Background: The relationship between risky sexual behaviour (RSB) and opioid use disorder (OUD) is discussed throughout the literature, with risk of viral transmission amongst substance-using populations now more closely linked to high-risk heterosexual sexual activity than injection drug use. There is evidence to suggest that treatment with medications for opioid use disorder (MOUD) reduces RSB for both sexes, through mechanisms such as reduced illicit substance use and associated economic burden. While there is repeated evidence for gender differences in RSB, substance use trajectory, treatment seeking and outcome, female opioid users are still underrepresented throughout the literature.

Aim: To measure sex-specific effects of engagement in MOUD treatment programs on RSB in female opioid users.

Design: Systematic review of all available literature for female participants, with narrative review on extracted data.

Findings and Conclusion: Seventeen studies (n=17) were eligible for inclusion. While no effects were found of MOUD on condom use, there were significant reductions seen across studies in outcomes such as multiple sex partners, transactional sex, and sex risk composite scores.

Conclusion: The study concludes that 1) female use of condoms with male sex partners is associated with self-efficacy and perceived negotiating skills and 2) a reduction in the economic burden of substance use, as a result of treatment with MOUD, reduces the necessity of transactional sex. This systematic review highlights the need for future sex-specific research in the field of RSB and a revision of the criteria to include female-specific sexual risks.

Presentation slides:
Medications for opioid use disorder and risky sexual behaviour in female opioid users: A systematic review

Presented by co-author, Dr Rebecca McDonald.