Archives of Sexual Behavior

, Volume 48, Issue 2, pp 599–607 | Cite as

Multidimensional Patterns of Sexual Risk Behavior and Psychiatric Disorders in Men with Substance Use Disorders

  • Luis Villalobos-Gallegos
  • María Elena Medina-Mora
  • Corina Benjet
  • Silvia Ruiz-Velasco
  • Carlos Magis-Rodriguez
  • Rodrigo Marín-NavarreteEmail author
Original Paper


Previous evidence links substance use disorders (SUD) to STI/HIV risk and suggests that comorbid psychiatric disorders increase the probability to engage in sexual risk behaviors. This study had two aims: (1) to identify subgroups based on sexual risk behavior using a person-centered approach in a sample of substance users and (2) to measure the association of psychiatric and SUD with subgroup membership. We assessed 402 male adults with SUD, reporting sexual intercourse in the previous 12 months using the HIV-Risk Behavior Scale and the Mini International Neuropsychiatric Interview. Latent class analysis was performed to determine multidimensional patterns of sexual risk behaviors and multinomial logistic regression was utilized to associate classes with disorders. The three-class model showed the best fit, and the classes were labeled: Relationship-Based (31.34% of the sample), Condom-Based (39.55%), and Multiple Risks (29.10%). Controlling for age and marital status, major depressive disorders, antisocial personality disorder, and any psychiatric disorder were associated with the Multiple Risks class. Results stress the importance of developing a personalized assessment and counseling for sexual risk behaviors in individuals with SUD, particularly when they endorse criteria for comorbid psychiatric disorders. Future studies should focus on evaluating differential response to preventive interventions.


Latent class analysis Sexual risk behaviors Substance use disorders Psychiatric disorders HIV prevention Condom use 



A special acknowledgment for their institutional support in this study: National Institute on Drug Abuse—Clinical Trials Network (NIDA-CTN), Consejo Nacional Contra las Adicciones (CONADIC-México), Instituto para la Atención y Prevención de las Adicciones en la Ciudad de México Instituto Mexiquense Contra las Adicciones, Consejo Estatal Contra las Adicciones de Puebla, Consejo Estatal Contra las Adicciones de Hidalgo, Consejo Estatal Contra las Adicciones de Querétaro. We also wish to thank David Sheehan M.D. for allowing the use of the Spanish-language adaptation of the 5th version of the Mini International Neuropsychiatric Interview.


This publication stems from the project “Development of a Clinical Trial Network on Addiction and Mental Health in Mexico” funded by a grant from the US Department of State (Grant No. SINLEC11GR0015-A001). The US Department of State had no role in the study design, collection, analysis or interpretation of the data, writing the manuscript, or the decision to submit the paper for publication. LVG received funding from the National Council of Science and Technology (CONACYT) to write this article via scholarship no. 383294. RMN received funding grant no. 262500 from CONACYT-FOSISS.

Compliance with Ethical Standards

Conflict of interests

Authors declare no conflicts of interest.

Ethical Approval

All protocol procedures, informed consent forms, assessment forms, and patient recruitment materials were approved by the Research on Ethics Committee of the National Institute of Psychiatry “Ramón de la Fuente Muñiz” and are in accordance with the 1964 Declaration of Helsinki and its later amendments. For all participants who endorsed criteria for any psychotic, manic episode, or suicide behavior, the research team informed the site director and local health authorities in charge to ensure patients received specialized treatment.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Supplementary material

10508_2018_1227_MOESM1_ESM.docx (20 kb)
Supplementary material 1 (DOCX 20 kb)


  1. Bari, A., & Robbins, T. W. (2013). Inhibition and impulsivity: Behavioral and neural basis of response control. Progress in Neurobiology, 108, 44–79. Scholar
  2. Beadnell, B., Morrison, D. M., Wilsdon, A., Wells, E. A., Murowchick, E., Hoppe, M., … Nahom, D. (2005). Condom use, frequency of sex, and number of partners: Multidimensional characterization of adolescent sexual risk-taking. Journal of Sex Research, 42, 192–202. Scholar
  3. Bergman, L. R., & Magnusson, D. (1997). A person-oriented approach in research on developmental psychopathology. Development and Psychopathology, 9, 291–319. Scholar
  4. Blair, R. J. R. (2015). Psychopathic traits from an RDoC perspective. Current Opinion in Neurobiology, 30, 79–84. Scholar
  5. Calsyn, D. A., Baldwin, H., Niu, X., Crits-Christoph, P., & Hatch-Maillette, M. A. (2011). Sexual risk behavior and sex under the influence: An event analysis of men in substance abuse treatment who have sex with women. American Journal on Addictions, 20, 250–256. Scholar
  6. Collins, L. M., & Lanza, S. T. (2010). Latent class and latent transition analysis: With applications in the social, behavioral, and health sciences. Hoboken, NJ: Wiley.Google Scholar
  7. Crosby, R. A., DiClemente, R. J., Wingood, G. M., Lang, D., & Harrirgton, K. R. (2003). Value of consistent condom use: A study of sexually transmitted disease prevention among African American adolescent females. American Journal of Public Health, 93, 901–903.CrossRefGoogle Scholar
  8. Darke, S., Hall, W., Heather, N., Ward, J., & Wodak, A. (1991). The reliability and validity of a scale to measure HIV risk-taking behaviour among intravenous drug users. AIDS, 5, 181–185. Scholar
  9. Davies, S. L., Cheong, J. W., Lewis, T. H., Simpson, C. A., Chandler, S. D., & Tucker, J. A. (2014). Sexual risk typologies and their relationship with early parenthood and STI outcomes among urban African-American emerging adults: A cross-sectional latent profile analysis. Sexually Transmitted Infections, 90, 475–477. Scholar
  10. De Boni, R., Veloso, V. G., & Grinsztejn, B. (2014). Epidemiology of HIV in Latin America and the Caribbean. Current Opinion in HIV and AIDS, 9, 192–198. Scholar
  11. Urueña-Durán, J. P., Salazar-Duarte, S. J., Ojeda-Quintero, L. P., & Mantilla-Reyes, T. (2014). Estudio de los costos en que incurren las entidades promotoras de salud en Colombia por la prevención y el tratamiento del VIH/SIDA [Study of the costs covered by health entities for the prevention and treatment of the HIV/AIDS in Colombia]. Ciencia & Tecnología Para La Salud Visual Y Ocular, 12, 51–63. Scholar
  12. First, M. B., Spitzer, R. L., Gibbon, M., & Williams, J. B. W. (1997). Structured clinical interview for DSM-IV axis I disorders, clinician version (SCID-CV). Washington, DC: American Psychiatric Press.Google Scholar
  13. Golub, S. A., Starks, T. J., Kowalczyk, W. J., Thompson, L. I., & Parsons, J. T. (2012). Profiles of executive functioning: Associations with substance dependence and risky sexual behavior. Psychology of Addictive Behaviors, 26, 895–905. Scholar
  14. Guan, M., Liao, Y., Ren, H., Wang, X., Yang, Q., Liu, X., & Wang, W. (2015). Impaired response inhibition in juvenile delinquents with antisocial personality characteristics: A preliminary ERP study in a Go/Nogo task. Neuroscience Letters, 603, 1–5. Scholar
  15. Insel, T., Cuthbert, B., Garvey, M., Heinssen, R., Pine, D., Quinn, K., … Wang, P. (2010). Research Domain Criteria (RDoC): Toward a new classification framework for research on mental disorders. American Journal of Psychiatry, 167, 748–751. Scholar
  16. Kaiser, S., Unger, J., Kiefer, M., Markela, J., Mundt, C., & Weisbrod, M. (2003). Executive control deficit in depression: Event-related potentials in a Go/Nogo task. Psychiatry Research-Neuroimaging, 122, 169–184. Scholar
  17. Kessler, R. C., & Üstün, B. B. (2004). The World Mental Health (WMH) Survey Initiative version of the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI). International Journal of Methods in Psychiatric Research, 13, 93–117. Scholar
  18. Kohno, M., Morales, A. M., Ghahremani, D. G., Hellemann, G., & London, E. D. (2014). Risky decision making, prefrontal cortex, and mesocorticolimbic functional connectivity in methamphetamine dependence. JAMA Psychiatry, 71, 812–820. Scholar
  19. Konda, K. A., Celentano, D. D., Kegeles, S., Coates, T. J., & Caceres, C. F. (2011). Latent class analysis of sexual risk patterns among esquineros (street corner men) a group of heterosexually identified, socially marginalized men in urban coastal Peru. AIDS and Behavior, 15, 862–868. Scholar
  20. Krueger, R. F., & South, S. C. (2009). Externalizing disorders: Cluster 5 of the proposed meta-structure for DSM-V and ICD-11. Psychological Medicine, 39, 2061–2070. Scholar
  21. Lanza, S. T., & Collins, L. M. (2008). A new SAS procedure for latent transition analysis: Transitions in dating and sexual risk behavior. Developmental Psychology, 44, 446–456. Scholar
  22. Lanza, S. T., & Rhoades, B. L. (2013). Latent class analysis: An alternative perspective on subgroup analysis in prevention and treatment. Prevention Science, 14, 157–168. Scholar
  23. Leigh, B. C., Vanslyke, J. G., Hoppe, M. J., Rainey, D. T., Morrison, D. M., & Gillmore, M. R. (2008). Drinking and condom use: Results from an event-based daily diary. AIDS and Behavior, 12, 104–112. Scholar
  24. MacKillop, J., Celio, M. A., Mastroleo, N. R., Kahler, C. W., Operario, D., Colby, S. M., … Monti, P. M. (2015). Behavioral economic decision making and alcohol-related sexual risk behavior. AIDS and Behavior, 19, 450–458. Scholar
  25. Magis-Rodríguez, C., del Rivera-Reyes, M. P., Gasca-Pineda, R., & Gutiérrez, J. P. (2005). El gasto en la atención y la prevención del VIH/SIDA en México: tendencias y estimaciones 1997–2002 [HIV/AIDS care and prevention expenditures in Mexico: Trends and estimations 1997–2002]. Salud Pública de México, 47, 361–368. Scholar
  26. Majer, J. M., Komer, A. C., & Jason, L. A. (2015). Psychiatric severity and HIV-risk sexual behaviors among persons with substance use disorders. Journal of Dual Diagnosis, 11, 3–11. Scholar
  27. Marín-Navarrete, R., Medina-mora, M. E., Horigian, V. E., Salloum, I. M., Villalobos-Gallegos, L., & Fernández-Mondragón, J. (2016). Co-occurring disorders: A challenge for Mexican community-based residential care facilities for substance use. Journal of Dual Diagnosis, 12, 261–270. Scholar
  28. Marín-Navarrete, R., & Szerman, N. (2015). Repensando el concepto de adicciones: Pasos hacia la patología dual [Rethinking the concept of addictions: Steps towards dual pathology]. Salud Mental, 38, 395–396. Scholar
  29. Masters, N. T., Beadnell, B., Morrison, D. M., Hoppe, M. J., & Wells, E. A. (2013). Multidimensional characterization of sexual minority adolescents’ sexual safety strategies. Journal of Adolescence, 36, 953–961. Scholar
  30. Masters, N. T., Casey, E., Beadnell, B., Morrison, D. M., Hoppe, M. J., & Wells, E. A. (2015). Condoms and contexts: Profiles of sexual risk and safety among young heterosexually active men. Journal of Sex Research, 52, 781–794. Scholar
  31. Meade, C. S. (2006). Sexual risk behavior among persons dually diagnosed with severe mental illness and substance use disorder. Journal of Substance Abuse Treatment, 30, 147–157. Scholar
  32. Moody, L., Franck, C., & Bickel, W. K. (2016). Comorbid depression, antisocial personality, and substance dependence: Relationship with delay discounting. Drug and Alcohol Dependence, 160, 190–196. Scholar
  33. Newman, P. A., & Zimmerman, M. A. (2000). Gender differences in HIV-related sexual risk behavior among urban African American youth: A multivariate approach. AIDS Education and Prevention, 12, 308–325.PubMedGoogle Scholar
  34. Noor, S. W. B., Ross, M. W., Lai, D., & Risser, J. M. (2014). Use of latent class analysis approach to describe drug and sexual HIV risk patterns among injection drug users in Houston, Texas. AIDS and Behavior, 18, 276–283. Scholar
  35. Nydegger, L. A., Ames, S. L., Stacy, A. W., & Grenard, J. L. (2014). Response inhibition moderates the association between drug use and risky sexual behavior. Substance Use and Misuse, 49, 1457–1464. Scholar
  36. Nylund, K. L., Asparouhov, T., & Muthén, B. O. (2007). Deciding on the number of classes in latent class analysis and growth mixture modeling: A Monte Carlo simulation study. Structural Equation Modeling, 14, 535–569. Scholar
  37. Ott, J. J., Stevens, G. A., Groeger, J., & Wiersma, S. T. (2012). Global epidemiology of hepatitis B virus infection: New estimates of age-specific HBsAg seroprevalence and endemicity. Vaccine, 30, 2212–2219. Scholar
  38. Reyes De-Beaman, S., Beaman, P. E., Garcia-Pena, C., Jagger, C., Villa, M. A., Heres, J., & Cordova, A. (2004). Validation of a modified version of the Mini-Mental State Examination (MMSE) in Spanish. Aging Neuropsychology and Cognition, 11, 1–11. Scholar
  39. Rodriguez-Seijas, C., Arfer, K. B., Thompson, R. G., Hasin, D. S., & Eaton, N. R. (2017). Sex-related substance use and the externalizing spectrum. Drug and Alcohol Dependence, 174, 39–46. Scholar
  40. Rosato, N. S., & Baer, J. C. (2012). Latent class analysis: A method for capturing heterogeneity. Social Work Research, 36, 61–69. Scholar
  41. Seedat, S., Scott, K. M., Angermeyer, M. C., Berglund, P., Bromet, E. J., Brugha, T. S., … Kessle, r R C. (2009). Cross-national associations between gender and mental disorders in the World Health Organization World Mental Health Surveys. Archives of General Psychiatry, 66, 785–795. Scholar
  42. Sheehan, D. V., Lecrubier, Y., Sheehan, K. H., Amorim, P., Janavs, J., Weiller, E., & Dunbar, G. C. (1998). The Mini-International Neuropsychiatric Interview (M.I.N.I.): The development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. Journal of Clinical Psychiatry, 59, 22–33. Scholar
  43. Shelton, J. D. (2009). Why multiple sexual partners? Lancet, 374, 367–369. Scholar
  44. Shoptaw, S., Montgomery, B., Williams, C. T., El-Bassel, N., Aramrattana, A., Metsch, L., … Strathdee, S. A. (2013). Not just the needle: The state of HIV-prevention science among substance users and future directions. Journal of Acquired Immune Deficiency Syndromes, 63, S174–S178. Scholar
  45. Sullivan, K. M. (2005). Male self-disclosure of HIV-positive serostatus to sex partners: A review of the literature. Journal of the Association of Nurses in AIDS Care. Scholar
  46. Vasilenko, S. A., Kugler, K. C., Butera, N. M., & Lanza, S. T. (2015). Patterns of adolescent sexual behavior predicting young adult sexually transmitted infections: A latent class analysis approach. Archives of Sexual Behavior, 44, 705–715. Scholar
  47. Vasilenko, S. A., & Lanza, S. T. (2014). Predictors of multiple sexual partners from adolescence through young adulthood. Journal of Adolescent Health, 55, 491–497. Scholar
  48. Vermunt, J. K. (2010). Latent class modeling with covariates: Two improved three-step approaches. Political Analysis, 18, 450–469. Scholar
  49. Volkow, N. D., Wang, G. J., Fowler, J. S., Telang, F., Jayne, M., & Wong, C. (2007). Stimulant-induced enhanced sexual desire as a potential contributing factor in HIV transmission. American Journal of Psychiatry, 164, 157–160. Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Luis Villalobos-Gallegos
    • 1
    • 2
  • María Elena Medina-Mora
    • 1
  • Corina Benjet
    • 1
  • Silvia Ruiz-Velasco
    • 3
  • Carlos Magis-Rodriguez
    • 4
  • Rodrigo Marín-Navarrete
    • 1
    Email author
  1. 1.Instituto Nacional de Psiquiatría “Ramón de la Fuente Muñiz” (INPRFM)Mexico CityMexico
  2. 2.Facultad de MedicinaUNAMMexico CityMexico
  3. 3.Instituto de Investigaciones en Matemáticas Aplicadas y SistemasUNAMMexico CityMexico
  4. 4.Centro Nacional para la Prevención y el Control del VIH y el SIDAMexico CityMexico

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