AIDS and Behavior

, 15:1834 | Cite as

Psychiatric, Behavioural and Social Risk Factors for HIV Infection Among Female Drug Users

  • Gail GilchristEmail author
  • Alicia Blazquez
  • Marta Torrens
Original Paper


Female drug users report greater psychopathology and risk behaviours than male drug users, putting them at greater risk for HIV. This mixed-methods study determined psychiatric, behavioural and social risk factors for HIV among 118 female drug users (27% (32/118) were HIV seropositive) in Barcelona. DSM-IV disorders were assessed using the Spanish Psychiatric Research Interview for Substance and Mental Disorders. 30 participants were interviewed in-depth. In stepwise multiple backward logistic regression, ever injected with a used syringe, antisocial personality disorder, had an HIV seropositive sexual partner and substance-induced major depressive disorder were associated with HIV seropositivity. Qualitative findings illustrate the complex ways in which psychiatric disorders and male drug-using partners interact with these risk factors. Interventions should address all aspects of female drug users’ lives to reduce HIV.


HIV HIV risk behaviours Female drug users Substance-induced depression Antisocial personality disorder 


Las mujeres consumidoras de drogas presentan más psicopatología y conductas de riesgo que los consumidores, exponiéndolas a un riesgo mayor de contraer la infección por el VIH. El objetivo del presente estudio fue evaluar, mediante metodología mixta, los factores de riesgo psiquiátricos, comportamentales y sociales para la infección por el VIH en 118 mujeres consumidoras de drogas (27% (32/118) seropositivas para el VIH) en Barcelona. Los trastornos psiquiátricos (según criterios DSM-IV) se evaluaron mediante la versión española de la Psychiatric Research Interview for Substance and Mental Disorders. Se entrevistaron a 30 mujeres en profundidad. En la regresión logística, los factores que se asociaron a la infección por el VIH fueron la inyección con jeringuillas usadas previamente, tener el trastorno de personalidad antisocial, una pareja sexual con infección por el VIH y tener una depresión mayor inducida por sustancias. Los análisis cualitativos ilustraron la complejidad con que los trastornos psiquiátricos y las parejas consumidoras interactúan con estos factores de riesgo. Las intervenciones diseñadas para reducir la infección del VIH deberían abordar diferentes aspectos de la vida de las mujeres usuarias de drogas.



This work was supported by The Foundation for AIDS Research (amfAR) (fellowship grant #106953-43-RFAT), RD06/0001/1009 and FIS PI 07/0342. We would like to thank the staff and patients from CAS Barceloneta, CAS Extracta La Mina, CAS Sants, CAS Garbivent, Hospital del Mar Inpatient Detoxification Unit, Hospital Universitari Germans Trias i Pujol Inpatient Detoxification Unit, Dual Diagnosis Unit Centre Forum-Hospital del Mar and Juanse Hernández from the HIV treatments working group for their participation in the study. We are especially grateful to Joan Mestre, Francina Fonseca, Laura Diaz, Diana Martinez and Clara Perez for assisting with data collection.


  1. 1.
    Mathers BM, Degenhardt L, Phillips B, et al. Global epidemiology of injecting drug use and HIV among people who inject drugs: a systematic review. Lancet. 2008;15:1733–45.CrossRefGoogle Scholar
  2. 2.
    Strathdee SA, Galai N, Safaiean M, et al. Sex differences in risk factors for hiv seroconversion among injection drug users: a 10-year perspective. Arch Intern Med. 2001;161:1281–8.PubMedCrossRefGoogle Scholar
  3. 3.
    Dwyer R, Richardson D, Ross MW, Wodak A, Miller ME, Gold JA. Comparison of HIV risk between women and men who inject drugs. AIDS Educ Prev. 1994;6:379–89.PubMedGoogle Scholar
  4. 4.
    El-Bassel N, Simoni JM, Cooper DK, Gilbert L, Schilling RF. Sex trading and psychological distress among women on methadone. Psychol Addict Behav. 2001;15:177–84.PubMedCrossRefGoogle Scholar
  5. 5.
    Gilchrist G, Gruer L, Atkinson J. Comparison of drug use and psychiatric morbidity between prostitute and non-prostitute female drug users in Glasgow, Scotland. Addict Behav. 2005;30:1019–23.PubMedCrossRefGoogle Scholar
  6. 6.
    O’Connell JM, Kerr T, Li K, et al. Requiring help injecting independently predicts incident HIV infection among injection drug users. J AIDS. 2005;40:83–8.Google Scholar
  7. 7.
    Krausz M, Degkwitz P, Kühne A, Verthein U. Comorbidity of opiate dependence and mental disorders. Addict Behav. 1998;23:767–84.PubMedCrossRefGoogle Scholar
  8. 8.
    Torrens M, Gilchrist G, Domingo-Salvany A. Psychiatric comorbidity in illicit drug users: substance induced versus independent disorders. Drug Alcohol Depend (in press).Google Scholar
  9. 9.
    Carey M, Carey K, Kalichman S. Risk for human immuno-deficiency virus (HIV) infection among persons with severe mental illnesses. Clin Psychol Rev. 1997;17:271–91.PubMedCrossRefGoogle Scholar
  10. 10.
    Dinwiddie SH, Cottler L, Compton W, Abdallah AB. Psychopathology and HIV risk behaviors among injection drug users in and out of treatment. Drug Alcohol Depend. 1996;43:1–11.PubMedCrossRefGoogle Scholar
  11. 11.
    Meade CS. Sexual risk behavior among persons dually diagnosed with severe mental illness and substance use disorder. J Subst Abuse Treat. 2006;30:147–57.PubMedCrossRefGoogle Scholar
  12. 12.
    Disney E, Kidorf M, Kolodner K, et al. Psychiatric comorbidity is associated with drug use and HIV risk in syringe exchange participants. J Nerv Ment Dis. 2006;194:577–83.PubMedCrossRefGoogle Scholar
  13. 13.
    Stein MD, Anderson BJ, Solomon DA, Herman DS, Ramsey SE, Brown RA. Reductions in HIV risk behaviors among depressed drug injectors. Am J Drug Alcohol Abuse. 2005;31:417–32.PubMedCrossRefGoogle Scholar
  14. 14.
    Kang S, De Leon G. Correlates of drug injection behaviors among methadone outpatients. Am J Drug Alcohol Abuse. 1993;9:107–18.CrossRefGoogle Scholar
  15. 15.
    Mandell W, Kim J, Latkin C, Suh T. Depressive symptoms, drug network, and their synergistic effect on needle-sharing behavior among street injection drug users. Am J Drug Alcohol Abuse. 1999;25:117–27.PubMedCrossRefGoogle Scholar
  16. 16.
    Morrill AC, Kasten L, Urato M, Larson MJ. Abuse, addiction, and depression as pathways to sexual risk in women and men with a history of substance abuse. J Subst Abuse. 2001;13:169–84.PubMedCrossRefGoogle Scholar
  17. 17.
    Williams CT, Latkin CA. The role of depressive symptoms in predicting sex with multiple and high-risk partners. J AIDS. 2005;38:69–73.Google Scholar
  18. 18.
    El-Bassel N, Gilbert L, Wu E, Go H, Hill J. Relationship between drug abuse and intimate partner violence: a longitudinal study among women receiving methadone. Am J Public Health. 2005;95:465–70.PubMedCrossRefGoogle Scholar
  19. 19.
    Wagner KD, Hudson SM, Latka MH, et al. The effect of intimate partner violence on receptive syringe sharing among young female injection drug users: an analysis of mediation effects. AIDS Behav. 2009;13:217–24.PubMedCrossRefGoogle Scholar
  20. 20.
    Mays N, Pope C. Rigour in qualitative research. BMJ. 1995;311:109–12.PubMedGoogle Scholar
  21. 21.
    Guest G, Bunce A, Johnson L. How many interviews are enough? An experiment with data saturation and variability. Field Methods. 2006;18:59–82.CrossRefGoogle Scholar
  22. 22.
    Torrens M, Serrano D, Astals M, Perez-Domınguez G, Martın-Santos R. Diagnosing psychiatric comorbidity in substance abusers validity of the Spanish versions of psychiatric research interview for substance and mental disorders (PRISM-IV) and the structured clinical interview for DSM-IV (SCID-IV). Am J Psychiatry. 2004;161:1231–7.PubMedCrossRefGoogle Scholar
  23. 23.
    Hasin D, Samet S, Nunes E, Meydan J, Matseoane K, Waxman R. Diagnosis of comorbid psychiatric disorders in substance users assessed with the psychiatric research interview for substance and mental disorders for DSM-IV. Am J Psychiatry. 2006;163:689–96.PubMedCrossRefGoogle Scholar
  24. 24.
    Morgello S, Holzer CE, Ryan E, et al. Interrater reliability of the psychiatric research interview for substance and mental disorders in an HIV-infected cohort: experience of the national NeuroAIDS tissue consortium. Int J Methods Psych Res. 2006;15:131–8.CrossRefGoogle Scholar
  25. 25.
    Hasin DS, Trautman KD, Endicott J. Psychiatric research interview for substance and mental disorders: phenomenologically based diagnosis in patients who abuse alcohol or drugs. Psychopharmacol Bull. 1998;34:3–8.PubMedGoogle Scholar
  26. 26.
    Gutierrez-Zotes JA, Bayon C, Montserrat C, et al. Temperament and character inventory revised (TCI-R) standardization and normative data in a general population sample. Actas espanolas psiquiatria. 2004;32:8–15.Google Scholar
  27. 27.
    Hegarty KL, Sheehan M, Schonfeld CA. Multidimensional definition of partner abuse: development and preliminary validation of the composite abuse scale. J Fam Violence. 1999;14:399–414.CrossRefGoogle Scholar
  28. 28.
    Hegarty K, Bush R, Sheehan M. The composite abuse scale: further development and assessment of reliability in two clinical settings. Violence Vict. 2005;20:529–47.PubMedCrossRefGoogle Scholar
  29. 29.
    Rathus SA. A 30-item schedule for assessing assertive behavior. Behav Ther. 1973;4:398–406.CrossRefGoogle Scholar
  30. 30.
    Norton R, Warnick B. Assertiveness as a communication construct. Hum Comm Res. 1976;3:62–6.CrossRefGoogle Scholar
  31. 31.
    Pearson JC. A factor analytic study of the items in the Rathus assertiveness schedule and the personal report of communication apprehension. Psychol Rep. 1979;45:491–7.CrossRefGoogle Scholar
  32. 32.
    Rathus SA. An experimental investigation of assertive training in a group setting. J Behav Ther Exp Psychiatry. 1972;3:81–6.CrossRefGoogle Scholar
  33. 33.
    Morokoff PJ, Quina K, Harlow LL, et al. Sexual assertiveness scale (SAS) for women: development and validation. J Pers Soc Psychol. 1997;73:790–804.PubMedCrossRefGoogle Scholar
  34. 34.
    Darke S, Hall W, Heather N, Ward J, Wodak A. The reliability and validity of a scale to measure HIV risk-taking among intravenous drug users. AIDS. 1991;5:181–5.PubMedCrossRefGoogle Scholar
  35. 35.
    SPSS Inc. Statistical Program for the Social Sciences. Chicago: SPSS; 2003.Google Scholar
  36. 36.
    QSR International Pty Ltd. NVivo qualitative data analysis software. Version 8; 2008.Google Scholar
  37. 37.
    Pope C, Ziebland S, Mays N. Qualitative research in health care: analysing qualitative data. BMJ. 2000;320:114–6.PubMedCrossRefGoogle Scholar
  38. 38.
    Zahari MM, Hwan Bae W, Zainal NZ, Habil H, Kamarulzaman A, Altice FL. Psychiatric and substance abuse comorbidity among HIV seropositive and HIV seronegative prisoners in Malaysia. Am J Drug Alcohol Abuse. 2010;36:31–8.PubMedCrossRefGoogle Scholar
  39. 39.
    Gilchrist G, Atkinson J, Gruer L. Illicit tranquilliser use and dependence among female opiate users. Drug Alcohol Rev. 2006;25:459–61.PubMedCrossRefGoogle Scholar
  40. 40.
    Gilchrist G, Gruer L, Atkinson J. Predictors of neurotic symptom severity among female drug users in Glasgow, Scotland. Drugs Educ Prev Pol. 2007;14:347–65.CrossRefGoogle Scholar
  41. 41.
    Brooner RK, Greenfield L, Schmidt CW, Bigelow GE. Antisocial personality disorder and HIV infection among intravenous drug abusers. Am J Psychiatry. 1993;150:53–8.PubMedGoogle Scholar
  42. 42.
    Kelley JL, Petry NM. HIV risk behaviors in male substance abusers with and without antisocial personality disorder. J Subst Abuse Treat. 2000;19:59–66.PubMedCrossRefGoogle Scholar
  43. 43.
    Ladd GT, Petry NM. Antisocial personality in treatment-seeking cocaine abusers: psychosocial functioning and HIV risk. J Subst Abuse Treat. 2003;24:323–30.PubMedCrossRefGoogle Scholar
  44. 44.
    Petry NM. Discounting of delayed rewards in substance abusers: relationship to antisocial personality disorder. Psychopharmacol. 2002;162:425–32.CrossRefGoogle Scholar
  45. 45.
    Fassino S, Dagaa GA, Delsedimea N, Rognaa L, Boggio S. Quality of life and personality disorders in heroin abusers. Drug Alcohol Depend. 2004;76:73–80.PubMedCrossRefGoogle Scholar
  46. 46.
    Hearn KD, O’Sullivan LF, El-Bassel N, Gilbert L. Intimate partner violence and monogamy among women in methadone treatment. AIDS Behav. 2005;9:177–86.PubMedCrossRefGoogle Scholar
  47. 47.
    Montgomery SB, Hyde J, De Rosa CJ, et al. Gender differences in HIV risk behaviors among young injectors and their social network members. Am J Drug Alcohol Abuse. 2002;28:453–75.PubMedCrossRefGoogle Scholar
  48. 48.
    Spittal PM, Craib KJP, Wood E, et al. Risk factors for elevated HIV incidence rates among female injection drug users in Vancouver. CMAJ. 2002;166:894–9.PubMedGoogle Scholar
  49. 49.
    MacRae R, Aalto E. Gendered power dynamics and HIV risk in drug-using sexual relationships. AIDS Care. 2000;12:505–15.PubMedCrossRefGoogle Scholar
  50. 50.
    Panchanadeswaran S, Frye V, Nandi V, Galea S, Vlahov D, Ompad D. Intimate partner violence and consistent condom use among drug-using heterosexual women in New York City. Women Health. 2010;50:107–24.PubMedCrossRefGoogle Scholar
  51. 51.
    Mateu-Gelabert P, Treloar C, Agulló Calatayud V, et al. How can hepatitis C be prevented in the long term? Int J Drug Policy. 2007;18:338–40.PubMedCrossRefGoogle Scholar
  52. 52.
    El Bassel N, Gilbert L, Wu E, Chang M, Fontdevila J. Perpetration of intimate partner violence among men in methadone treatment programs in New York City. Am J Public Health. 2007;97:1230–2.PubMedCrossRefGoogle Scholar
  53. 53.
    Copenhaver MM, Johnson BT, Lee IC, Harman JJ, Carey MP, SHARP Research Team. Behavioral HIV risk reduction among people who inject drugs: meta-analytic evidence of efficacy. J Sub Abuse Treat. 2006;31:163–71.CrossRefGoogle Scholar
  54. 54.
    Hien DA, Campbell AN, Killeen T, et al. The impact of trauma-focused group therapy upon HIV sexual risk behaviors in the NIDA clinical trials network “Women and trauma” multi-site study. AIDS Behav. 2010;14:421–30.PubMedCrossRefGoogle Scholar
  55. 55.
    Gilbert L, El-Bassel N, Terlikbayeva A, et al. Couple-based HIV prevention for injecting drug users in Kazakhstan: a pilot intervention study. J Prev Interv Community. 2010;38:162–76.PubMedCrossRefGoogle Scholar
  56. 56.
    El-Bassel N, Terlikbaeva A, Pinkham S. HIV and women who use drugs: double neglect, double risk. Lancet. 2010;376:312–3.PubMedCrossRefGoogle Scholar
  57. 57.
    Rounsaville B, Kleber H. Untreated opiate addicts: how do they differ from those seeking treatment? Arch Gen Psychiatry. 1985;42:1072–7.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Gail Gilchrist
    • 1
    • 2
    Email author
  • Alicia Blazquez
    • 1
  • Marta Torrens
    • 1
    • 3
    • 4
  1. 1.Substance Use Disorders Research GroupIMIM-Hospital del Mar, Parc de Salut Mar de BarcelonaBarcelonaSpain
  2. 2.Centre for Applied Social Research, School of Health and Social CareThe University of GreenwichLondonUK
  3. 3.Institute of Neuropsychiatry and Addictions, Parc de Salut Mar de BarcelonaBarcelonaSpain
  4. 4.Department of PsychiatryUniversidad Autónoma de BarcelonaBarcelonaSpain

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