The dual risks of male-to-male sex and drug injection have put men who have sex with men and inject drugs (MSM-IDU) at the forefront of the HIV epidemic, with the highest rates of infection among any risk group in the United States. This study analyzes data collected from 357 MSM-IDU in San Francisco between 1998 and 2002 to examine how risk behaviors differ by HIV serostatus and self-identified sexual orientation and to assess medical and social service utilization among HIV-positive MSM-IDU. Twenty-eight percent of the sample tested HIV antibody positive. There was little difference in risk behaviors between HIV-negative and HIV-positive MSM-IDU. Thirty percent of HIV-positive MSM-IDU reported distributive syringe sharing, compared to 40% of HIV negatives. Among MSM-IDU who reported anal intercourse in past 6 months, 70% of positives and 66% of HIV negatives reported unprotected anal intercourse. HIV status varied greatly by self-identified sexual orientation: 46% among gay, 24% among bisexual, and 14% among heterosexual MSM-IDU. Heterosexual MSM-IDU were more likely than other MSM-IDU to be homeless and to trade sex for money or drugs. Gay MSM-IDU were more likely to have anal intercourse. Bisexual MSM-IDU were as likely as heterosexual MSM-IDU to have sex with women and as likely as gay-identified MSM-IDU to have anal intercourse. Among MSM-IDU who were HIV positive, 15% were currently on antiretroviral therapy and 18% were currently in drug treatment, and 87% reported using a syringe exchange program in the past 6 months. These findings have implications for the development of HIV interventions that target the diverse MSM-IDU population.
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1. CDC HIV/AIDS among men who have sex with men and inject drug—United States, 1985–1998. MMWR Morb Mortal Wkly Rep. 2000;49:465–470. [PubMed] 2. Bluthenthal RN, Kral AH, Gee L, et al. Trends in HIV seroprevalence and risk among gay and bisexual men who inject drugs in San Francisco, 1988–2000. J Acquir Immune Defic Syndr. 2001;28:264–269. [PubMed]
3. 2001 HIV Consensus Meeting Report: San Francisco, Estimates of Population Size, HIV Prevalence, and HIV Incidence. San Francisco Department of Public Health; 2001.
4. Kral AH, Lorvick J, Gee L, et al. Trends in Human Immunodeficiency Virus seroincidence among street-recruited injection drug users in San Francisco, 1987–1998. Am J Epidemiol. 2003;157:915–922. doi: 10.1093/aje/kwg070. [PubMed] [Cross Ref] 5. Ekstrand ML, Stall RD, Paul JP, Osmond DH, Coates TJ. Gay men report high rates of unprotected anal sex with partners of unknown or discordant HIV status. AIDS. 1999;13:1525–1533. doi: 10.1097/00002030-199908200-00013. [PubMed] [Cross Ref] 6. Maslow CB, Friedman SR, Perlis TE, Rockwell R, Jarlais DC. Changes in HIV seroprevalence and related behaviors among male injection drug users who do and do not have sex with men: New York City, 1990–1999. Am J Public Health. 2002;92:382–384. [PubMed]
7. Deren S, Estrada A, Stark M, Williams M, Goldstein M. A multisite study of sexual orientation and injection drug use as predictors of HIV serostatus in out-of-treatment male drug users. J Acquir Immune Defic Syndr. 1997;15:289–295.
8. Strathdee SA, Galai N, Safaiean M, et al. Sex differences in risk factors for HIV seroconversion among injection drug users: a 10-year perspective. Arch Intern Med. 2001;161:1281–1288. doi: 10.1001/archinte.161.10.1281. [PubMed] [Cross Ref] 9. Stall R, Purcell DW. Intertwining epidemics: a review of research on substance use among men who have sex with men and its connection to the AIDS epidemic. AIDS Behav. 2000;4:181–192. doi: 10.1023/A:1009516608672. [Cross Ref] 10. Rietmeijer CA, Wolitski RJ, Fishbein M, Corby NH, Cohn DL. Sex hustling, injection drug use, and non-gay identification by men who have sex with men. Associations with high-risk sexual behaviors and condom use. Sex Transm Dis. 1998;25:353–360. [PubMed] 11. Bull SS, Piper P, Rietmeijer C. Men who have sex with men and also inject drugs-profiles of risk related to the synergy of sex and drug injection behaviors. J Homosex. 2002;42:31–51. doi: 10.1300/J082v42n03_03. [PubMed] [Cross Ref] 12. Catania JA, Osmond D, Stall RD, et al. The continuing HIV epidemic among men who have sex with men. Am J Public Health. 2001;91:907–914. doi: 10.2105/AJPH.91.6.907. [PubMed] [Cross Ref] 13. Patterson TL, Semple SJ. Sexual risk reduction among HIV-positive drug-using men who have sex with men. J Urban Health. 2003;80(suppl 3):iii77–iii87. [PMC free article] [PubMed] 14. Kral AH, Bluthenthal RN, Lorvick J, Gee L, Bacchetti P, Edlin BR. Sexual transmission of HIV-1 among injection drug users in San Francisco, USA: risk-factor analysis. Lancet. 2001;357:1397–1401. doi: 10.1016/S0140-6736(00)04562-1. [PubMed] [Cross Ref]
15. Watters JK, Biernacki P. Targeted sampling: options for the study of hidden populations. Social Probl. 1989;36:416–430.
16. CDC Interpretation and use of the Western blot assay for serodiagnosis of human immunodeficiency virus type 1 infections. MMWR Morb Mortal Wkly Rep. 1989;38:1–7.
17. Halkitis PN, Parsons JT, Wilton L. Barebacking among gay and bisexual men in New York City: explanations for the emergence of intentional unsafe behavior. Arch Sex Behav. 2003;32:351–357. doi: 10.1023/A:1024095016181. [PubMed] [Cross Ref]
18. HIV/AIDS Epidemiology Annual Report 2002. San Francisco, CA: San Francisco Department of Public Health, HIV/AIDS Statistics and Epidemiology Section; 2002.
19. Rawson RA, Huber A, McCann M, et al. A comparison of contingency management and cognitive-behavioral approaches during methadone maintenance treatment for cocaine dependence. Arch Gen Psychiatry. 2002;59:817–824. doi: 10.1001/archpsyc.59.9.817. [PubMed] [Cross Ref] 20. Ciccarone DH, Kanouse DE, Collins RL, et al. Sex without disclosure of positive HIV serostatus in a US probability sample of persons receiving medical care for HIV infection. Am J Public Health. 2003;93:949–954. [PubMed]