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IDUs in NYC Have Risky Sexual Behavior
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"Self-reported sexual risk behaviors and HIV prevalence among a sample of active injection drug users residing in New York City"
...82% were sexually active in last 12 months....72% did not use condoms...18% were tested HIV+ among IDUs surveyed in this study...
Murrill C.1, Hagan H.2, Wendel T.2, Cleland C.2, Liu K.-l.1, Raj-Singh S.1, Woodall A.2, Torian L.1
1New York City Department of Health and Mental Hygiene, HIV Epidemiology Program, New York, United States, 2National Development and Research Institutes, Inc., New York, United States
Epidemiologic monitoring of HIV prevalence and sexual risk behaviors, in addition to injection related risk behaviors, is critical for effective planning and evaluation of prevention services targeting injection drug users (IDUs).
A cross-sectional anonymous survey was used to question active IDUs recruited through respondent driven sampling methods as part of the U.S. CDC's National HIV Behavioral Surveillance system. Information on sexual risk was collected through a standardized questionnaire administered by trained interviewers. HIV testing was performed on a sub-sample of participants. Sexual activity was defined as one or more sex partner in the past 12 months. Sexual risk was defined as unprotected vaginal or anal sex with a partner at least once during the previous 12 months.
RESULTS:
-- A total of 504 IDUs participated in the survey during July-December, 2005.
-- Median age of participants was 43 years, 57% were Hispanic, 27% Black, and 28% female.
-- Preliminary unadjusted data show that 82% were sexually active within the previous 12 months.
-- 8% of males had reported sex with another man, 52% of them had unprotected anal sex.
-- Overall, 71% of the sexually active participants reported non-condom use during vaginal or anal sex.
-- Females compared to males were as likely to engage in unprotected sex (72% vs. 71%) as well as to engage in exchange of money or drugs for sex (30% vs. 32%), with 3% vs. 8% reporting unprotected sex during such encounters. Among 249 persons who consented to HIV testing, HIV prevalence was 18%.
The authors concluded:
"Sexual risk, in addition to injection related risk, should be addressed in prevention programs implemented in settings that target this population group (i.e. syringe exchange)".
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Sexual Transmission Appears Greater than Transmission Due to Sharing Syringes in NYC Study
"Convergence of HIV seroprevalence among injecting and non-injecting drug users in New York City: a new stage in a very large HIV epidemic"
Des Jarlais D.C.1, Arasteh K.1, Perlis T.1, Hagan H.2, Abdul-Quader A.3, Heckathorn D.D.4, McKnight C.5, Bramson H.1, Nemeth C.6, Torian L.7, Friedman S.R.2
1Beth Israel Medical Center, Baron Edmond de Rothschild Chemical Dependency Institute, New York, United States, 2National Development and Research Institutes, Inc., New York, United States, 3Centers for Disease Control and Prevention, Atlanta, United States Minor Outlying Islands, 4Cornell University, Ithaca, United States, 5Beth Israel Medical Center, Baron Edmond de Rothschild Chemical Dependency Institute, New York, United States Minor Outlying Islands, 6New York State Department of Health, Albany, United States, 7New York City Department of Health and Mental Hygiene, New York, United States
New York City has experienced the oldest and largest epidemic of HIV among drug users. Injection related transmission has traditionally been the dominant mode of transmission, but there are indications of the increasing importance of heterosexual transmission. We compared current HIV prevalence among injecting and non-injecting drug users to assess the relative importance of injecting and sexual transmission among drug users in the city. As HIV is readily transmitted through the sharing of drug injecting equipment, excess HIV infection would be expected among injecting drug users.
Risk behavior and HIV prevalence surveys were conducted with injecting and non-injecting heroin and cocaine users entering detoxification and methadone maintenance treatment from 2000-04 (N = 2121) and recruited through respondent driven sampling from a research storefront in 2004 (N = 448) in New York City.
In both studies, HIV prevalence was nearly identical among current injectors (injected in the last 6 months) and heroin and cocaine users who had never injected : 13% (95% CI 12% to 15%) among current injectors and 12% (95% CI 9% to 16%) among never-injectors in the drug treatment program study, and 15% (95% CI 11% to 19%) among current injectors and 17% (95% CI 12% to 21%) among never injectors in the respondent driven sampling storefront study. There were overlaps in the 95% CIs in all gender and race/ethnicity subgroup comparisons in both studies.
The authors concluded:
The very large HIV epidemic among drug users in New York City appears to be entering a new phase, in which heterosexual transmission may be equally or more important than injecting related transmission. Over long time periods, endemic HIV may generate substantial self-sustaining heterosexual transmission among both injecting and non-injecting drug users. New prevention programs are needed to address this transition.
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