Disability, Binge Drinking, and HIV Risk in the United States

Background and Purpose. People with pre-existing disabilities may face increased risk of HIV infection due to exposure to sexual violence, substance abuse, difficulties navigating safer sex, and inadequate access to HIV prevention services. Despite calls for increased research with existing survey data, there is little population-based scholarship examining HIV risk, alcohol abuse, and disability status. This lack of research into interrelationships between disability status, HIV risk and alcohol abuse lays bare gaps in health research that could inform HIV and substance abuse prevention as well as support services for people with disabilities. Using data from a nationally-representative survey in the United States, this study examined the relationship between disability, binge drinking, and HIV risk behaviors.

Methods. The current findings are based on data from the 2011 and 2012 Behavioral Risk Factor Surveillance System (BRFSS) survey, comprising 982,154 non-institutionalized adults. The measure for HIV risk indicated whether any of the following high risk situations occurred in the past year: intravenous drug use, treatment for a sexually transmitted or venereal disease, giving/receiving money or drugs in exchange for sex, and anal sex without a condom. Drawing from prior disability research (see Pharr & Bungum, 2012), 3 measures for disability status were used: 1) activity limitations (“Are you limited in any way in any activities because of physical, mental, or emotional problems?”), 2) Use of special equipment (“Do you now have any health problem that requires you to use special equipment, such as a cane, a wheelchair, a special bed, or a special telephone?”) and 3) both activity limitations and use of special equipment. Binge drinkers were identified by five or more drinks on one occasion (males) or four or more drinks on one occasion (females). Alcohol use in the past 30 days was also inlcuded. Controlling for sociodemographic factors and weighting for the complex survey design, logistic regression was used to model associations between each disability measure, HIV risk, and alcohol use.

Results. Relationships were found between higher HIV risk and the 3 disability measures. People with activity limitations (n = 163,563) were more likely to report HIV risk behavior than those without activity limitations (AOR = 1.56, 95% CI = 1.45-1.68). Similarly, people using special equipment (n = 21,441) were 1.5 times more likely to report HIV risk behaviors in the past year than people without special equipment needs. For people with both activity limitations and special equipment needs, HIV risk was 19% higher than those without both disabilities (AOR = 1.19, 95% CI = 1.04-1.37). Binge drinking was more likely among people using special equipment than counterparts not using special equipment (AOR = 1.05, 95% CI = .913-1.21).

Conclusions. The present study draws attention to the confluence of HIV risk, alcohol abuse, and disability status in the U.S. Using rigorous quantitative analysis of nationally-representative data, higher HIV risk was found to be associated with 3 different measures of disability. Moreover, binge drinking, a well-documented risk factor for HIV acquisition, was more likely among people with special equipment needs.