Sexual Risk Among African Americans in Substance Use Treatment: Secondary Analysis of Two Clinical Trials

African Americans who use substances experience a particular risk for HIV. Negative attitudes towards condoms are a strong predictor of risk and can serve as barriers to safe sex. They also vary by gender. In a secondary analysis of data from two National Drug Abuse Treatment Clinical Trials Network trials collecting data from 2004 to 2006, the relationship between gender, unprotected sex, and condom barriers among 203 African Americans in substance use treatment was examined. Results indicated that no gender differences were present in unprotected sex. Men reported more motivational barriers to condom use and were more likely to believe that condoms would impede sexual experience (the latter not statistically significant). For both genders, the perception that condoms might negatively impact sexual experience was associated with unprotected sex. Gender did not moderate the relationship between condom barriers and unprotected sex. These findings suggest the need for gender and race-specific prevention strategies that focus on motivation and address pleasure-based concerns regarding condoms. Substance use treatment facilities are well-positioned to support interventions to target these issues.