Cocaine users with antisocial personality improve HIV risk behaviors as much as those without antisocial personality

Previous work has documented that antisocial personality disorder (APD) is associated with increased rates of HIV risk behaviors and with worse substance abuse treatment outcomes. The question addressed by this paper is whether cocaine users with APD respond to an HIV risk-reduction intervention as well as cocaine users without the disorder. The study subjects were 333 cocaine users followed up at 18 months as part of a NIDA-funded treatment demonstration project. The total sample improved across a wide range of HIV risk behaviors. Improving significantly (P < 0.05) from baseline to the 18-month follow-up were several drug-related behaviors: cocaine use; current cocaine dependence; use of drugs other than cocaine drug injection; injection equipment sharing, and use of syringes that were not cleaned. Several sex-related HIV risk behaviors also improved significantly: having multiple sex partners; being intoxicated during sex, giving drugs for sex; receiving money for sex; and receiving drugs for sex. When the sample was stratified by APD status, very similar improvement was seen in respondents with and without APD. To examine further the relationship of APD to change in HIV risk behaviors, separate logistic regression models of improving and worsening HIV risk behaviors were tested. What the authors found was no association of APD with improvement in HIV risk behaviors but a significant association of APD with worsening HIV risk behaviors. It appears that cocaine users with APD improve their HIV risk behaviors just as much as those without APD but may be at higher HIV risk for the development of such behaviors.