HIV Transmission Among Injection Drug Users ‘Strongly Associated’ with Sexual Behavior, Study Shows

New HIV infections among injection drug users in San Francisco are "strongly associated" with sexual behavior, according to a study published in the current issue of the Lancet, leading the study authors to conclude that HIV risk may be reduced by incorporating "sexual-risk-reduction strategies" into "harm-reduction programs" that have traditionally focused on the prevention of needle-sharing. The study of 1,192 IDUs, conducted by Dr. Alex Kral and associates at the University of California-San Francisco, found that men who have sex with men were 8.8 times more likely to become infected with HIV than heterosexual men, and women who traded sex for money were 5.1 times more likely to become infected than other female IDUs. The authors note that the only factors significantly associated with an increased risk of HIV for both men and women were "being African-American, shorter duration of injection behavior and number of sex partners." Researchers conducted 13,099 interviews and HIV tests with 6,115 different volunteers (2,120 were interviewed and tested more than once) who participated in the UCSF Urban Health Study from 1986 to 1998. IDUs were recruited from the street, not from drug treatment centers, and were administered a "structured questionnaire" during a private interview with a trained interviewer. Interviewers collected demographic information and asked participants about their drug use, sexual practices and "use of services," such as needle-exchange programs and substance-abuse counselling. After the interview and a session with a counselor, participants were given an HIV test and referred to medical and social services "as needed." Of those interviewed, 58 were assigned to the study group and 1,134 were used as controls.

Recommendations
Because over half of those who contracted HIV reported either trading sex for money or were men who had sex with men, the researchers determined that sexual behavior had a high association with HIV infection and that therefore HIV prevention programs among IDUs should increase their emphasis on "sexual risk." Two-thirds of the study participants reported using needle-exchange programs as their "usual" source of syringes, but exchange programs and HIV infection were not "significantly linked" among men. HIV prevalence among IDUs in San Francisco is "moderate" and has been between 10% and 14% since 1987 (Kral et al., Lancet, 5/5). "There has been a tendency for IDU prevention programming to be needle obsessed, and here in San Francisco that has worked to a certain degree. Now we need to focus new energy on sexual risk reduction among IDUs, while continuing current programs that address needle-borne risks," Kral said (UCSF release, 5/4). The study recommends that prevention programs aimed at sexual risk be instituted at needle-exchange sites and in drug-treatment programs, as well as in prisons (Lancet, 5/5).