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Medical News

Prevalence and Correlates of HIV Infection Among Young Injection Drug Users in San Francisco

February 4, 2003

San Francisco is among U.S. cities most severely affected by the HIV/AIDS epidemic. Most cases occur in MSM, followed by IDUs. The current study assesses the prevalence of HIV infection and associated risk behaviors among young, street-recruited IDUs in San Francisco.

Studies have shown that many young IDUs in the city are runaways and homeless, with high unemployment, poor education and mental health problems. Such youth fear and mistrust authority. A 1993-1995 outreach intervention in Haight-Ashbury demonstrated that at-risk youth were more likely to use services and adopt safer behaviors if they were accessing programs targeted directly toward them. Researchers recently found that a peer-based intervention combining secondary needle exchange with community activities had a positive effect on homeless young IDUs. San Francisco has youth-oriented needle exchange programs but they are not part of the mainstream, according to the report, and the city suffers from a scarcity of services targeted specifically to the young IDU population.

From 1997 to 1999, the researchers conducted a cross-sectional survey of 304 English-speaking IDUs under age 30 who had injected drugs within the previous 30 days. Recruiters paired with community-based organizations to distribute study invitation cards and post recruitment signs for the "UFO Study" (U find out [serostatus])in the Haight-Ashbury, Polk Street, Tenderloin/South of Market and Mission neighborhoods.

The 304 study participants had a median age of 22; most were white males. More than half had been in San Francisco less than a year; 66.6 percent had been incarcerated during the past year; and half had not finished high school.

The authors found 16 HIV infections among the group (prevalence estimate: 5.3 percent). Nine of the participants knew they were HIV-positive from a previous test. Two said they had tested negative previously, two had never been tested before, and three declined to state earlier test results. Fourteen of those infected were males. The highest number and proportion of infections occurred among subjects from the Polk Street neighborhood. IDUs who had lived in San Francisco for more than a year "had significantly higher odds of HIV infection than did those who had been in San Francisco for [less than or equal to] 1 year," the researchers wrote.

More than one-third of the male participants identified themselves as homosexual or bisexual; two of the infected subjects were male-to-female transgenders. Researchers found that young male IDUs who have male sexual partners, or who identify as homosexual/bisexual are at greatest risk of HIV infection in San Francisco. "Significantly, the prevalence of HIV infection was very low among heterosexually identified IDUs," they stated.

The Polk Street area, the study notes, has a high prevalence of sex trade almost exclusively among men. Men recruited in that neighborhood were more than seven times more likely to have HIV than men of similar ages and behaviors in other neighborhoods. A higher proportion of men in the Polk Street area reported methamphetamine as the most frequently injected drug.

"Although few specific sexual behaviors were found to be associated with HIV infection," investigators wrote, "we believe that these two risk factors, male-to-male sex and neighborhood, are especially strong indicators that sexual behavior -- rather than injection behavior -- is the primary hazard for HIV infection in this population."

"Neighborhood and high-risk exchange sex should be included in current HIV intervention models for IDUs in San Francisco," Shafer and colleagues suggested, "emphasizing sexual risk reduction measures, in particular among young male IDUs who have sex with men."

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Adapted from:
Journal of Acquired Immune Deficiency Syndromes
12.01.02; Vol. 31: P. 422-431; Kimberly Page Shafer; Judith A. Hahn; Paula J. Lum; Kristen Ochoa; Alison Graves; Andrew Moss

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This article was provided by CDC National Prevention Information Network. It is a part of the publication CDC HIV/Hepatitis/STD/TB Prevention News Update.