Recent marijuana use in HIV-infected Russians associated with increased sex and drug risk behaviors

(Press-News.org) (Boston) – Researchers from Boston Medical Center (BMC) and Boston University's School of Medicine (BUSM) and School of Public Health (BUSPH) have found that in Russian HIV-infected risky drinkers, marijuana use is associated with other increased risky behaviors involving drug use and sex. These findings, published online in the journal Drug and Alcohol Dependence, may aid clinicians and public health experts in detecting individuals at a higher risk of transmitting HIV.

Marijuana, otherwise known as cannabis, is the most frequently used illicit drug worldwide. Previous research has shown that in certain non-HIV infected populations, marijuana use is associated with the use of other drugs such as cocaine and heroin, as well as an increase in unprotected sex and a larger number of sexual partners. In Russia, the HIV epidemic has been largely propelled by injection drug use (IDU), although HIV transmission through unprotected sex is increasing. Still, not much is known about marijuana use and its impact on those behaviors in individuals already infected with HIV.

To investigate this, Jeffrey Samet, MD, MPH, from the Clinical Addiction Research and Education (CARE) Unit at BUSM and colleagues examined data collected in St. Petersburg, Russia, in a cohort of 700 HIV-infected individuals with risky drinking practices. Risky drinkers were defined as men who drink more than four drinks a day or 14 drinks a week and women who consume more than three drinks a day or seven drinks a week. In this population, the frequency of marijuana use within the previous year was determined and those who used were compared to the non-users with regard to risky drug and sex practices, including needle sharing, IDU, the number of sex partners and frequency of condom use.

Working with colleagues from Russia, the researchers found that baseline marijuana use was relatively common, with 20 percent having used within the previous month and 46 percent within the previous year. Forty-two percent of the respondents admitted to IDU and 23 percent to sharing needles within the previous 30 days, and 27 percent reported multiple sexual partners in the previous three months.

The data also showed a significant association among individuals who reported using marijuana within the previous 30 days and an increase in sharing needles, IDU and increase in the number of injections. In addition, while marijuana use was not associated with decreased condom use, it was associated with an increased number of sexual partners.

The study results indicate that asking HIV-infected patients about marijuana use may identify those who are at a higher risk for transmitting HIV.

"I don't think physicians currently inquire about marijuana use among HIV-infected individuals in part because they are not sure what to do with the information," said Samet, chief of general internal medicine at BMC and the article's corresponding author. "Given these findings and the high prevalence of marijuana use, it is important to explore whether or not its use results in risky behavior."

### Funding for this study was provided by the National Institutes of Health's National Institute of Alcohol Abuse and Alcoholism under grant awards R01AA016059 (Principal Investigator (PI): Samet), U24AA020778 (PI: Samet), U24AA020779 (PI: Debbie Cheng, ScD) and K24AA015674 (PI: Samet) and a National Institute on Drug Abuse INVEST fellowship.