Inconsistent Condom Use and Its Associations Among Individuals with Substance Use Disorders: A Systematic Review and Meta-analysis

IntroductionThe prevalence of risky sexual behaviors-especially inconsistent condom use (ICU)-is greater among individuals with substance use disorders (SUDs). ICU may lead to sexually transmitted diseases (STDs) and HIV infection among individuals with SUDs. The present study aimed to determine the prevalence, sociodemographic characteristics, risky behaviors, and type of psychoactive drug use associated with ICU among individuals with SUD.MethodsPapers published between January 1, 1990, and December 20, 2022, were reviewed and extracted from the PubMed, Scopus, Web of Science, and Cochrane Library databases. Two independent authors reviewed the full texts of the selected papers in accordance with the PECOS guidelines as well as the study's exclusion criteria. For detecting heterogeneity between the studies, several sub-group analyses were conducted. To perform sensitivity analyses, Baujat plots with random effect models were applied.ResultsAfter initial assessment of 11,969 papers, a total of 117 studies met the eligibility criteria. Among individuals with SUD, the findings indicated lifetime pooled prevalence rates of ICU with any sexual partners to be 61% for vaginal sex (95% CI, 57-65%), 48% for anal sex (95% CI, 39-56%), and 81% for oral sex (95% CI, 68-93%). The findings indicated that individuals with SUD who report ICU with any sexual partners were more likely to be female, to have multiple sexual partners, to have a history of HIV testing, to have HIV-negative status, and to primarily use methamphetamine, cocaine, crack, ecstasy, or heroin (or engage in polysubstance use).ConclusionsIncreasing awareness regarding the importance of consistent condom use, as well as HIV/AIDS at family, peer, and partner levels, would likely substantially help to improve safe sex among individuals with SUD.Policy ImplicationsThese programs can include needle/syringe exchange programs, condom distribution, and opioid substitution interventions. Consequently, the likelihood of high-risk sexual activities and contracting STDs could be minimized among this vulnerable population.