Substance-Abusing Men Place Wives at High Risk for HIV

BUFFALO, N.Y. -- Substance-abusing men who engage in behavior that puts them at high risk for direct exposure to HIV are likely to put their wives at high risk for indirect HIV exposure through unprotected sexual intercourse with their spouses, according to a study at the University at Buffalo's Research Institute on Addictions (RIA).

In most cases, wives in the study were not having sex out of their marriage, were unaware of their husband's high-risk behavior and did not know that they, in turn, were being placed at high risk.

The study, involving 362 drug-abusing men entering outpatient treatment and their wives, found that 40 percent -- or 144 -- of the husbands had during the year prior to entering treatment engaged in unprotected penetrative sexual intercourse with a person other than their spouse or engaged in risky needle practices, such as utilizing a used syringe.

With all but six of the wives in the subgroup reporting that they had sexual intercourse with their spouse during the same time period, 78 percent -- or 108 -- of the wives reported that condoms were not used regularly when they had intercourse with their husband. Seventy-one percent -- or 77 -- of the 108 wives reported they were not aware of their husbands' high-risk behaviors. Thirty-one wives were aware of their husband's high-risk behaviors, but still engaged in unprotected sexual intercourse with them.

Results of the study are reported in the May 2003 issue of Drug and Alcohol Dependence.

William Fals-Stewart, Ph.D., lead researcher on the study, said it identifies a "hidden" at-risk group -- non-substance-abusing women indirectly and unknowingly exposed to HIV, sexually transmitted disease and hepatitis by having unprotected sexual intercourse with their husbands.

"This population is under-recognized as being at-risk," said Fals-Stewart, a clinical psychologist who is a senior research scientist at RIA and research associate professor in the Department of Psychology in the UB College of Arts and Sciences.

"By publishing this information, we hope to get the word out to women in these relationships to begin thinking about having themselves tested for sexually transmitted diseases and also using condoms when having intercourse with their husbands."

The article notes that women are the fastest-growing group infected by HIV in the U.S. HIV infection is the fifth-leading cause of death among American women ages 25-44 and the No. 3 cause of death among African-American women in that age group. The Centers for Disease Control estimates that among women, about 40 percent of new AIDS cases and 75 percent of new HIV infections are due to heterosexual transmission.

Eighty-two percent of the 362 men in the UB study abused and were dependent on alcohol, and other drugs also were involved. Sixty-nine percent were dependent on cocaine, 64 percent were dependent on opiates.

Couples in the study had been married on average for six years. More than 70 percent of participants were white; fewer than 20 percent were African American. Couples were not included in the study if a partner reported he or she was HIV seropositive.

According to Fals-Stewart, "The majority of the husbands engaging in extramarital relationships were doing so with very high-risk women. These women either used intravenous drugs and/or had multiple sexual partners." In contrast, the wives in the study reported no drug use and less than 2 percent reported extramarital relationships.

"The couples in which wives are placed at high indirect exposure to HIV," Fals-Stewart explained, "also appear to include husbands with high levels of antisocial characteristics." Those antisocial personalities are typified by behaviors such as callousness, selfishness and remorseless use of others. Antisocial characteristics increase the likelihood of risky needle practices, extramarital relationships and general disregard for health concerns -- their own as well as their partner's.

Fals-Stewart said that while the researchers could not breach confidentiality by informing wives in the study of their husband's promiscuity, they "initiated strategies for reducing the risk by introducing psychoeducational counseling into future treatment studies.

"As a result of this research, our staff now talks with couples and communicates the general findings of the study. We encourage couples to talk to each other about the findings, provide assistance in negotiating future behaviors, and suggested a 'safety contract' in which each partner agrees to be tested for HIV and to share the results with each other. Partners also agree to use condoms in any relationship outside the marriage and to engage in safe needle practices."

Although previous studies have found that women in long-term relationships often have low levels of power and difficulty negotiating safer sex practices, Fals-Stewart said that

building the negotiation into a treatment program allows trained, master's-level counselors to assist wives with this effort during sessions that include both husband and wife.

"Viewing risk and prevention in the context of a marital relationship provides an important vantage point from which to understand the dynamics of HIV exposure," he added. "Among these couples, husbands had engaged in high-risk behaviors, marriages were long-term relationships where couples rarely used condoms, husbands had been diagnosed with antisocial personality disorder and wives lacked knowledge of husbands' high-risk behaviors. Within this scenario, there is a unique and increased likelihood of wives being placed at high-risk for indirect exposure to HIV."

The study was funded by a $2 million award from the National Institute on Drug Abuse and a $10,000 faculty development award from Old Dominion University. Fals-Stewart was affiliated with Old Dominion when the data were being collected.

The other researchers on the study were: Gary R. Birchler, Ph.D., of the San Diego VA Medical Center, and Cassandra Hoebbel, Todd B. Kashdan, James Golden, Ph.D., and Kathleen Parks, Ph.D., all of the University at Buffalo's RIA.

The Research Institute on Addictions (RIA) has been a leader in the study of addictions since 1970 and a research center of the University at Buffalo since 1999.