ABSTRACT
Purpose: Risky overdose behaviors, such as using drugs by oneself, and risky sexual behaviors, such as engaging in unprotected sex, can lead to serious health outcomes, including experiencing a drug overdose and contracting HIV. During the COVID-19 pandemic, we have seen alarming increases in depression and anxiety, as well as COVID-19 fears and worries. A better understanding of how mental health symptoms and fears surrounding the COVID-19 pandemic have impacted risk behaviors is crucial to remedying the growing public health concern of increasing overdoses and HIV infections. The goal of this project is to measure the potential impact of anxiety, depression, and COVID-19 fears on overdose and sexual risk behaviors. Brief statement of methods used: Adults (n = 214) who resided in Texas and reported regular use of illicit drugs were considered eligible for a longitudinal study assessing mental health among PWUD during COVID-19. For this secondary analysis, we used measures of anxiety (GAD-7), depression (CES-D), fear of COVID-19 (FCV-19), overdose risk behavior, and HIV and sexual risk behavior. We performed Fisher's odds ratio tests to determine whether scoring above the clinical cutoffs for anxiety, depression, or fear of COVID-19 significantly affected the risk of engaging in certain overdose or HIV and sexual risk behaviors. Summary of results: In regard to overdose risk behaviors, we found that high scores of anxiety and depression significantly increased the likelihood of using opioids and alcohol at the same time. Higher levels of anxiety also significantly raised the odds of using opioids alone or witnessing an overdose. Concerning HIV risk behaviors, high scores of anxiety significantly increased the odds of injecting drugs. On the contrary, high scores of COVID-19 fear significantly decreased the odds of engaging in sexual activity with someone who did not know their HIV status. Statement about conclusion: These results showed that individuals experiencing high levels of anxiety or depression are at a greater risk of engaging in risky behaviors that may lead to experiencing an overdose, while fear of COVID-19 may act as a protective factor against sexual risk behaviors. Harm reduction resources and safer drug use education should be made available to those most vulnerable.