Drug-related HIV Risk Behaviors Decrease during Treatment with Buprenorphine/Naloxone in Primary Care

Methadone maintenance treatment reduces HIV risk behaviors and transmission among opioid dependent patients; however, the impact of primary-care based buprenorphine/naloxone (BN) maintenance treatment on HIV risk behaviors has not been examined. Researchers studied changes in HIV risk behaviors among 155 opioid dependent subjects receiving primary-care–based BN maintenance treatment who were enrolled in a randomized controlled trial of 2 levels of psychosocial counseling. Neither counseling arm received HIV-specific risk reduction counseling.

• Past 3-month injection drug use decreased from 37% at baseline to 12% at 12 weeks and 7% at 24 weeks.

• Past 3-month needle sharing decreased from 8% at baseline to 4% at 12 weeks and 1% at 24 weeks.

• Past 3-month sex with a steady partner while under the influence of drugs or alcohol was the only sex-related HIV risk behavior that decreased (from 64% at baseline, to 13% at 12 weeks and 15% at 24 weeks).

• Other sex-related HIV risk behaviors, including using a condom less than 50% of the time with a steady partner and suggesting using a condom, did not change significantly during follow-up.

• No changes in HIV risk behaviors were detected by counseling group assignment.

Comments:

This secondary analysis of a randomized controlled trial demonstrates that drug-related HIV risk behaviors decrease during BN maintenance in primary care. Additional risk-reduction counsel-ing interventions are needed to increase condom use and decrease non-drug–related sexual risk behaviors among BN maintenance patients.

Alexander Y. Walley, MD, MSc

Reference:

Sullivan LE, Moore BA, Chawarski MC, et al. Buprenorphine/naloxone treatment in primary care is associated with decreased human immunodeficiency virus risk behaviors. J Subst Abuse Treat. 2008;35(1):87–92.