subjects. Logistic regression analysis found recent inpatient treatment and previous attempts to stop using substances to be among the significant predictors of intent to quit. More than half of subjects who reported having sex within the last 30 days at baseline did not use condoms. Previous condom use was a statistically significant predictor of future intent to use condoms consistently and this research supported the basic staging premise of TTM as it relates to safer sex. Subjects in the preparation stage of change at baseline were more likely to report condom use at six-months than those in the pre-contemplation or contemplation stages. High rates of unprotected sex among HIV-positive subjects at baseline, and much lower rates at six months highlight the value of timely diagnosis and prevention efforts. The study outlines practice and public policy implications for HIV prevention and substance use interventions.