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J Kermanshah Univ Med Sci. Young adults are considered to be a potentially risk-taking population, and college transition is a significant period for every individual. Independence, separation from the parents, lack of supervision, and peer pressure significantly increase the risk of illicit drug use by these students, which may lead to academic failure and other issues in life 1. In general, illicit drug use has been a major public health concern among students in the past few years 2. Illicit drug use is defined as the non-medicinal use of various drugs that are prohibited by international laws, such as amphetamine-type stimulants ATS , cannabis, cocaine, heroin and other opioids, and ecstasy 3. Illicit drug use is associated with numerous health problems, including premature death, disability, hepatitis, human immunodeficiency virus, and chronic diseases 4 , 5. However, the studies conducted in the United States and European countries have indicated a recent upsurge in the prevalence of illicit drug use among students. For instance, the results of monitoring the future MTF indicated that the prevalence of illicit drug use among US students in and was Furthermore, several studies have confirmed the high prevalence of illicit drug use in developing countries 4 , 7 - 9. Young adults constitute the vast majority of the Iranian population who are considered susceptible to illicit drug use A study conducted on Iranian students indicated that hashish, opioids, and ATS are the most commonly used drugs among university students Another study in Iran reported the rate of illicit substance abuse to be 2. Previous studies have identified a number of factors associated with illicit drug use among university students, such as male gender, high-income families, single life, use of other substances e. Moreover, some other factors may be involved in this issues that have received less attention, such as physical fights, religious beliefs, and family support 10 , 12 , To date, few studies have been focused on illicit drug use and the associated factors among Iranian university students. The present study aimed to determine the prevalence of illicit drug use and identify the influential factors in a population of Iranian university students. This cross-sectional study was conducted on the students of Bushehr University in The participants were selected via multistage sampling. Initially, the total number of the students of Bushehr University was calculated. Based on the number of the students, the proportion of the required samples was calculated in each college. In addition, classes were randomly selected as a cluster, and all the students of the selected classes were enrolled in the study. Finally, students were selected and completed the self-administrated questionnaires; each student had 15 - 20 minutes to complete the questionnaire. The objectives of the research were explained to the participants, they were assured of confidentiality terms regarding their personal information, and participation was voluntary. The research instrument has been previously used in the studies in this regard and designed based on the smoking and substance involvement screening test, which has been developed by the World Health Organization WHO. The contents of the questionnaire have been previously validated by some researchers, and the validity was assessed by pretesting the questionnaire in a class of master of public health students In this questionnaire, the developers have considered the current status of drug use in Iran 9. The questionnaire included data on demographic variables and use of illicit drugs, such as cannabis, opium, heroin, steroidal substances, and other stimulants e. Some of the items in the questionnaire provided data on the correlations between illicit drug use and other high-risk behaviors, including smoking habits, hookah smoking, alcohol consumption, and drugs use by the family members and friends. In addition, data on unsafe sexual relations and physical fights were collected and evaluated using the questionnaire. Religious beliefs were evaluated using a item questionnaire, the total score of which was within the range of 28 - , with the higher scores indicating significant religious beliefs and lower scores indicating average religious beliefs. Furthermore, family support was evaluated using a item questionnaire, the score of which was within the range of 13 - 65, with the higher scores indicating better family support. Another article has been published regarding the other data collected by these two questionnaires As for smoking habits, hookah smoking, and alcohol consumption, data were collected on the past month, while the data on physical fights were recorded for the past year, and the data on unsafe sexual relations were recorded for the most recent intercourse. In the case of illicit drug use, data were collected regarding the lifetime use of the participants. Data analysis was performed in SPSS version 16 using chi-square and independent t -test for a simple statistical analysis. For the estimation of the crude odds ratios ORs and adjusted ORs, univariate and multiple logistic regression models were employed, respectively. In addition, Hosmer-Lemeshow guidelines were used for the selection of the variables in the multiple logistic regression model In all the statistical analyses, the P value of less than 0. S , and written informed consent was obtained from all the participants. The mean age of the participants was The majority of the participants were female Table 1 shows the prevalence of using various illicit drugs by gender. According to the findings, the prevalence of using all the illicit drugs was higher in the male students 8. In addition, the prevalence of ATS use was higher compared to the other drugs in all the selected periods. According to the information in Table 1 , the prevalence of the lifetime use of cannabis, ATS, opium, and heroin use was 1. On the other hand, the prevalence of drug use in the past year for cannabis, ATS, opium, and heroin use was 0. Table 2 shows the correlations between illicit drug use, demographic characteristics, and the influential factors in illicit drug use. However, the mean scores of religious belief and family support were significantly lower among the students who used any of the mentioned illicit drugs within their lifetime. The univariate analysis also demonstrated that the scores of family support and religious beliefs had significant effects on illicit drug use, and the higher scores of family support and religious beliefs led to the decreased ORs of illicit drug use to 0. Multiple logistic analysis was performed to control the possible effect of the confounding variables Table 3. In addition, the daily prevalence of illicit drug use was estimated at 0. The prevalence of illicit drug use in the present study was lower compared to Middle Eastern countries such as Kuwait and India 10 , Furthermore, a study conducted in Tehran Iran reported the prevalence of illicit drug use to be 2. The definition of illicit drugs varies due to the different items and concepts used in various studies. The discrepancy in the prevalence rate of illicit drug use in different studies may be attributed to the definition of illicit drugs. In addition, most of the studies in this regard have mentioned the prevalence of the illicit drugs totally. Therefore, it is better to compare the prevalence of each specific illicit drug use separately as the prevalence of a specific illicit drug is significantly higher in some countries. For instance, the prevalence of opium use is relatively higher in Iran compared to western countries due to the vicinity to Afghanistan. In the current research, the lifetime, past year, and past month prevalence of ATS use was 1. On the other hand, the results of the MTF study showed that the lifetime, past year, and past month prevalence of ATS use was In a study conducted on students in Tehran, the lifetime, past year, past month, and daily prevalence of amphetamine use was estimated at 1. In addition, the findings of a study conducted in Iran revealed that Ritalin is used by students to increase the time of their studies and improve academic function Due to the high prevalence of ATS use in students and its side-effects, training interventions are required to increase the knowledge of ATS to reduce the prevalence of ATS use among students. In the current research, the lifetime, past year, past month, and daily prevalence of opium use was estimated at 1. In a study performed on students in the United States, the prevalence of opium use was reported to be 2. On the same note, Amin-Esmaeili et al. Another study in Iran reported the prevalence of opium use to be 2. The prevalence of heroin use was extremely low in the present study as only one male student reported heroin use. However, the lifetime and past year prevalence of heroin use has been reported to be 0. In the students in Tehran, the prevalence of heroin use was reported to be 0. In the present study, the lifetime, past year, past month, and daily prevalence of cannabis use was estimated at 1. On the other hand, Peltzer et al. The mentioned findings support the public health concern regarding illicit drug use among students 2. According to the results of the final logistic model in the current research, the lifetime prevalence of illicit drug use was significantly associated with gender, working along with education, smoking habits, physical fights, and illicit drug use by friends, which is in line with the previous studies in this regard 9 , Similarly, Pengpid et al. Furthermore, a study conducted in Africa indicated that a history of physical fights over the past year and smoking habits were associated with illicit drug use Similar results have also been reported in Iranian university students Several studies have confirmed the protective effects of family support and religious beliefs on high-risk behaviors as involvement in religious activities could considerably improve the behaviors of individuals to have a healthy life and comply with normative values 15 , 28 , Our findings in this regard indicated that the mean score of religious belief was significantly lower in the students with a history of illicit drug use although religious beliefs were not considered statistically significant in the final regression model. According to the univariate analysis in the present study, family support was another protective factor associated with illicit drug use as the students with lower family support were at a higher risk of illicit drug use. Numerous findings have shown that students with strong family support were less likely to report high-risk behaviors 30 - Although family support was not considered significant in the final regression model of the current research, it could be regarded as a significant protective factor for illicit drug use in preventive interventions. The results of the present study indicated that the prevalence of illicit drug use was higher among the male students compared to the females. The previous studies in Iran and other countries have also revealed that male students are more likely to use illicit drugs compared to females 15 , 25 , 26 , The higher odds of illicit drug use by male students could be due to the higher availability of illicit drugs to men, as well as their pleasure-seeking nature and more freedom, independence, and risk-taking behaviors. Some studies have denoted a positive association between peer illicit drug use and the prevalence of illicit drug use 9 , 34 , Entering the university and post-secondary settings, living in the dormitory, and making new acquaintances accompanied with lifestyle changes are some of the influential factors in this regard. Due to the lack of parental supervision and peer pressure, university students are more vulnerable to illicit drug use and considered as a high-risk population. Therefore, educational, recreational, sports, and cultural programs for students, implementing training interventions for their parents, and providing educational interventions on life skills, social skills, and friendship programs could prevent the emergence of risky situations and reduce exposure to illicit drugs Previous studies have demonstrated the co-occurrence of high risk behaviors, which should be incorporated into the design and implementation of the preventive interventions in this regard 37 , It is suggested that comprehensive training and preventive interventions be designed and implemented to effectively reduce the prevalence of high-risk behaviors, such as illicit drug use, among university students. Due to the cross-sectional design of the study, the casual inference could not be identified based on our findings. Another limitation of the study was the use of self-report data, assuming that the participants completed the questionnaires with honesty. This study aimed to determine the prevalence of illicit drug use and some of the influential factors in this regard. According to the results, the prevalence of illicit drug use was relatively low among the students, albeit significant, and illicit drug use by friends was observed to have a strong association. Longitudinal studies are required for consistent monitoring mechanisms and appropriate planning for interventional studies. Our findings could be used in the planning and evaluation of interventions based on the associated risk factors and protective factors of illicit drug use in universities. Prevalence and associated factors of illicit drug use among university students in the association of southeast Asian nations ASEAN. Substance abuse treatment, prevention, and policy. Global journal of health science. Illicit drug use. Comparative quantification of health risks: global and regional burden of disease attributable to selected major risk factors. The prevalence of substance use and associated risk factors among university students in the city of Jahrom, Southern Iran. Monitoring the future national survey results on drug use, — Pattern of psychoactive substance use among university students in South-Western Nigeria. Journal of Behavioral Health. Epidemiology of substance use among university students in Sudan. Journal of addiction. Prescription drugs, alcohol, and illicit substance use and their correlations among medical sciences students in Iran. Prevalence, pattern and familial effects of substance use among the male college students—a North Indian study. Journal of clinical and diagnostic research: JCDR. Prevalence and factors associated with the use of illicit substances among male university students in Kuwait. Medical Principles and Practice. Estimating the prevalence of high-risk behaviors using network scale-up method in university students of Larestan in Journal of Substance Use. Addict Health. The Prevalence of illicit substance use among students of medical sciences in Tehran: results from four repeated surveys from to Substance abuse in relation to religiosity and familial support in Iranian college students. Asian journal of psychiatry. Trend of smoking among students of Tehran University of Medical Sciences: results from four consecutive surveys from to Medical journal of the Islamic Republic of Iran. Journal of research in health sciences. Jewell NP. Statistics for epidemiology. Peltzer K, Pengpid S. Central Asian Journal of Global Health. Drug Des Devel Ther. Gender differences in substance use and psychiatric distress among medical students: A comprehensive statewide evaluation. Substance abuse. The frequency of high-risk behaviors among Iranian college students using indirect methods: network scale-up and crosswise model. Prevalence of lifetime tobacco, alcohol and drug use among 10th grade students in Istanbul. Revista Brasileira de Epidemiologia. Pengpid S, Peltzer K. Prevalence and psychosocial correlates of illicit drug use among school-going adolescents in Thailand. Journal of Social Sciences. Correlates of illicit drug use among university students in Africa and the Caribbean. Journal of Psychology in Africa. JRSM open. Religion as a protective factor against drug use among Brazilian university students: a national survey. Revista Brasileira de Psiquiatria. Drug use, family support and related factors in university students. A cross-sectional study based on the uniHcos Project data. Gaceta sanitaria. Iranian Journal of Psychiatry and Behavioral Sciences. Prevalence of hookah smoking in relation to religiosity and familial support in college students of Tabriz, northwest of Iran. International Journal of Epidemiologic Research. Slovenian Journal of Public Health. Prevalence and correlates of substance use among health care students in Nepal: a cross sectional study. BMC public health. Risk-taking behaviors and subgrouping of college students: a latent class analysis. American journal of men's health. Sexting, substance use, and sexual risk behavior in young adults. Journal of Adolescent Health. We use cookies to provide you with the best possible experience. They also allow us to analyze user behavior in order to constantly improve the website for you. Abstract Background: Illicit drug use is a major public health concern among university students. Objectives: The present study aimed to determine the prevalence of illicit drug use and the associated factors in a population of Iranian university students. Methods: This cross-sectional study was conducted in Bushehr, located in the Northwest of Iran in The participants were selected randomly and included university students. Anonymous, structured questionnaires were completed by the students. The self-administered questionnaire consisted of data on illicit drug use, smoking habits, sexual behaviors, alcohol consumption, physical fights, religious beliefs, parental support, and illicit drug use by the family members and friends. Data analysis was performed using chi-square and logistic regression analysis. The lifetime prevalence of cannabis, amphetamine-type stimulants, opium, and heroin was 1. Conclusions: According to the results, the prevalence of illicit drug use was relatively low, albeit significant, among the students in Bushehr. Among the determined factors associated with this issue, illicit drug use was strongly correlated with drug use by friends. Our findings could be used for the planning and evaluation of interventions based on the related risk factors. Background Young adults are considered to be a potentially risk-taking population, and college transition is a significant period for every individual. Objectives The present study aimed to determine the prevalence of illicit drug use and identify the influential factors in a population of Iranian university students. Methods This cross-sectional study was conducted on the students of Bushehr University in Results The mean age of the participants was Table 1. Table 2. Table 3. References 1. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4. Leave a comment here:. Cookie Setting We use cookies to provide you with the best possible experience.

Prevalence and Correlates of HIV Risk Behaviors among Drug Users in China

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This study examined the prevalence and correlates of HIV risk behaviors among 1, current drug users in China. Chi-squared tests of differences were used to test if drug users differed from non-users; logistic regression was used to identify behavior-specific risk factors. Among drug users, ethnic minorities and migrants were most vulnerable to unprotected casual sex and needle sharing. Drug users who experienced social isolation were associated with lower odds of risk behaviors; those who had experiences of anti-social behaviors and commercial sex, poor HIV knowledge, and perceived greater vulnerability were more prone to unprotected casual sex and needle sharing. Additional risk factors of needle sharing included education and initiated drug use at younger ages. It is imperative that HIV interventions in China target drug users and address behavior-specific risk factors. The sweeping HIV epidemic among drug users has taken place in the context of growing drug consumption and spread of HIV risky drug using and sexual behaviors in contemporary China. The number of registered drug users has been increasing rapidly since the s, reaching one million in ; the actual number of drug addicts being probably many times higher CCTV, While very few in the country injected drugs before , a number of studies have reported sharp increases in the proportion of drug users who inject; among injecting drug users, a growing number share used needles without appropriately cleaning them first Garten et al. In addition, unprotected sex with multiple partners is common among drug users Lau et al. The intermingling of risky drug using and sexual behaviors greatly increases drug users' vulnerability to HIV and also makes them an important source and a critical bridging population in the spread of the AIDS virus to the general population through sexual transmission Lau et al. While the HIV risk among drug users as a group has been well documented, not all drug users engage in HIV risk behaviors to the same extent and are at the same risk of acquiring or transmitting HIV. In a study of heroin users in Guangxi province, Lai and colleagues found that more recent, male, and non-ethnic minority users were at increased risk of injecting drugs Lai et al. Age and age at initiation of drug use were also important predictors of injection drug use Lai et al. Among female drug users, exchange of sex for drugs or money was significantly associated with HIV risk behaviors Wang and Lin, Although more limited, research in China has suggested the important influence of family and peers in risky drug using behaviors. For example, Lai et al. The encouragement from friends to try drugs was the strongest predictor of the initiation of drug use Wu et al. A study in southwestern China among the general population, too, suggested that having family members or friends who used drugs or had risky sexual behaviors was a significant predictor of HIV risk behavior Yang, in press. More studies in western societies have documented the importance of social influence of family and peers Hoffmann et al. More systematic research and better understanding of the social and behavioral correlates of drug users' HIV risk behaviors are critical for designing effective behavioral prevention interventions among drug users in China Yu et al. However, such studies are still limited in China Lau et al. Further, prior studies of risky behaviors among drug users in China were largely based on convenient non-probability samples of largely institutionalized drug users; few had looked at the impact of drug users' social and psychological wellbeing on their HIV risk behavior. The purpose of this paper is to examine the prevalence and risk factors of HIV risk behaviors among a random probability sample of 1, current drug users both in and outside drug rehabilitation institutions in southwestern China. Specifically, we address: which drug users are particularly vulnerable to unprotected casual sex and needle sharing and to what extent these HIV risk behaviors were predicted independently by demographic characteristics, measures of economic and psychosocial wellbeing, behavior-specific characteristics and social influence, and HIV-related knowledge and perceived vulnerability. Data used in the analysis were from a large and population-based survey conducted in , covering an entire province in southwestern China. In total, a population-based and probability sample of 5, individuals 18 to 55 years of age was successfully recruited, who consented to participate and completed a face-to-face interview. However, only the sub-sample of 1, current drug users, which included probability samples of both current drug users enrolled in drug rehabilitation institutions and those lived in communities at the time of the survey will be included in the analysis of risk factors of unprotected casual sex and needle sharing among drug users. Briefly, first, eight counties were selected, considering HIV and drug use prevalence and geographic representation of the province. This resulted in a total of 40 townships and neighborhoods as the primary sampling units PSUs. Finally, in each PSU, all individuals between the ages of 18 and 55 were ordered in sequence in one of four mutually exclusive categories: HIV positive, drug users, migrants, and non-migrants. Target random samples of 20 HIV positive, 30 drug users, 40 migrants, and 60 non-migrants were selected from the corresponding categories in each PSU via disproportionate probability sampling Bilsborrow et al. Because not every PSU had the target number of subjects in all categories, the actual sample size in a category varied across PSUs. During the fieldwork, trained interviewers visited the sampled individuals, explained to them the purpose of the study, their right to refuse, and compensation for their time, and invited them to participate. If the respondent was absent, a second visit was scheduled. If a respondent could not be reached the second time or refused to participate, a replacement was selected randomly from the original sampling list containing the absent or refused respondent unless there was no one left on the list. The main outcome variables were self-reported lifetime and day measures of HIV risk drug using and sexual behaviors, namely, unprotected casual sex and needle sharing while injecting. Independent variables included individual demographic characteristics, economic and psychosocial wellbeing, behavior-specific characteristics and influence, and HIV-related knowledge and perceived vulnerability. Individual demographic and most behavior-specific characteristics are self-explanatory. Economic and psychosocial wellbeing was measured by four composite scales, indicating the extent of economic marginalization, social isolation, and lax social control. The higher the score, the more economically marginalized the individual. Cronbach's alpha for the summative composite score was 0. For the former, survey respondents reported on a four-point scale how lonely they felt on each of 20 statements, while the latter was based on ratings of 20 statements on a four-point scale on the frequency of depressive symptoms experienced in the week prior to the interview. The higher the scales, the more lonely or depressed the respondent felt. Cronbach's alphas for the two scales are 0. Lax social control was measured by a modified version of the Attitudes toward Authority Scale Emler, Answers were then summed to create a lax social control scale. The higher the scale, the more likely the respondent had behaved in anti-social or deviant ways. Cronbach's alpha for the scale is 0. Behavior-specific social influence was measured by respondents' self-report of having family members or peers with HIV risk behaviors. For sexual behavior influence, respondents reported separately on whether they knew if parents, siblings, relatives, and friends had multiple sexual partners, homosexual behavior, and exchanged sex for money or drugs. For drug influence, respondents answered separately whether they had parents, siblings, relatives, and friends known to have ever used drugs. Finally, HIV-related knowledge was measured by respondents' number of correct answers to a set of 11 questions on the transmission of HIV and a dichotomous variable indicating whether respondents had discussed condom use with peers. A hot-deck imputation Korn and Graubard, was used to replace missing values for any variable with more than 20 of the 1, cases missing. First, the entire sample was classified into cells, 40 PSUs by four groups HIV positive, drug users, migrants, and non-migrants. Respondents within each cell were then randomly sorted into a sequence. Missing values of respondents within a cell were replaced by the corresponding values of a randomly selected respondent donor from the same cell. If the initial donor happened to also have missing values, the next respondent from the cell was chosen. The process continued until a donor with non-missing values was found within the cell and used to replace the missing values. The validity of the hot-deck imputation is premised on the assumption that, if they had responded, study participants who had missing values would have had the same distribution of responses as the one by participants who had non-missing values on the question. In other words, if respondents who had missing values and those who had non-missing values were very different in what the variable was designed to measure, the imputation method would produce biases. However, for most questions for which imputation was applied, the number of cases with missing value was small, ranging between 20 and Potential biases, if any, introduced by the imputation, would likely be small. Statistical analyses were divided into two parts. In the first part, Chi-squared test of difference in proportions was used to test if drug users differ from non-users in prevalence of HIV risk sexual behaviors as well as STDs and HIV. The second part of the analysis then focused on the sub-sample of 1, current drug users. Chi-squared test of difference in proportions and t -test of difference in means were first used to test bivariate relationship between each independent variable and the likelihood of having unprotected casual sex and needle sharing while injecting in the 30 days prior to the survey. Logistic regression analysis was then conducted to identify if and to what extent the four groups of factors predict independently the odds of having unprotected casual sex and needle sharing while injecting in the 30 days prior to the survey. Compared to non-users, current drug users were on average younger mean age of Both lifetime measures and measures within the 30 days prior to the survey indicate that current drug users had a sex life that was significantly HIV riskier than their non-drug using counterparts. Drug users were also significantly more likely to have been involved in commercial sex than non-users. Further, one in four drug users had taken drugs or alcohols while having sex. The difference in prevalence rates of HIV was large and highly significant between drug users and non-users. After controlling for possible differences in the rate of HIV testing, the likelihood of being HIV positive for a current drug user remained to be more than 50 times that of a non-drug user. Table II presents the results comparing individual demographic characteristics, economic and psychosocial wellbeing, behavior-specific characteristics and social influences, and HIV-related knowledge and perceived vulnerability between current drug users who had unprotected casual sex in the 30 days prior to the survey and those who did not. Compared to those who did not have unprotected casual sex, drug users who had unprotected casual sex in the month prior to the survey were younger and more likely to be single and migrants. In terms of economic and psychosocial wellbeing, they scored significantly higher on the depression, loneliness, and lax social control scales. For behavior-specific characteristics and influence, all five factors were statistically significant. Drug users who reported unprotected casual sex were more likely than those who did not to have initiated sex at an earlier age and before marriage, to have bought sex or exchanged sex for money, to take drugs or alcohols while having sex, and to have more relatives or peers with HIV risk sexual behaviors i. Finally, for HIV-related knowledge, current drug users who had unprotected casual sex did not differ significantly from those who did not. But they perceived greater HIV vulnerability and were more likely to have discussed condom use with friends or peers. However, data in Table III suggest that few variables could statistically separate drug users who shared needles while injecting drugs from those who did not inject or who injected but did not share needles. Of the 15 factors examined, only age, the lax social control scale, age at first drug use, and ever selling or buying sex obtained statistical significance at the bivariate level. On average, drug users who shared needles were younger and initiated drug use at younger ages; they were also more likely to have had more anti-social behaviors i. In the multivariate logistic regression, marital status, ethnicity, and migrant status were significant and independent predictors of the odds of having unprotected casual sex See Table IV. Being married and ethnic majority i. Being migrant, however, was associated with more than four-fold increase in the odds of unprotected casual sex. Therefore, demographically, current drug users who were single, ethnic minority, and migrants were the most vulnerable to HIV risk sexual behavior. As expected, psychosocial wellbeing contributed independently to drug users' sexual behavior. Depression and lax social control both increased the odds of unprotected casual sex among current drug users. But social isolation as measured by the loneliness scale decreased the odds of unprotected casual sex. Two behavior-specific characteristics were predictors of drug users' sexual behavior. Taking drugs or alcohol during sex increased the odds of unprotected casual sex by more than 10 fold, confirming the impact of drug and alcohol consumption on decisions and judgments related to one's sexual behavior. Involvement in commercial sex was another independent risk factor, more than doubling the odds of unprotected casual sex. Somewhat unexpectedly, having family members and friends who practiced risky sexual behavior did not influence drug users' own risky sexual behavior once other factors were controlled for. Finally, drug users' risky sexual behavior was associated independently with perceived vulnerability and peer discussion of condom use. As expected, peer discussion of condoms use predicted lower odds of unprotected casual sex. But the positive impact of perceived HIV vulnerability seemed just the opposite of what would be expected. Instead of decreasing, greater perceived vulnerability actually increased significantly the odds of unprotected casual sex. For the likelihood of needle sharing while injecting drugs, three of the six demographic characteristics were independently associated with the odds of needle sharing among current drug users. The relationship between education and the odds of needle sharing seemed to be curvilinear in that current drug users with a junior high school education had significantly lower odds than both their more and less educated counterparts. For measures of psychosocial wellbeing, social isolation predicted lower, whereas lax social control predicted higher odds of needle sharing among current drug users. In addition, drug users' odds of needle sharing were also predicted independently and significantly by two behavior-specific characteristics, HIV-related knowledge, and perceived vulnerability. Once other factors were controlled, involvement in commercial sex more than doubled the odds of needle sharing. The older the respondent initiated drug use, the lower the odds of having shared needles while injecting. Drug users who know more about HIV and its transmission were less likely to share needles while injecting. But, in opposite to what would be expected, drug users who perceived greater vulnerability were more likely to share needles. Compared to non-users, current drug users were significantly more likely to have had unprotected casual sex with non-stable partners. The combination of high prevalence of HIV and unprotected casual sex among drug users suggests that drug users are not only at significant risk themselves but also an important source of HIV infection and a critical bridging population between high risk and the general populations through sexual transmission. Effective intervention efforts are urgently needed, which should target not only drug users' HIV risk drug using practices but also their risky sexual behavior. However, not all drug users have engaged in HIV risk behaviors to the same extent and are at the same risk of acquiring or transmitting HIV. As the analyses suggest, being ethnic minority and migrant were the common risk factors of unprotected casual sex and needle sharing. Therefore, ethnic minority and migrant drug users are particularly vulnerable to HIV and should be particularly targeted for prevention intervention. Drug users' psychosocial wellbeing was found to contribute significantly and independently to their HIV risk behaviors. An important finding was that drug users who had experience of anti-social behaviors i. The implication and challenge for HIV prevention intervention is, therefore, the need to develop a comprehensive approach that goes beyond targeting exclusively specific HIV risk behaviors and promotes HIV risk reduction in the context of problem behavior reduction in general. In particular, early prevention of problem behaviors through measures that enhance the normative control of behavior may be an important step to take to prevent HIV risk behaviors. An interesting and unexpected finding was that other things being equal social isolation was associated with lower odds of both unprotected casual sex and needle sharing. One possible explanation is that social withdrawal—often a result of drug addiction—may insulate drug users from social contacts, which in turn may advertently reduce their likelihood of unprotected casual sex and needle sharing. Results on behavior-specific factors underscored the potentially detrimental impact of drug and alcohol consumptions on individuals' decisions concerning sexual behavior, which in turn may increase the likelihood of having unprotected casual sex. Given the widespread consumption of alcohols in China, HIV intervention programs need to pay particular attention to the influence of alcohol on risky sexual behavior. Our results also confirmed a clear link between the age at initiation of drug use and the likelihood of needle sharing later. This calls for early prevention and education to be built into school curriculum, job training, or community outreach programs Cuijpers, ; McBride, ; Nation et al. Such early prevention efforts can help to prevent young adults from starting the drug habit. Even if that outright prevention fails our finding suggests that a delay in initiation in drug use may help reduce drug addicts' HIV risk drug using behavior later. A surprising finding on behavior-specific factors was the lack of significant impact of social influences of family and peers. Neither unprotected casual sex nor needle sharing among drug users was predicted by similar behaviors in their social network of family and peers. The finding is in sharp contrast to the literature, which suggests important influence of family and peers in risky drug using behaviors Lai et al. It is also inconsistent with a previous study in the general population from the same survey Yang, in press , in which the same sexual and drug use influence indices were found to be significant and powerful predictors of risky behaviors in the general population. It is possible that family members and peers may exert important influence on the initiation of drug use. But once started the drug habit, drug users' risky behaviors are influenced more by factors other than family and peers. More research is needed to look into the impact of social influence of family and peers on drug users' HIV risk behaviors. Consistent with the literature, we found that knowledge about HIV and its transmission helped to reduce drug users' HIV risk behaviors. Although perceived vulnerability was found significant in predicting both unprotected casual sex and needle sharing, the direction of the impact was counterintuitive. Instead of reducing risk behavior, greater perceived vulnerability predicted higher odds of both unprotected casual sex and needle sharing among the study participants. Unfortunately, the cross-sectional and retrospective design of the survey did not provide data that would allow a clear identification of cause and effect. Another limitation of the study is that, like many behavioral studies of HIV risk behavior, data were based on self-report, which is subject to recall errors. Further, because of high sensitivities of drug using and casual sex in China, people may underreport these behaviors. A third limitation of the study was the use of drug user registries in sample selection. Although the study sample included both drug users enrolled in involuntary detoxification centers and those living in communities, they were known to community and government authorities. Some hidden drug users might have been included in the sample and revealed drug using activities during the interview. But the final sample consisted mainly of known drug users, not representative of hidden drug users. For these study limitations, a prospective study design that also includes hidden drug users in natural settings and incorporates biomarkers to verify HIV risk behaviors is highly recommended in future research. This is one of only a few population-based studies in China that have used probability samples of both drug users enrolled in detoxification centers and those living in communities and appropriate statistical methods to adjust for sampling weights and survey design effects. It is also one of few studies in China that have examined the impact of drug users' psychosocial wellbeing on their HIV risk behavior. The results are, therefore, more representative, offering a more comprehensive understanding of risk factors of unprotected sex and needle sharing among drug users in China. Bilsborrow, R. International migration statistics: Guidelines for the improvement of data collection systems. Geneva: International Labor Office. News broadcast, February Google Scholar. Compton, W. Is antisocial personality disorder associated with increased HIV risk behaviors in cocaine users? Drug and Alcohol Dependence , 37 , 37— Cuijpers, P. Effective ingredients of school-based drug prevention programs: A systematic review. Addictive Behaviors , 27 , — Article PubMed Google Scholar. Emler, N. Moral character. Derlega, B. Winstead, and W. Jones Eds. Chicago, IL: Nelson-Hall. Garten, R. Rapid transmission of hepatitis C virus among young injecting heroin users in southern China. International Journal of Epidemiology , 33 , — Grusky, O. AIDS and Behavior , 6 , — Article Google Scholar. Hammett, T. Correlates of HIV status among injection drug users in a border region of southern China and northern Vietnam. Journal of Acquired Immune Deficiency Syndromes , 38 , — Hoffmann, J. 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Injecting drug use and HIV infection in southwest China. Zhou, H. Zhu, T. Download references. The authors would like to thank the editor and two anonymous reviewers for their helpful suggestions on an earlier version of the paper. You can also search for this author in PubMed Google Scholar. Correspondence to Xiushi Yang. Reprints and permissions. AIDS Behav 10 , 71—81 Download citation. Published : 02 December Issue Date : January Anyone you share the following link with will be able to read this content:. Sorry, a shareable link is not currently available for this article. Provided by the Springer Nature SharedIt content-sharing initiative. Download PDF. Use our pre-submission checklist Avoid common mistakes on your manuscript. Measures The main outcome variables were self-reported lifetime and day measures of HIV risk drug using and sexual behaviors, namely, unprotected casual sex and needle sharing while injecting. Missing Values A hot-deck imputation Korn and Graubard, was used to replace missing values for any variable with more than 20 of the 1, cases missing. Statistical Analysis Statistical analyses were divided into two parts. Table I. Table II. Table III. Table IV. Google Scholar Compton, W. Google Scholar Garten, R. Article Google Scholar Hammett, T. Google Scholar Kelley, J. Google Scholar Lai, S. Google Scholar McBride, N. Article Google Scholar Radloff, L. Article Google Scholar Russell, D. Google Scholar Wang, Q. Google Scholar Wu, Z. Google Scholar Xia, M. Google Scholar Yang, J. Article Google Scholar Yu, E. View author publications. Rights and permissions Reprints and permissions. About this article Cite this article Yang, X. Copy to clipboard. Search Search by keyword or author Search. Navigation Find a journal Publish with us Track your research.

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