The social course of drug injection and sexual activity among YMSM and other high-risk youth: an agenda for future research

Prevalence of HIV/Hepatitis C Virus Co-Infection and Injection Risk Correlations in People Who Inject Drugs in Colombia: A Cross-Sectional Study Using Respondent Driven Sampling

Background: In Colombia, an exponential growth of people who inject drugs (PWID) has been reported over the past decades. The main burden of disease in PWID is attributed to human immunodeficiency virus (HIV) and hepatitis C virus (HCV) and their co-infection is associated with poor prognosis, high morbidity and treatment related implications. Nevertheless, the prevalence of HIV/HCV co-infection in Colombian PWIDs is unknown. Objective: To determine the prevalence, demographic characteristics, and injecting behaviors of HIV/HCV co-infected PWID in Colombia. Methods: This was a cross-sectional study of 1,123 PWID recruited by respondent driven sampling in five Colombian cities between January and June of 2014. Each participant completed a quantitative survey, and blood samples for HIV and HCV antibody testing were obtained. A multinomial logistic regression was used for statistical analysis. Results: Average participant age was 26.3 ± 6.5 years, and the majority was male (86%). HIV or HCV mono-infection prevalence was 27.6%, while co-infection was 3.3%. Compared with PWID with mono-infection, co-infected PWID exhibited higher odds of: injecting ≥4 times daily (OR: 3.5; CI: 1.7-7.2; p < .001), cleaning needles and syringes with water (OR 3.2; CI: 1.6-6.3; p < .001), passing drug mix between syringes (OR: 2.7; CI: 1.3-5.3; p = .04), injecting on illegal indoor shooting galleries (OR: 2.4; CI: 1.0-5.3, p = .02), and getting injected by someone who charges for injecting (OR 2.3; CI: 1.0-5.2; p = .04). Conclusion: Prevalence of HIV/HCV co-infection among PWID in Colombia is lower than that reported in other countries. However, addressing the identified demographic characteristics and injection risk behaviors of co-infected PWID is essential for the implementation of broadly available harm reduction interventions as well as routine HIV/HCV testing and treatment strategies aiming to control the spread of both viruses and their associated morbidity and mortality.

Perceived social support, problematic drug use behaviors, and depression among prescription drugs-misusing young men who have sex with men

This study examined the relationship of perceived social support with problematic drug use behaviors and depression among young men who have sex with men (YMSM). A diverse sample of 191 substance-using YMSM (aged 18-29 years) reported on perceived social support, high-risk drug use behaviors (i.e., polydrug use and use of drugs before sex in the past 6 months, and lifetime injection drug use), and depression. Associations were examined using bivariate and multivariable logistic regression. Participants receiving higher levels of family social support were at lower odds of reporting polydrug use, drug use before sex, and depressive symptomology. Individuals with higher levels of friends' social support were at lower odds of reporting polydrug use, drug use before sex, and depression. Participants receiving higher levels of support from a special other were at lower odds of reporting depression. Intervention efforts should address YMSM's capacity to build supportive relationships and obtain adequate social support.

Methods for Collection of Participant-aided Sociograms for the Study of Social, Sexual and Substance-using Networks Among Young Men Who Have Sex with Men

In this study, we adapted and tested a participant-aided sociogram approach for the study of the social, sexual, and substance use networks of young men who have sex with men (YMSM); a population of increasing and disproportionate risk of HIV infection. We used a combination of two interviewer-administered procedures: completion of a pre-numbered list form to enumerate alters and to capture alter attributes; and a participant-aided sociogram to capture respondent report of interactions between alters on an erasable whiteboard. We followed the collection of alter interactions via the sociogram with a traditional matrix-based tie elicitation approach for a sub-sample of respondents for comparison purposes. Digital photographs of each network drawn on the whiteboard serve as the raw data for entry into a database in which group interactions are stored. Visual feedback of the network was created at the point of data entry, using NetDraw network visualization software for comparison to the network structure elicited via the sociogram. In a sample of 175 YMSM, we found this approach to be feasible and reliable, with high rates of participation among those eligible for the study and substantial agreement between the participant-aided sociogram in comparison to a traditional matrix-based approach. We believe that key strengths of this approach are the engagement and maintenance of participant attention and reduction of participant burden for alter tie elicitation. A key weakness is the challenge of entry of interview-based list form and sociogram data into the database. Our experience suggests that this approach to data collection is feasible and particularly appropriate for an adolescent and young adult population. This builds on and advances visualization-based approaches to social network data collection.

Cost-effectiveness of Methadone Maintenance Treatment in Prevention of HIV Among Drug Users in Shiraz, South of Iran

Background:

The increase in high-risk injections and unsafe sexual behaviors has led to increased HIV infection prevalence among Intravenous Drug Users (IDUs). The high costs of HIV/AIDS care and low financial resources necessitate an economic evaluation to make the best decision for the control of HIV/AIDS.

Objectives:

This study was conducted to determine the cost-effectiveness of Methadone Maintenance Treatment (MMT) centers in HIV infection prevention among drug users.

Materials and Methods:

In this interventional study, we included all the seven MMT centers and the drug users registered there (n = 694). We calculated all the costs imposed on the government, i.e. Provider of case. Mathematical models were used to estimate the number of HIV cases averted from high-risk behaviors. Sensitivity analyses were performed to show the effects of uncertainty in parameters on the number of HIV cases averted and also Incremental Cost-Effectiveness Ratio (ICER).

Results:

Based on the averted models, the selected MMT centers could prevent 128 HIV cases during 1 year. The total cost was $ 547423 and that of HIV/AIDS care in the no intervention scenario was estimated $ 14171816. ICER was $ 106382 per HIV case averted. The results of the sensitivity analysis indicated that MMT intervention was cost-effective even in the worst scenario and ICER varied from $ 39149 to $ 290004 per HIV case averted.

Conclusions:

With regard to the high prevalence of drug injection among drug users and considering the high effectiveness and cost-effectiveness of MMT centers in preventing HIV infection, establishment of MMT centers in regional and national levels seems reasonable.

Associations between social support network characteristics and receipt of emotional and material support among a sample of male sexual minority youth

Few studies have examined how social support network characteristics are related to perceived receipt of social support among male sexual minority youth. Using egocentric network data collected from a study of male sexual minority youth (n=592), multivariable logistic regression analyses examined distinct associations between individual and social network characteristics with receipt of (1) emotional and (2) material support. In multivariable models, frequent communication and having friends in one's network yielded a two-fold increase in the likelihood of receiving emotional support whereas frequent communication was associated with an almost three-fold higher likelihood of perceived material support. Finally, greater internalized homophobia and personal experiences of gay-related stigma were inversely associated with perceived receipt of emotional and material support, respectively. Understanding the evolving social context and social interactions of this new generation of male sexual minority youth is warranted in order to understand the broader, contextual factors associated with their overall health and well-being.

Environmental risk, social cognition, and drug use among young men who have sex with men: longitudinal effects of minority status on health processes and outcomes

BACKGROUND

Young men who have sex with men (YMSM) continue to be at elevated risk for substance use; however, models explaining this phenomenon have often focused on a limited array of explanatory constructs. This study examined the longitudinal relationship of contextual risk factors, social cognitive processes, mental health, and health protective behavior to identify key mechanisms of illicit drug use of YMSM as they aged through emerging adulthood.

METHODS

Our sample included an ethnically diverse cohort of 487 YMSM recruited through venue based probability sampling in Los Angeles. We used latent growth curve modeling to understand relationships between environmental risk factors, changing individual and social process variables, health protective behavior, psychological distress, and illicit drug use outcomes among YMSM.

RESULTS

Age, ethnicity, violence and discrimination, depression, and previous histories of illicit drug use were key elements of risk for future illicit drug use among YMSM. During this theoretically distinct time period, health as a value, self-efficacy, and social support are vital social cognitive processes for promoting self-change among YMSM, and YMSM have independent growth within each process. Health as a value, self-efficacy, and social support were dynamic social cognitive processes, which served as key mechanisms by which risk factors were converted into health promotion strategies or psychological distress, and ultimately illicit drug use.

CONCLUSIONS

The efficacy of prevention interventions aimed at reducing illicit drug use among YMSM can be enhanced by addressing social cognitive processes for this underserved portion of the male population.

Romantic ideation, partner-seeking, and HIV risk among young gay and bisexual men

Structural changes in the acceptability of same-sex relationships may provide young gay and bisexual men (YGBM) with opportunities to develop expectations about their ideal future relationships. Expectations about the future may act as a promotive factor in youths' lives and reduce HIV risk-taking behaviors; however, few studies have examined the relationship between ideation of a future relationship and sexual behaviors of YGBM. In this study, we examined the relationship between romantic ideation (i.e., intimacy, passion, and commitment) and number of sexual partners in a sample of young men (N = 431; M age = 21.49 years; 88% self-identified as gay) who reported using the Internet to meet other men. Using multivariate Poisson regressions, we found a negative association between commitment and number of partners for unprotected sex, both receptive and insertive, in the past two months. We found similar results when we examined the association between relationship exclusivity and number of partners. These associations persisted after accounting for age, race/ethnicity, sexual identity, and hours spent seeking casual and romantic partners online. We found no significant association between number of partners and ideation of an intimate or passionate relationship, respectively. We discuss the implications of our findings and conclude that there is a need to consider and include YGBM's expectations about the future in on-going HIV prevention programs.

HIV and club drugs in emerging adulthood

PURPOSE OF REVIEW

To evaluate the incidence of club drug use in pediatric patients, especially those aged 13-25, and how it relates to the spread of HIV.

RECENT FINDINGS

Transmission of HIV among younger patients has become largely associated with risky sexual behaviors, as the rate of transmission from vertical infection and intravenous drug use has decreased. Use of club drugs in emerging adult populations contributes to the HIV epidemic through a combination of decreased inhibitions as well as physiological effects that increase high-risk sexual practices. Robust data exists linking the use of club drugs by the men who have sex with men population with spread of HIV, but this data in other at-risk populations (e.g. African Americans) is not as robust. Additional research is needed to identify the rates of transmission among adolescents and emerging adults, as well as knowledge, attitudes, beliefs, and practices that affect HIV transmission in this population.

SUMMARY

Use of club drugs by adolescents and emerging adults contributes to the current rate of HIV transmission among this age group.

Utilizing Social Action Theory as a framework to determine correlates of illicit drug use among young men who have sex with men

Young men who have sex with men (YMSM) continue to be at elevated risk for substance use; however, models explaining this phenomenon have often focused on a limited array of explanatory constructs. This study utilizes Social Action Theory (SAT) as a framework to address gaps in research by documenting the social, behavioral, and demographic risk factors associated with illicit drug use among YMSM. Structural equation modeling was used to apply SAT to a cross-sectional sample of 526 men from the Healthy Young Men Study, a longitudinal study of substance use and sexual risk behavior among YMSM in Los Angeles. The final model possessed very good fit statistics (Comparative Fit Index (CFI) = 0.936, Tucker-Lewis Index (TLI) = 0.925, Root Mean Square Error of Approximation (RMSEA) = 0.040) indicating that SAT is appropriate for use with YMSM. Substance use interventions for YMSM could be enhanced by employing SAT as conceptualized in this study and using a multitargeted strategy for impacting illicit drug use.

Continuing HIV risk in New York City injection drug users: the association of syringe source and syringe sharing

Sterile syringe access is an important means to reduce HIV risk, but many injection drug users (IDU) who obtain syringes from sterile sources continue to share syringes. We examined the factors associated with continuing syringe sharing in New York City. We recruited 500 active IDU in 2005 through respondent-driven sampling. In multiple logistic regression, not obtaining all syringes in the past year exclusively from sterile sources was associated with increased syringe sharing. Ensuring adequate syringe availability as well as engaging and retaining nonusers and inconsistent users in sterile syringe services may increase sterile syringe access and decrease syringe sharing.

Sex drugs, peer connections, and HIV: Use and risk among African American, Latino, and Multiracial young men who have sex with men (YMSM) in Los Angeles and New York

African American and Latino young men who have sex with men are at high risk for HIV infection. We administered brief intercept surveys (N=416) at 18 Black and Latino gay pride events in Los Angeles and New York in 2006 and 2007. Ordinal logistic regressions were used to model the effects of substance use during sex, peer connectedness, relationship status, and homelessness on condom use. Alcohol use, crystal use, homelessness, and having a primary relationship partner were negatively associated with condom use, while peer connectedness and marijuana use during sex were positively associated with condom use. Implications for service providers and future research are discussed.

Non-Injection Drug Use Patterns and History of Injection among Street Youth

AIMS

Efforts to prevent youth from initiating injection drug use require an understanding of the drug use patterns that predispose to injecting. Here we identify such patterns and describe the circumstances of first injection among street youth.

METHODS

From October 2005 to November 2007, data were collected for the At Risk Youth Study, a prospective cohort of 560 street-recruited youth aged 14-26 in Vancouver, Canada. Non-injection drug use behaviors were compared between those with and without a history of injection through multiple logistic regression. The circumstances of first injection were also examined in gender-stratified analyses.

RESULTS

Youth who had previously injected were more likely to have engaged in non-injection use of heroin or of crystal methamphetamine. Daily users of marijuana were less likely to have injected. Among prior injectors, the median age of first injection was lower among females. Females were also more likely to have had a sexual partner present at first injection and to have become a regular injector within one week of initiation.

CONCLUSION

Preventing transition to injection among street youth may require special attention to predisposing drug use patterns and should acknowledge gender differences in the circumstances of first injection.

Injection drug use among street-involved youth in a Canadian setting

Background

Street-involved youth contend with an array of health and social challenges, including elevated rates of blood-borne infections and mortality. In addition, there has been growing concern regarding high-risk drug use among street-involved youth, in particular injection drug use. We undertook this study to examine the prevalence of injection drug use and associated risks among street-involved youth in Vancouver, Canada.

Methods

From September 2005 to November 2007, baseline data were collected for the At-Risk Youth Study (ARYS), a prospective cohort of street-recruited youth aged 14 to 26 in Vancouver, Canada. Using multiple logistic regression, we compared youth with and without a history of injection.

Results

The sample included 560 youth among whom the median age was 21.9 years, 179 (32%) were female, and 230 (41.1%) reported prior injection drug use. Factors associated with injection drug use in multivariate analyses included age ≥ 22 years (adjusted odds ratio [AOR] = 1.18, 95% CI: 1.10–1.28); sex work involvement (AOR = 2.17, 95% CI: 1.35–3.50); non-fatal overdose (AOR = 2.10, 95% CI: 1.38–3.20); and hepatitis C (HCV) infection (AOR = 22.61, 95% CI: 7.78–65.70).

Conclusion

These findings highlight an alarmingly high prevalence of injection drug use among street-involved youth and demonstrate its association with an array of risks and harms, including sex work involvement, overdose, and HCV infection. These findings point to the need for a broad set of policies and interventions to prevent the initiation of injection drug use and address the risks faced by street-involved youth who are actively injecting.

Social influences upon injection initiation among street-involved youth in Vancouver, Canada: a qualitative study

BACKGROUND

Street-involved youth are a population at risk of adopting injection as a route of administration, and preventing the transition to injection drug use among street youth represents a public health priority. In order to inform epidemiological research and prevention efforts, we conducted a qualitative study to investigate the initiation of injection drug use among street-involved youth in Vancouver, Canada.

METHODS

Qualitative interviews with street youth who inject drugs elicited descriptions of the adoption of injection as a route of administration. Interviewees were recruited from the At-Risk Youth Study (ARYS), a cohort of street-involved youth who use illicit drugs in Vancouver, Canada. Audio recorded interviews were transcribed verbatim and a thematic analysis was conducted.

RESULTS

26 youth aged 16 to 26 participated in this study, including 12 females. Among study participants the first injection episode frequently featured another drug user who facilitated the initiation of injecting. Youth narratives indicate that the transition into injecting is influenced by social interactions with drug using peers and evolving perceptions of injecting, and rejecting identification as an injector was important among youth who did not continue to inject. It appears that social conventions discouraging initiating young drug users into injection exist among established injectors, although this ethic is often ignored.

CONCLUSION

The importance of social relationships with other drug users within the adoption of injection drug use highlights the potential of social interventions to prevent injection initiation. Additionally, developing strategies to engage current injectors who are likely to initiate youth into injection could also benefit prevention efforts.

Variations in sexual risks in drug users: emerging themes in a behavioral context

Drug users are an especially complex population among those studied in HIV risk behavior research. Although injection drug use accounts for over one third of the cumulative HIV transmission in the United States, the scope of the direct and indirect impacts of all drug use is difficult to quantify, especially in relation to attributing HIV to drug use directly, via parenteral exposures, or indirectly, through unsafe sex. Important behavioral issues such as social and drug network overlaps, partner selection, and the combinations of illicit drugs with erectile dysfunction medications have added complexity to the study of sexual behavior in drug users. This review covers recent substantive research in the United States and Canada on current themes in sexual risk behavior in injection drug and non-injection drug users. We address gender, situational, and sexual preference factors that may influence sexual behaviors affecting HIV risk by class of drug and route of administration. Special attention is paid to minority populations, both sexual and racial/ethnic, as their marginalized role in contemporary society places special barriers to risk reduction.

Relating diarrheal disease to social networks and the geographic configuration of communities in rural Ecuador

Social networks and geographic structures of communities are important predictors of infectious disease transmission. To examine their joint effects on diarrheal disease and how these effects might develop, the authors analyzed social network and geographic data from northern coastal Ecuador and examined associations with diarrhea prevalence. Between July 2003 and May 2005, 113 cases of diarrhea were identified in nine communities. Concurrently, sociometric surveys were conducted, and households were mapped with geographic information systems. Spatial distribution metrics of households within communities and of communities with respect to roads were developed that predict social network degree in casual contact ("contact") and food-sharing ("food") networks. The mean degree is 25-40% lower in communities with versus without road access and 66-94% lower in communities with lowest versus highest housing density. Associations with diarrheal disease were found for housing density (comparing dense with dispersed communities: risk ratio = 3.3, 95% confidence interval (CI): 1.1, 10.0) and social connectedness (comparing lowest with highest degree communities: risk ratio = 3.4, 95% CI: 1.1, 10.1 in the contact network and risk ratio = 4.9, 95% CI: 1.1, 21.9 in the food network). Some of these differences may be related to more new residents, lower housing density, and less social connectedness in road communities.

Factors associated with recent-onset injection drug use among drug users in Pakistan

Seventy-two recent-onset injection drug users and 241 non-injection drug users were recruited in Quetta and Lahore, Pakistan, in 2003. Trained interviewers administered questionnaires regarding drug use behaviors and perceived changes in drug cost/supply. Logistic regression identified independent correlates of recent-onset injection. In Lahore, a perceived increase in drug cost was associated with higher odds of recent-onset injection, with no association in Quetta. Recent-onset injection was also associated with family history of drug use, group drug use, and sharing snorting/chasing tools. Changes in perception of the drug supply may be associated with recent-onset injection drug use. Familial/social influences were also associated with recent-onset injection, suggesting peer-led interventions could discourage transition to injection drug use.

HIV prevalence and factors associated with HIV infection among male injection drug users under 30: a cross-sectional study in Long An, Vietnam

Background

Sufficient targeted HIV prevention activities aiming at reducing HIV transmission within and from an extremely marginalized population of injection drug users (IDUs) must urgently and efficiently be implemented in Vietnam. This study was conducted to facilitate the development of such activities by describing transmission risks of young IDUs and evaluating factors in association with HIV infection.

Methods

Thirty clusters were selected from 29 hotspot communes in Long An province by probability proportional to size (PPS) sampling method. The snowball technique was used for enrolling participants in each cluster. The cross-sectional association of factors obtained during direct structured interviews to 248 male IDUs aged 14 to 29 years old and with their HIV test results were examined.

Results

The HIV prevalence among the studied IDUs was 32%. Age range of 18–20 years old, low educational level, sharing injection equipment or injection drug use in the other cities were independently associated with HIV serostatus in the multivariate analysis. Sexual behaviors did not differ between HIV-positive and -negative IDUs. Among HIV seropositive IDUs who had sexual contact with primary (n = 37), casual (n = 6), and commercial (n = 15) partners, only 5.4% (n = 2), 33.3% (n = 2), and 46.7% (n = 7), respectively, responded that they had used condoms every time.

Conclusion

About one-third of young IDUs aged less than 30 identified in the hotspot communes in Long An, Vietnam was found to be infected with HIV, and socio-demographic and injection-related factors might account for the infection risk. Prevailing risky sexual behavior of this extremely marginalized population highlights the need to reduce their high transmission risks as a public health priority.

Evaluating methamphetamine use and risks of injection initiation among street youth: the ARYS study

Many Canadian cities are experiencing ongoing infectious disease and overdose epidemics among injection drug users (IDU). These health concerns have recently been exacerbated by the increasing availability and use of methamphetamine. The challenges of reducing health-related harms among IDU have led to an increased recognition that strategies to prevent initiation into injection drug use must receive renewed focus. In an effort to better explore the factors that may protect against or facilitate entry into injection drug use, the At Risk Youth Study (ARYS) has recently been initiated in Vancouver, Canada. The local setting is unique due to the significant infrastructure that has been put in place to reduce HIV transmission among active IDU. The ARYS study will seek to examine the impact of these programs, if any, on non-injection drug users. In addition, Vancouver has been the site of widespread use of methamphetamine in general and has seen a substantial increase in the use of crystal methamphetamine among street youth. Hence, the ARYS cohort is well positioned to examine the harms associated with methamphetamine use, including its potential role in facilitating initiation into injection drug use. This paper provides some background on the epidemiology of illicit drug use among street youth in North America and outlines the methodology of ARYS, a prospective cohort study of street youth in Vancouver, Canada.

The urban environment and sexual risk behavior among men who have sex with men

Increasingly, studies show that characteristics of the urban environment influence a wide variety of health behaviors and disease outcomes, yet few studies have focused on the sexual risk behaviors of men who have sex with men (MSM). This focus is important as many gay men reside in or move to urban areas, and sexual risk behaviors and associated outcomes have increased among some urban MSM in recent years. As interventions aimed at changing individual-level risk behaviors have shown mainly short-term effects, consideration of broader environmental influences is needed. Previous efforts to assess the influence of environmental characteristics on sexual behaviors and related health outcomes among the general population have generally applied three theories as explanatory models: physical disorder, social disorganization and social norms theories. In these models, the intervening mechanisms specified to link environmental characteristics to individual-level outcomes include stress, collective efficacy, and social influence processes, respectively. Whether these models can be empirically supported in generating inferences about the sexual behavior of urban MSM is underdeveloped. Conceptualizing sexual risk among MSM to include social and physical environmental characteristics provides a basis for generating novel and holistic disease prevention and health promotion interventions.

Reducing the risk of HIV infection associated with illicit drug use

Substance abuse, specifically the use of illicit drugs that are administered intravenously, continues to play a role in the transmission of human immunodeficiency virus type 1 (HIV-1) among adolescents and young adults (youth). Risks of HIV-1 infection may result from direct exposure to contaminated blood through sharing of injection drug equipment and from unsafe sexual practices (while under the influence of drugs and/or in exchange for drugs). Reducing the risk of HIV-1 infection that is associated with illicit drug use requires prevention education and prompt engagement in treatment. Providing patients with education, instruction on decontamination of used injection drug equipment, improved access to sterile syringes and needles, and postexposure prophylaxis may decrease their risk of acquiring HIV-1 infection. Pediatricians should assess risk behaviors as part of every health care encounter, including queries about tobacco, alcohol, and marijuana use. The risks and benefits of postexposure prophylaxis with antiretroviral drugs should be considered for youth with a single recent (within 72 hours) high-risk exposure to HIV-1 through sharing needles/syringes with an HIV-1-infected individual or having unprotected intercourse with an individual who engages in injection drug use. Such prophylaxis must be accompanied by risk-reduction counseling, appropriate referrals for treatment, and evaluation for pregnancy and associated sexually transmitted infections. There is an urgent need for more substance-abuse prevention and treatment programs, legislation that facilitates unencumbered access to sterile syringes, and expedient availability of reproductive health care services for sexually active youth, including voluntary HIV-1 counseling and testing.

Drug and sexual risk in four men who have sex with men populations: evidence for a sustained HIV epidemic in New York City

The objective of this article was to examine drug and sexual risk in four salient groups of men who have sex with men (MSM) in New York City (NYC): (1) nonhomeless young MSM (YMSM), (2) homeless YMSM, (3) adult MSM Speed users, and (4) HIV-positive "POZ Party" MSM. Lifetime and current exposure to drugs, drug injection, and selected drug-sex interactions are highlighted in each group. Data derive from recently completed field-based, ethnoepidemiological studies that used venue-oriented/targeted sampling and semistructured interviews. Across all four groups, findings show that both drug and sexual risk remain prevalent in the MSM population in NYC. This is especially troubling given the already high background prevalence of HIV and other sexually transmitted diseases in NYC and the widespread suffering and death already wrought by HIV/AIDS among MSM. These findings suggest that available public health interventions today are, in many respects, failing to reach, engage, and affect critical risk groups within the NYC MSM population.

A comparison of HIV seropositive and seronegative young adult heroin- and cocaine-using men who have sex with men in New York City, 2000-2003

The purpose of this analysis was to determine the prevalence and correlates of HIV infection among a street-recruited sample of heroin- and cocaine-using men who have sex with men (MSM). Injection (injecting <or=3 years) and non-injection drug users (heroin, crack, and/or cocaine use <10 years) between 18 and 40 years of age were simultaneously street-recruited into two cohort studies in New York City, 2000-2003, by using identical recruitment techniques. Baseline data collected among young adult men who either identified as gay/bisexual or reported ever having sex with a man were used for this analysis. Nonparametric statistics guided interpretation. Of 95 heroin/ cocaine-using MSM, 25.3% tested HIV seropositive with 75% reporting a previous HIV diagnosis. The majority was black (46%) or Hispanic (44%), and the median age was 28 years (range 18-40). HIV-seropositive MSM were more likely than seronegatives to be older and to have an HIV-seropositive partner but less likely to report current homelessness, illegal income, heterosexual identity, multiple sex partners, female partners, and sex for money/drug partners than seronegatives. These data indicate high HIV prevalence among street-recruited, drug-using MSM compared with other injection drug use (IDU) subgroups and drug-using MSM; however, lower risk behaviors were found among HIV seropositives compared with seronegatives. Large-scale studies among illicit drug-using MSM from more marginalized neighborhoods are warranted.