Antisocial behavior as a predictor of risk behavior for HIV transmission in HIV-positive mentally ill substance abusers
Objective. Prior research has found that individuals with Antisocial Personality Disorder (ASPD) and Borderline Personality Disorder (BPD) engage in high rates of sexual and injection drug risk behaviors. The goal of the present study was to elucidate the relationship between antisocial behavior and sexual and injection drug risk behavior among HIV-positive individuals with a history of substance abuse and major mental illness. It was hypothesized that a diagnosis of ASPD or BPD would significantly add to the prediction of sexual and injection drug risk behaviors over and above years of drug use. Additionally, given prior research suggesting a relationship between drug abuse and crime, the present study sought to determine whether non-violent and violent crime significantly added to the prediction of risk behavior over and above years of drug use. Gender differences with respect to engagement in risk behaviors were also examined. Method. The SCID-I and II were used to determine the presence of select Axis I and Axis II among 106 HIV-positive substance abusers enrolled in methadone maintenance treatment. The BPRS was use to assess psychiatric symptom severity. Select questions from the RAB were used to assess sexual and injection drug risk behavior. The Legal Status section of the ASI was used to assess history of non-violent and violent offenses. Results. Fifty-nine percent of the sample met criteria for ASPD and thirty-one percent met criteria for BPD. Among the 57 female participants in the study, eight (14%) reported engaging in unprotected sex with an HIV-negative partner or partner of unknown status in the preceding three months, while eight (14%) reported engaging in unprotected sex with an HIV-positive partner. None of the 49 male participants in the study reported engaging in unprotected sex with an HIV-negative partner or partner of unknown status, while six (12%) reported engaging in unprotected sex with an HIV-positive partner. Thirty (28%) of the participants (28.3%) reported using needles to inject drugs in the past three months, but only one participant (.9%) reported sharing drug equipment with someone else. Eighty-five percent of the sample had committed a non-violent offense, while forty-seven percent had committed a violent crime. Substance use in the past months and past six months significantly added to the prediction of both sexual and injection drug risk behavior over and above years of drug use. Non-violent crime significantly added to the prediction of injection drug risk over and above years of drug use. A diagnosis of ASPD or BPD did not enhance the predictability of sex or drug risk. Further, gender, the interactions of gender with personality variables, violent crime, and depression/anxiety were unrelated to both sex and drug risk. Conclusions. The present findings do not provide evidence of an association between personality disorder and sexual and injection drug risk behavior. Rather, they suggest that current substance use is related to both sexual and injection drug risk behavior, while non-violent crime is related to injection drug risk. These findings suggest a more complex taxonomy of antisocial behavior than is currently represented by DSM-IV. ^
Diana M Dimitri,
"Antisocial behavior as a predictor of risk behavior for HIV transmission in HIV-positive mentally ill substance abusers"
(January 1, 2005).
ETD Collection for Fordham University.