Substance Use, HIV Serostatus Disclosure, and Sexual Risk Behavior in People Living with HIV: An Event-level Analysis

Objective. Sexually active people living with HIV (PLWH) face difficult decisions about disclosing their HIV status to sexual partners. Alcohol and other drug use are prevalent in medically engaged PLWH, and could impact these decision-making processes. We sought to examine the event-level relationships between substance use, HIV disclosure, and condom use in PLWH. Method. Adult PLWH were recruited from care settings in a southeastern US city. Participants reported psychosocial and health information at baseline, and reported their sexual behavior for 28 consecutive days via text message prompts. Multi-level modeling was employed to examine event-level associations between substance use, HIV disclosure, and condom use in first-time sexual encounters with HIV-/unknown status partners. Results. From a larger sample, 251 participants (85% male, 92% African American) engaged in anal or vaginal intercourse with presumed serodiscordant first-time partners on 529 days (mean=2.11 partners). Event-level substance use did not predict condom use in inconsistent condom users (p\u3e0.05), yet heavier alcohol users used condoms less frequently on average (p=0.01). Event-level substance use negatively predicted disclosure across the 28-day study period (odds ratio=0.46; p=0.04). Disclosure was more frequent among consistent condom users than those who consistently engaged in condomless sex (p0.05). Conclusions. Results found that substance use at the time of intercourse is associated with decreased HIV disclosure in PLWH. Substance using PLWH may benefit from interventions designed to moderate substance use or enhance behavior skills for reducing HIV transmission risk when using substances