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
April 1, 2002
Injection drug users (IDUs) who are also men who have sex with men (MSM) continue to be at particularly high risk for HIV infection. In 1999, over 23 percent of US AIDS patients with a history of injecting drugs were MSM. MSM IDUs may be more likely than other IDUs to engage in some injection and sexual risk behaviors, and these behaviors may serve as a bridge for HIV transmission to various other groups. In New York City, HIV seroprevalence, HIV seroincidence, and injection risk behaviors have declined among IDUs. Relatively little is known about differences between MSM IDUs and other male IDUs regarding trends in risk behaviors and HIV prevalence.
Data were collected as part of an ongoing series of studies of entrants to a drug detoxification program at Beth Israel Medical Center in New York City. Male subjects entering the program between Jan. 16, 1990, and July 23, 1999, age 18 or older who had injected illicit drugs within the previous 6 months were eligible for inclusion. Potential participants were eligible to be interviewed once in any calendar year during which they remained behaviorally eligible. Subjects were classified as MSM if they reported sexual intercourse with a man in the 5 years prior to the interview. The period of observation was dichotomized into 1990-1994 and 1995-1999. Analyses compared male IDUs who were and were not MSM within and between periods.
In general, MSM IDUs tended to be at least as likely as other male IDUs to engage in high-risk injection and sexual behaviors. Both groups of men reduced high-risk injection behaviors and increased protective injection behaviors over time. However, neither group reduced its participation in commercial sex exchange, and only the non-MSM IDU group increased condom use between the first and second periods.
MSM IDUs were significantly more likely to be HIV seropositive than were other male IDUs during the first period, and they tended to be so during the second period also. They remained more likely to be HIV-positive after adjustment for changes in the demographic and behavioral composition of the two groups. HIV seroprevalence declined by approximately 15 percent between periods in each group. The use of needle exchange increased from 20.91 percent to 56.9 percent for MSM and from 25.31 percent to 46.84 percent for non-MSM.
"This study highlighted important developments affecting the HIV epidemic in New York City. HIV prevalence and HIV risk behaviors have declined among MSM in general and IDUs in general. Injection risk behaviors and HIV prevalence also declined among MSM IDUs, who are at particularly high risk for infection," the authors wrote in their discussion section. "Declining seroprevalence among MSM IDUs may be partially attributable to the effects of intervention efforts targeting MSM, as well as IDU populations, although it appears that such interventions have primarily affected injection risk. Injection risk behaviors declined among the IDUs in this study, whereas sexual risk behaviors did not. Although condom use increased among other male IDUs, it did not increase among MSM IDUs."
The authors concluded, "These interviewees did indicate (and the findings confirmed) the need for multidimensional interventions with heightened sensitivity to and awareness of sexual orientation. Whether this can best be achieved through improvements to existing interventions or by developing approaches specific to MSM IDUs requires further research. Given the high-risk profile of MSM IDUs, such approaches should be prioritized for implementation and assessment in the near future."
American Journal of Public Health
03.01.02; Carey B. Maslow, Dr.P.H.; Samuel R. Friedman, Ph.D.; Theresa E. Perlis, Ph.D.; Russell Rockwell, Ph.D.; Don C. Des Jarlais, Ph.D.
This article was provided by U.S. Centers for Disease Control and Prevention. It is a part of the publication CDC HIV/Hepatitis/STD/TB Prevention News Update. Visit the CDC's website to find out more about their activities, publications and services.