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HIV/AIDS risks, alcohol and illicit drug use among young adults in areas of high and low rates of HIV infection a
G. Bagnall & M. A. Plant
a
a
Alcohol Research Group, Department of Psychiatry , University of Edinburgh , Morningside Park, Edinburgh, EH10 5HF, UK Published online: 25 Sep 2007.
To cite this article: G. Bagnall & M. A. Plant (1991) HIV/AIDS risks, alcohol and illicit drug use among young adults in areas of high and low rates of HIV infection, AIDS Care: Psychological and Sociomedical Aspects of AIDS/HIV, 3:4, 355-361, DOI: 10.1080/09540129108251591 To link to this article: http://dx.doi.org/10.1080/09540129108251591
PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms & Conditions of access and use can be found at http://www.tandfonline.com/page/termsand-conditions
AIDS CARE, VOL. 3, NO. 4, 1991
355
HIV/AIDS risks, alcohol and illicit drug use among young adults in areas of high and low rates of HIV infection
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G. BAGNALL& M. A. PLANT Alcohol Research Group, Department of Psychiatry, University of Edinburgh, Morningside Park, Edinburgh EHlO SHF, UK
Abstract The results are presented of a survey of HIV/AIDS related risks amongst young adults in two urban areas in Scotland. This exercise elicited datafiom random samples of those aged 16-30 in Muirhouse and Easterhouse. Muirhouse has a high rate of HIV infection, mainly related to intravenous drug use. Easterhouse has a much lower rate of recorded HIV infection. A total of 1,378 individuals were successfully interviewed. Levels of knowledge about risks of HIV infection were relatively high. Even so levels of condom use were low. Respondents in Muirhouse reported high levels of personal knowledge of HIV infected people. In addition 8% of those in Muirhouse and 3% of those in Easterhouse reported having had sex with a person who was HIV infected. Few of such encounters had involved condom use. The combination of alcohol consumption and sexual activity was reported by 82% of respondents. Twelve per cent had combined sexual activity and illicit drug use. Overall patterns of selfreported HIVIAIDS related risks in the two study areas were very similar.
Introduction The full extent of HIV infection in the general population remains unclear. Even so it has been established that in certain localities, such as Edinburgh, atypically high levels of HIV infection and AIDS have been recorded (Robertson, 1987; ‘ANSWER’, 1991). It has also been established that one of the primary modes of virus transmission is through the sharing of infected injecting equipment (National Research Council, 1989; Strang & Stimson, 1990). In 1989, it was reported that in addict samples the HIV infection rates were 38-65% in Edinburgh, 39% in Dundee and 4.5-7.0% in Glasgow (Monitoring Research Group, 1989). Moreover, growing evidence indicates that unprotected sexual contact, another important method of HIV transmission, is associated with the use of alcohol and other psychoactive drugs (Stall, 1987; Plant, 1990a; Hingson et al., 1990; Leigh, 1990; Plant, 1990b). The response of young adults to high or low rates of detected HIV infection in their areas is unknown. Accordingly a study was undertaken to examine levels of psychoactive
Address for correspondence: Dr Martin Plant, Director, Alcohol Research Group, Department of Psychiatry, University of Edinburgh, Morningside Park, Edinburgh EHlO 5HF, Scotland, UK.
356
G. BAGNALL & M. A. PLANT
drug use and HIVIAIDS-related risks in two areas characterized by high and low rates of recorded HIV infection. The first of these areas was Muirhouse in Edinburgh. This locality has a high rate of HIV infection, mainly associated with intravenous drug use. The second study area was Easterhouse in Glasgow. This resembles Muirhouse in certain respects being an urban area with multiple problems, but currently has a lower rate of recorded HIV infection than Muirhouse. This paper presents descriptive data which compare general levels of HIV/AIDS related risks in the two study areas. A subsequent publication is planned which will explore some of these issues in greater depth.
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Subjects and methods
Data were elicited by a single phase, cross-sectional survey. Standardized interviews were conducted by trained interviewers who visited a random sample of 16-30 year old residents in the two study areas. Households for survey were selected from the Post Code Address File. The use of this data base as a sampling frame has been described by Wilson and Elliot (1987). Interviewers were required to call at each household on a list of randomly selected addresses within the postcode area. A standardized introduction was used to describe the research as a survey of community health issues requiring interviews with any 16-30 year olds resident at that address. All eligible respondents within each household were then interviewed individually and, whenever possible, in private. The questionnaire elicited biographical information and data on consumption of alcohol, tobacco and illicit drugs, using questions replicated from other relevant surveys. Respondents’ knowledge about the risks of HIV infection was assessed by 16 ‘factual‘ questions, and individual experience of exposure to HIV explored. This involved asking sensitive questions about personal sexual behaviours, including condom use with past and present partner(s). Some evidence of high levels of internal non-response was evident for specific questions, and this issue has been examined by Bagnall (1991a). The response rate for survey participation in both areas was 70% with data being successfully collected from 628 respondents in Muirhouse and 750 in Easterhouse. The distribution of respondents in relation to sex and mean age is indicated by Table 1. Table 1. Study group characteristics Number of respondents
Age All subjects
Muirhouse Easterhouse
Males
Females
Total
Males
Females
Mean
(sd)
Mean
(sd)
Mean
(sd)
628 750
262 325
366 425
23 23
(4.1) (4.2)
24 23
(4.2) (4.2)
23 23
(4.0) (4.2)
Results
The marital status of respondents was similar in both areas, with roughly half of all respondents single, one quarter married and one-fifth co-habiting. Approximately half the respondents in both areas had children. Long-term residency in the area (1 1 years or more) was significantly more commonplace amongst Easterhouse respondents (57%) than amongst those in Muirhouse (33%)
HIVIAIDS RISKS, ALCOHOL AND DRUG USE AMONG YOUNG ADULTS
357
(xz = 91.00, d.f. = 6; p < 0.005). Unemployment rates were high, at 28% in Muirhouse and 35% in Easterhouse (x2 = 24.5, d.f. = 1; p < 0.005).
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Alcohol and illicit drug use The two study areas did not differ significantly in relation to either frequency or quantity of self-reported alcohol consumption. The average weekly consumption for the complete sample was 10 units* (s.d. = 17.5; Range = 0-172). Six per cent of males and 2% of females in both areas were ‘heavy drinkers’. For the purpose of this study, ‘heavy drinking’ is defined as a weekly consumption of >30 units for females and >35 units for males. There were no significant differences in the distribution of heavy drinkers between the two areas for either males or females. One hundred and eighty-five respondents in Muirhouse (29%) and 178 in Easterhouse (23%) reported having at some time used illicit drugs, most commonly cannabis. This difference between the two areas was not statistically significant. In both areas males were significantly more likely than females to report having used illicit drugs (x2 = 81.73; d.f. = 1; p < 0.005). In Muirhouse 10 males and 5 females (2% of respondents in that area) reported having injected illicit drugs. In Easterhouse 6 males and 6 females (2%) reported having injected drugs. Seven of the 15 Muirhouse injectors had at some time shared injecting equipment compared with all of those in Easterhouse. None of the seven female injectors reported having shared injecting equipment with anybody whom they ‘knew’ to be infected with HIV. Five of the 12 males, however, reported that they had done so.
HIV status One hundred and sixty-eight respondents in Muirhouse (27%) and 69 respondents in Easterhouse (9%), reported having had an HIV test. Seven of those in Muirhouse and seven of those in Easterhouse reported having received positive test results. Four of these were self-reported intravenous drug users. This is elaborated in Table 2. Table 2. Number of people mer tested fos HIV Muirhouse
Ever tested for HIV Test result negative Test result positive Test result unknown Refused to give test result
Easterhouse
Males
Females
Males
(n = 262)
(n = 366)
(n = 325)
Females (n = 425)
41 37 3 1
*127 110 4 13
31 28 3
38 31 4
-
-
-
This high number may reflect ante-natal blood testing, although no information to con& available from the questionnaire.
3 this was
A unit is defined as either half a pint of ordinary beer, cider, stout or lager, or a single public house measure of spirits or a glass of wine. Each unit contains approximately one centilitre of alcohol.
358 G. BAGNALL L M. A. PLANT
Sexual behaviour Respondents were asked whether or not they had had sexual intercourse with anyone whom they believed to be infected with HIV. Forty-five (89%) of those in Muirhouse and 21 (3%) of those in Easterhouse reported having done so with no significant difference between males and females. Approximately three-quarters of these individuals reported having never used condoms during such contacts. Only a small minority reported having always used condoms during sexual contact with an HIV infected partner. This is shown in Table 3. Table 3. Sex and condom use with HIV contact (column percentages in brackets)
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Had sex with HIV Contact*
Muirhouse Number(%)
Easterhouse Number(%)
Yes No Don’t know
47 (8) 488 (87) 25 (5)
21 (3) 604 (93) 22 (4)
Total
560 (100)
647 (100)
Condom use with HIV contact
Muirhouse Number(%)
Easterhouse Number(%)
36 (77) 4 (8) 7 (15)
15 (71) 5 (24) 1 (5)
47 (loo)
21 (loo)
Never Sometimes Always
68 (11%) Muirhouse and 103 (14%) Easterhouse respondents refused to answer this question.
In both areas approximately 80% of respondents who answered this question had a current sexual partner (18% refused to answer); 87% had been in this relationship for at least 12 months. The condom use of the entire sample was examined. This is illustrated in Table 4, which demonstrates that condom use was infrequent in both areas. This, however, has to be interpreted in the context of marital and partner status of respondents, especially those reporting stable, single partner relationships. Table 4. Use of condoms and other contraceptives Muirhouse
Easterhouse
Condom use with current partner Never Sometimes Always
60% 33% 7% (n = 440,30% refusal)
63%
Condom use since sexually active Never Sometimes Always
45%
48% 7% (n = 550; 13% refusal)
51% 44% 5% (n = 623; 17% refusal)
Other contraceptive use with current partner
Never Sometimes Always
21% 27% 53% (n = 439; 30% refusal)
19% 43% 37% (n = 495; 34% refusal)
Other contraceptive use since sexually active
Never Sometimes Always
19% 51% 30% (n = 534; 15% refusal)
24% 55% 22%
32% 6% (n = 497; 34% refusal)
(n = 624; 17% refusal)
HIVIAIDS RISKS, ALCOHOL AND DRUG USE AMONG YOUNG ADULTS
359
Combining sex with alcohol on illicit drugs
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Sex and alcohol. Eighty-two per cent of all respondents reported having combined sexual activity with alcohol, with little difference between Muirhouse and Easterhouse. Four hundred and forty-six females (83% of those who respodded) and 342 males (76% of those who responded) said this made no difference to their condom use. Eighty females (15% of those who responded) and 100 males (22% of those who responded) thought they were less likely to use condoms. Referring to the last occasion on which alcohol had been combined with sexual activity, 468 females (88%) and 379 males (86%) reported that they had not used condoms.
Sex and illicit drug use. Eighty-eight males and 55 females (12% of the total sample) reported having combined sex with illicit drug use. Here too, a similar pattern emerged for both areas. Amongst these respondents, 68 males (77%) and 48 females (87%) said this made no different to their condom use. Six females and eighteen males said they were less likely to use condoms. Of all respondents who had combined illicit drug use with sexual activity, 44 females (80%) and 80 males (91%) reported that on the last occasion they had not used a condom.
HIV-related knowledge, behaviour and personal contact The total study group demonstrated a good knowledge of risks of HIV infection in their responses to the ‘factual‘ questions on this topic. There were no significant differences between areas or genders. Muirhouse respondents were, however, significantly more likely than those in Easterhouse to report that they worried about AIDS (23% compared to 16%: x2 = 18.93; d.f. = 1; p < 0.005). Significantly more Muirhouse respondents (37%) than Easterhouse respondents ( 12%) knew someone who was HIV seropositive (x2 = 113.81, d.f. = 2; p < 0.005). In both areas the most likely source of infection was reported to be intravenous drug use.
Discussion
This survey indicated striking similarities between ‘risky behaviours’ in Muirhouse and Easterhouse. Overall patterns of alcohol and illicit drug use, including injected drug use, in the two areas were similar. Self-reported illicit drug use was not exceptionally high, matching closely that of a cohort of approximately 800 25 year olds surveyed 18 months earlier (Bagnall et al., 1990; Bagnall, 1991b). Nevertheless, it may be of some concern to note that needle and syring sharing was reported by a higher proportion of drug injectors in Easterhouse than in Muirhouse. Levels of self-reported HIV infection in the two areas were similar even though Easterhouse is generally regarded as having a lower rate of such infection than Muirhouse. However, these self-reported levels were also considerably lower than those from alternative sources, and may therefore reflect the difficulties of collecting valid data in this context. The findings from this survey support earlier evidence that condom use is far from the norm amongst young adults (McQueen et al., 1989; Plant ?i Plant, 1991). As noted in the introduction, other research has indicated that the combination of sexual activity with the use of alcohol and illicit drugs is associated with risky behaviour. In
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G. BAGNALL & M. A. PLANT
this survey low rates of condom use and high levels of combining sexual activity with alcohol, or less commonly, illicit drugs, were evident in both areas, perhaps suggesting that there remains a high potential risk for HIV infection in both study areas. The findings,however, must be interpreted cautiously. For example, although condom use was not common, the majority of respondents appeared to be in long-term single partner relationships. Furthermore, the highly sensitive nature of some of the questions resulted in significant levels of non-response,sometimes as high as 33%. These methodological issues will be addressed in greater detail in a subsequent paper. Nevertheless, the results presented here, particularly the similarities between the study areas, suggest that the atypically high level of HIV infection evident in Edinburgh has failed to lead young adults in Muirhouse to adopt harm minimization strategies in their sexual behaviour to reduce HIVIAIDS risks. This contrasts with the generally high levels of HIVIAIDS-related knowledge evident amongst young people in the two study areas. This finding suggests that the provision of factual information is, by itself, insufficient to foster safer sex and safer drug use. Future health education should aim to identify and implement strategies (such as peer education) which are effective in encouraging the uptake of harm minimization behaviours. These results indicate that unless alternative strategies are adopted, the risk of spreading HIV infection in areas such as Muirhouse and Easterhouse could well remain high. Acknowledgements
This study was funded by the Substance Abuse Research Committee of the Mental Health Foundation. Additional support was provided by the Scotch Whisky Association and the Portman Group. Mr John Duffy is thanked for advice and assistance with random sample selection. The Director and staff of the MRC Medical Sociology Unit, Glasgow, are thanked for providing facilities for interviewer briefing sessions. Mr Douglas Allsop and Mrs Ethel Thompson of the Scottish Council on Alcohol are thanked for helping with the management of the Easterhouse Survey. Mrs Wilma Warwick is thanked for assistance and support with survey design and implementation. Mrs Joyce Greig and Mrs Sheila McLennan are thanked for their speedy and efficient word processing. References ANSWER (AIDS News Supplement) (1991) CDS Weekly Report, 26th January, Communicable Diseases (Scotland) Unit, CDS 91/04. BAGNALL, G.M. (1991a) Survey research and HIV/AIDS-related behaviours-a case for caution, Health Education Journal, 50 (in press). BAGNALL, G.M. (1991b) Alcohol and drug use in a Scottish cohort: 10 years on, British Journal of Addiction, 86, pp. 895-904. BAGNALL,G., PLANT, M.A. & WARWICK,W. (1990) Alcohol, drugs and AIDS-related risks: results from a prospective study, AIDS Care, 2, pp. 309-31 7. HINGSON,R., STRUNIN,L., HEEREN,T. & BERLIN, B. (1990) Beliefs about AIDS, use of alcohol, drugs and unprotected sex among Massachusetts adolescents, American Journal of Public Health, 80, pp. 295-299. LEIGH,B. (1990) The relationship of substance use during sex to high risk sexual behaviour, Journal of Sex Research, 27, pp. 199-213. B.J., SMITH, R.J. & UITBNBROBK, D. (1988189) A Study of MCQUEEN,D.V., GORST, T., NISBET, L., ROBERTSON, Lifestyle and Health, Interim Report, November 1, Edinburgh, Research Unit in Health and Behavioural Change, University of Edinburgh. RESBARCHGROUP(1989) National Syn'nge Exchange Monitoring Study: Final Report, Goldsmith's MONITORING College, University of London. NATIONAL R ~ s m c x iCOUNCIL(1989) AIDS, Sexual Behaviour and Intravenous Drug Use (Washington, DC, National Academy Press).
HIVIAIDS RISKS, ALCOHOL AND DRUG USE AMONG YOUNG ADULTS
36 1
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PLANT,M.A. (Ed.) (1990a) AIDS, Drugs and Prostitution (London, Tavistock/Routledge). PLANT,M.A. (1990b) Alcohol, sex and AIDS, Alcohol and Alcoholism, 25, pp. 293-301. PLANT,M.A. & PLANT,M.L. (1991) Risk T a h : alcohol, drugs, sex andyourh (London, Tavistock/Routledge) (in press). ROBERTSON, J.R. (1987) Heroin,AIDS and Society (London, Hodder and Stoughton). STALL, R. (1 987) The prevention of HIV infection associated with drug and alcohol use during sexual activity, in: L. SIEGEL(Ed.) AIDS and Substance Abuse, pp. 73-88. (New York, Harrington, Park Press). STRANG, J. & STIMSON,G.V. (Eds) (1990) AIDS and Drug Misuse (London, TavistockIRoutledge). WILSON,P.R. & ELLIOT,D.J. (1987) An evaluation of the Post Code Address File as a sampling frame and its use with OPCS, Journal ofRqua1 Statistical Society, 150, pp, 230-240.
AIDS Care: Psychological and Sociomedical Aspects of AIDS/HIV Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/caic20
HIV/AIDS risks, alcohol and illicit drug use among young adults in areas of high and low rates of HIV infection a
G. Bagnall & M. A. Plant
a
a
Alcohol Research Group, Department of Psychiatry , University of Edinburgh , Morningside Park, Edinburgh, EH10 5HF, UK Published online: 25 Sep 2007.
To cite this article: G. Bagnall & M. A. Plant (1991) HIV/AIDS risks, alcohol and illicit drug use among young adults in areas of high and low rates of HIV infection, AIDS Care: Psychological and Sociomedical Aspects of AIDS/HIV, 3:4, 355-361, DOI: 10.1080/09540129108251591 To link to this article: http://dx.doi.org/10.1080/09540129108251591
PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms & Conditions of access and use can be found at http://www.tandfonline.com/page/termsand-conditions
AIDS CARE, VOL. 3, NO. 4, 1991
355
HIV/AIDS risks, alcohol and illicit drug use among young adults in areas of high and low rates of HIV infection
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G. BAGNALL& M. A. PLANT Alcohol Research Group, Department of Psychiatry, University of Edinburgh, Morningside Park, Edinburgh EHlO SHF, UK
Abstract The results are presented of a survey of HIV/AIDS related risks amongst young adults in two urban areas in Scotland. This exercise elicited datafiom random samples of those aged 16-30 in Muirhouse and Easterhouse. Muirhouse has a high rate of HIV infection, mainly related to intravenous drug use. Easterhouse has a much lower rate of recorded HIV infection. A total of 1,378 individuals were successfully interviewed. Levels of knowledge about risks of HIV infection were relatively high. Even so levels of condom use were low. Respondents in Muirhouse reported high levels of personal knowledge of HIV infected people. In addition 8% of those in Muirhouse and 3% of those in Easterhouse reported having had sex with a person who was HIV infected. Few of such encounters had involved condom use. The combination of alcohol consumption and sexual activity was reported by 82% of respondents. Twelve per cent had combined sexual activity and illicit drug use. Overall patterns of selfreported HIVIAIDS related risks in the two study areas were very similar.
Introduction The full extent of HIV infection in the general population remains unclear. Even so it has been established that in certain localities, such as Edinburgh, atypically high levels of HIV infection and AIDS have been recorded (Robertson, 1987; ‘ANSWER’, 1991). It has also been established that one of the primary modes of virus transmission is through the sharing of infected injecting equipment (National Research Council, 1989; Strang & Stimson, 1990). In 1989, it was reported that in addict samples the HIV infection rates were 38-65% in Edinburgh, 39% in Dundee and 4.5-7.0% in Glasgow (Monitoring Research Group, 1989). Moreover, growing evidence indicates that unprotected sexual contact, another important method of HIV transmission, is associated with the use of alcohol and other psychoactive drugs (Stall, 1987; Plant, 1990a; Hingson et al., 1990; Leigh, 1990; Plant, 1990b). The response of young adults to high or low rates of detected HIV infection in their areas is unknown. Accordingly a study was undertaken to examine levels of psychoactive
Address for correspondence: Dr Martin Plant, Director, Alcohol Research Group, Department of Psychiatry, University of Edinburgh, Morningside Park, Edinburgh EHlO 5HF, Scotland, UK.
356
G. BAGNALL & M. A. PLANT
drug use and HIVIAIDS-related risks in two areas characterized by high and low rates of recorded HIV infection. The first of these areas was Muirhouse in Edinburgh. This locality has a high rate of HIV infection, mainly associated with intravenous drug use. The second study area was Easterhouse in Glasgow. This resembles Muirhouse in certain respects being an urban area with multiple problems, but currently has a lower rate of recorded HIV infection than Muirhouse. This paper presents descriptive data which compare general levels of HIV/AIDS related risks in the two study areas. A subsequent publication is planned which will explore some of these issues in greater depth.
Downloaded by [Monash University Library] at 18:25 02 February 2015
Subjects and methods
Data were elicited by a single phase, cross-sectional survey. Standardized interviews were conducted by trained interviewers who visited a random sample of 16-30 year old residents in the two study areas. Households for survey were selected from the Post Code Address File. The use of this data base as a sampling frame has been described by Wilson and Elliot (1987). Interviewers were required to call at each household on a list of randomly selected addresses within the postcode area. A standardized introduction was used to describe the research as a survey of community health issues requiring interviews with any 16-30 year olds resident at that address. All eligible respondents within each household were then interviewed individually and, whenever possible, in private. The questionnaire elicited biographical information and data on consumption of alcohol, tobacco and illicit drugs, using questions replicated from other relevant surveys. Respondents’ knowledge about the risks of HIV infection was assessed by 16 ‘factual‘ questions, and individual experience of exposure to HIV explored. This involved asking sensitive questions about personal sexual behaviours, including condom use with past and present partner(s). Some evidence of high levels of internal non-response was evident for specific questions, and this issue has been examined by Bagnall (1991a). The response rate for survey participation in both areas was 70% with data being successfully collected from 628 respondents in Muirhouse and 750 in Easterhouse. The distribution of respondents in relation to sex and mean age is indicated by Table 1. Table 1. Study group characteristics Number of respondents
Age All subjects
Muirhouse Easterhouse
Males
Females
Total
Males
Females
Mean
(sd)
Mean
(sd)
Mean
(sd)
628 750
262 325
366 425
23 23
(4.1) (4.2)
24 23
(4.2) (4.2)
23 23
(4.0) (4.2)
Results
The marital status of respondents was similar in both areas, with roughly half of all respondents single, one quarter married and one-fifth co-habiting. Approximately half the respondents in both areas had children. Long-term residency in the area (1 1 years or more) was significantly more commonplace amongst Easterhouse respondents (57%) than amongst those in Muirhouse (33%)
HIVIAIDS RISKS, ALCOHOL AND DRUG USE AMONG YOUNG ADULTS
357
(xz = 91.00, d.f. = 6; p < 0.005). Unemployment rates were high, at 28% in Muirhouse and 35% in Easterhouse (x2 = 24.5, d.f. = 1; p < 0.005).
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Alcohol and illicit drug use The two study areas did not differ significantly in relation to either frequency or quantity of self-reported alcohol consumption. The average weekly consumption for the complete sample was 10 units* (s.d. = 17.5; Range = 0-172). Six per cent of males and 2% of females in both areas were ‘heavy drinkers’. For the purpose of this study, ‘heavy drinking’ is defined as a weekly consumption of >30 units for females and >35 units for males. There were no significant differences in the distribution of heavy drinkers between the two areas for either males or females. One hundred and eighty-five respondents in Muirhouse (29%) and 178 in Easterhouse (23%) reported having at some time used illicit drugs, most commonly cannabis. This difference between the two areas was not statistically significant. In both areas males were significantly more likely than females to report having used illicit drugs (x2 = 81.73; d.f. = 1; p < 0.005). In Muirhouse 10 males and 5 females (2% of respondents in that area) reported having injected illicit drugs. In Easterhouse 6 males and 6 females (2%) reported having injected drugs. Seven of the 15 Muirhouse injectors had at some time shared injecting equipment compared with all of those in Easterhouse. None of the seven female injectors reported having shared injecting equipment with anybody whom they ‘knew’ to be infected with HIV. Five of the 12 males, however, reported that they had done so.
HIV status One hundred and sixty-eight respondents in Muirhouse (27%) and 69 respondents in Easterhouse (9%), reported having had an HIV test. Seven of those in Muirhouse and seven of those in Easterhouse reported having received positive test results. Four of these were self-reported intravenous drug users. This is elaborated in Table 2. Table 2. Number of people mer tested fos HIV Muirhouse
Ever tested for HIV Test result negative Test result positive Test result unknown Refused to give test result
Easterhouse
Males
Females
Males
(n = 262)
(n = 366)
(n = 325)
Females (n = 425)
41 37 3 1
*127 110 4 13
31 28 3
38 31 4
-
-
-
This high number may reflect ante-natal blood testing, although no information to con& available from the questionnaire.
3 this was
A unit is defined as either half a pint of ordinary beer, cider, stout or lager, or a single public house measure of spirits or a glass of wine. Each unit contains approximately one centilitre of alcohol.
358 G. BAGNALL L M. A. PLANT
Sexual behaviour Respondents were asked whether or not they had had sexual intercourse with anyone whom they believed to be infected with HIV. Forty-five (89%) of those in Muirhouse and 21 (3%) of those in Easterhouse reported having done so with no significant difference between males and females. Approximately three-quarters of these individuals reported having never used condoms during such contacts. Only a small minority reported having always used condoms during sexual contact with an HIV infected partner. This is shown in Table 3. Table 3. Sex and condom use with HIV contact (column percentages in brackets)
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Had sex with HIV Contact*
Muirhouse Number(%)
Easterhouse Number(%)
Yes No Don’t know
47 (8) 488 (87) 25 (5)
21 (3) 604 (93) 22 (4)
Total
560 (100)
647 (100)
Condom use with HIV contact
Muirhouse Number(%)
Easterhouse Number(%)
36 (77) 4 (8) 7 (15)
15 (71) 5 (24) 1 (5)
47 (loo)
21 (loo)
Never Sometimes Always
68 (11%) Muirhouse and 103 (14%) Easterhouse respondents refused to answer this question.
In both areas approximately 80% of respondents who answered this question had a current sexual partner (18% refused to answer); 87% had been in this relationship for at least 12 months. The condom use of the entire sample was examined. This is illustrated in Table 4, which demonstrates that condom use was infrequent in both areas. This, however, has to be interpreted in the context of marital and partner status of respondents, especially those reporting stable, single partner relationships. Table 4. Use of condoms and other contraceptives Muirhouse
Easterhouse
Condom use with current partner Never Sometimes Always
60% 33% 7% (n = 440,30% refusal)
63%
Condom use since sexually active Never Sometimes Always
45%
48% 7% (n = 550; 13% refusal)
51% 44% 5% (n = 623; 17% refusal)
Other contraceptive use with current partner
Never Sometimes Always
21% 27% 53% (n = 439; 30% refusal)
19% 43% 37% (n = 495; 34% refusal)
Other contraceptive use since sexually active
Never Sometimes Always
19% 51% 30% (n = 534; 15% refusal)
24% 55% 22%
32% 6% (n = 497; 34% refusal)
(n = 624; 17% refusal)
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Combining sex with alcohol on illicit drugs
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Sex and alcohol. Eighty-two per cent of all respondents reported having combined sexual activity with alcohol, with little difference between Muirhouse and Easterhouse. Four hundred and forty-six females (83% of those who respodded) and 342 males (76% of those who responded) said this made no difference to their condom use. Eighty females (15% of those who responded) and 100 males (22% of those who responded) thought they were less likely to use condoms. Referring to the last occasion on which alcohol had been combined with sexual activity, 468 females (88%) and 379 males (86%) reported that they had not used condoms.
Sex and illicit drug use. Eighty-eight males and 55 females (12% of the total sample) reported having combined sex with illicit drug use. Here too, a similar pattern emerged for both areas. Amongst these respondents, 68 males (77%) and 48 females (87%) said this made no different to their condom use. Six females and eighteen males said they were less likely to use condoms. Of all respondents who had combined illicit drug use with sexual activity, 44 females (80%) and 80 males (91%) reported that on the last occasion they had not used a condom.
HIV-related knowledge, behaviour and personal contact The total study group demonstrated a good knowledge of risks of HIV infection in their responses to the ‘factual‘ questions on this topic. There were no significant differences between areas or genders. Muirhouse respondents were, however, significantly more likely than those in Easterhouse to report that they worried about AIDS (23% compared to 16%: x2 = 18.93; d.f. = 1; p < 0.005). Significantly more Muirhouse respondents (37%) than Easterhouse respondents ( 12%) knew someone who was HIV seropositive (x2 = 113.81, d.f. = 2; p < 0.005). In both areas the most likely source of infection was reported to be intravenous drug use.
Discussion
This survey indicated striking similarities between ‘risky behaviours’ in Muirhouse and Easterhouse. Overall patterns of alcohol and illicit drug use, including injected drug use, in the two areas were similar. Self-reported illicit drug use was not exceptionally high, matching closely that of a cohort of approximately 800 25 year olds surveyed 18 months earlier (Bagnall et al., 1990; Bagnall, 1991b). Nevertheless, it may be of some concern to note that needle and syring sharing was reported by a higher proportion of drug injectors in Easterhouse than in Muirhouse. Levels of self-reported HIV infection in the two areas were similar even though Easterhouse is generally regarded as having a lower rate of such infection than Muirhouse. However, these self-reported levels were also considerably lower than those from alternative sources, and may therefore reflect the difficulties of collecting valid data in this context. The findings from this survey support earlier evidence that condom use is far from the norm amongst young adults (McQueen et al., 1989; Plant ?i Plant, 1991). As noted in the introduction, other research has indicated that the combination of sexual activity with the use of alcohol and illicit drugs is associated with risky behaviour. In
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this survey low rates of condom use and high levels of combining sexual activity with alcohol, or less commonly, illicit drugs, were evident in both areas, perhaps suggesting that there remains a high potential risk for HIV infection in both study areas. The findings,however, must be interpreted cautiously. For example, although condom use was not common, the majority of respondents appeared to be in long-term single partner relationships. Furthermore, the highly sensitive nature of some of the questions resulted in significant levels of non-response,sometimes as high as 33%. These methodological issues will be addressed in greater detail in a subsequent paper. Nevertheless, the results presented here, particularly the similarities between the study areas, suggest that the atypically high level of HIV infection evident in Edinburgh has failed to lead young adults in Muirhouse to adopt harm minimization strategies in their sexual behaviour to reduce HIVIAIDS risks. This contrasts with the generally high levels of HIVIAIDS-related knowledge evident amongst young people in the two study areas. This finding suggests that the provision of factual information is, by itself, insufficient to foster safer sex and safer drug use. Future health education should aim to identify and implement strategies (such as peer education) which are effective in encouraging the uptake of harm minimization behaviours. These results indicate that unless alternative strategies are adopted, the risk of spreading HIV infection in areas such as Muirhouse and Easterhouse could well remain high. Acknowledgements
This study was funded by the Substance Abuse Research Committee of the Mental Health Foundation. Additional support was provided by the Scotch Whisky Association and the Portman Group. Mr John Duffy is thanked for advice and assistance with random sample selection. The Director and staff of the MRC Medical Sociology Unit, Glasgow, are thanked for providing facilities for interviewer briefing sessions. Mr Douglas Allsop and Mrs Ethel Thompson of the Scottish Council on Alcohol are thanked for helping with the management of the Easterhouse Survey. Mrs Wilma Warwick is thanked for assistance and support with survey design and implementation. Mrs Joyce Greig and Mrs Sheila McLennan are thanked for their speedy and efficient word processing. References ANSWER (AIDS News Supplement) (1991) CDS Weekly Report, 26th January, Communicable Diseases (Scotland) Unit, CDS 91/04. BAGNALL, G.M. (1991a) Survey research and HIV/AIDS-related behaviours-a case for caution, Health Education Journal, 50 (in press). BAGNALL, G.M. (1991b) Alcohol and drug use in a Scottish cohort: 10 years on, British Journal of Addiction, 86, pp. 895-904. BAGNALL,G., PLANT, M.A. & WARWICK,W. (1990) Alcohol, drugs and AIDS-related risks: results from a prospective study, AIDS Care, 2, pp. 309-31 7. HINGSON,R., STRUNIN,L., HEEREN,T. & BERLIN, B. (1990) Beliefs about AIDS, use of alcohol, drugs and unprotected sex among Massachusetts adolescents, American Journal of Public Health, 80, pp. 295-299. LEIGH,B. (1990) The relationship of substance use during sex to high risk sexual behaviour, Journal of Sex Research, 27, pp. 199-213. B.J., SMITH, R.J. & UITBNBROBK, D. (1988189) A Study of MCQUEEN,D.V., GORST, T., NISBET, L., ROBERTSON, Lifestyle and Health, Interim Report, November 1, Edinburgh, Research Unit in Health and Behavioural Change, University of Edinburgh. RESBARCHGROUP(1989) National Syn'nge Exchange Monitoring Study: Final Report, Goldsmith's MONITORING College, University of London. NATIONAL R ~ s m c x iCOUNCIL(1989) AIDS, Sexual Behaviour and Intravenous Drug Use (Washington, DC, National Academy Press).
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PLANT,M.A. (Ed.) (1990a) AIDS, Drugs and Prostitution (London, Tavistock/Routledge). PLANT,M.A. (1990b) Alcohol, sex and AIDS, Alcohol and Alcoholism, 25, pp. 293-301. PLANT,M.A. & PLANT,M.L. (1991) Risk T a h : alcohol, drugs, sex andyourh (London, Tavistock/Routledge) (in press). ROBERTSON, J.R. (1987) Heroin,AIDS and Society (London, Hodder and Stoughton). STALL, R. (1 987) The prevention of HIV infection associated with drug and alcohol use during sexual activity, in: L. SIEGEL(Ed.) AIDS and Substance Abuse, pp. 73-88. (New York, Harrington, Park Press). STRANG, J. & STIMSON,G.V. (Eds) (1990) AIDS and Drug Misuse (London, TavistockIRoutledge). WILSON,P.R. & ELLIOT,D.J. (1987) An evaluation of the Post Code Address File as a sampling frame and its use with OPCS, Journal ofRqua1 Statistical Society, 150, pp, 230-240.
