Relationship-level analysis of drug users' anticipated changes in risk behavior following HIV vaccination

Formative research into the behavioral factors surrounding HIV vaccine uptake is becoming increasingly important as progress is made in HIV vaccine development. Given that the first vaccines on the market are likely to be partially effective, risk compensation (i.e., increased risk behavior following vaccination) may present a concern. This study characterized the relationships in which HIV vaccine-related risk compensation is most likely to occur using dyadic data collected from people who use drugs, a high-risk group markedly underrepresented in extant literature. Data were collected from 433 drug users enrolled in a longitudinal study in the USA. Respondents were asked to provide the first name and last initial of individuals with whom they had injected drugs and/or had sex during the past six months. For each partner, respondents reported their likelihood of increasing risk behavior if they and/or their partner received an HIV vaccine. Using generalized linear mixed models, relationship-level correlates to risk compensation were examined. In bivariate analysis, risk compensation was more likely to occur between partners who have known each other for a shorter time (odds ratio [OR] = 0.95, 95% confidence interval [CI]: 0.90-0.99, p = 0.028) and between those who inject drugs and have sex together (OR = 2.52, CI: 1.05-6.04, p = 0.039). In relationships involving risk compensation, 37% involved partners who had known each other for a year or less compared to only 13% of relationships not involving risk compensation. Adjusting for other variables, duration (OR: 0.95, CI: 0.90-1.00, p = 0.033) was associated with risk compensation intent. These analyses suggest that risk compensation may be more likely to occur in less established relationships and between partners engaging in more than one type of risk behavior. These data provide further support for the need to expand measures of risk compensation in HIV vaccine preparedness studies to assess not only if people will change their behavior, but also with whom.