This poster was presented at the 10th Annual Canadian Conference on HIV/AIDS Research in Toronto in June 2001. A revised version of these data was presented orally by Amy Weber at the AIDS Impact conference in Brighton, England, in July 2001.

Gay and bisexual men who inject drugs are at greater 
sexual risk for HIV than non-injecting gay and bisexual men

Jacqueline M. O'Connell, Patricia Spittal, Amy E. Weber, Mary Lou Miller, Keith Chan, Steve Martindale, Robert S. Hogg.

OBJECTIVES:

To compare sexual risk behaviours and HIV prevalence and incidence among young gay and bisexual men who had injected drugs (MSM/IDU) in the past year with those who had not (MSM).

BACKGROUND:

Men who have sex with men and inject drugs pose unique challenges for HIV risk reduction efforts, as they have multiple risks for HIV acquisition and transmission.1,2 HIV-prevention efforts geared toward injection drug users generally focus on injecting behaviours, without addressing their sexual risk behaviours.

METHODS:

Since May 1995, young gay and bisexual men aged 15 to 30 have been recruited into an ongoing prospective study of HIV incidence and risk behaviors in the Greater Vancouver region. HIV test results and self-reported data on socio-demographics, sexual behaviours and substance use were obtained. Contingency table and non-parametric methods identified socio-demographic and sexual risk factors associated with injection drug use.

RESULTS:

Of 910 Vanguard participants surveyed, 106 (12%) had injected drugs in the past year and 804 (88%) had not.

MSM/IDU were younger, more likely to be Aboriginal, unemployed, less educated, living in unstable housing and making less than $10,000/year (Table 1).

Although MSM/IDUs were less likely than MSM to have regular sex partners, those MSM/IDUs with regular partners reported a greater number of regular partners. Also, those with regular partners were less likely to have receptive anal sex with their primary partner (Table 2).

MSM/IDUs were more likely to have a greater number of casual sexual partners, and to have had unprotected receptive or insertive anal sex with a casual partner.

MSM/IDU were also more likely to have been paid for sex in the past year or in their lifetimes (Table 3).

There was no difference in self-report of sexual assault before the age of 18. As shown in Table 4, however, MSM/IDU were more likely to have had their first consensual sexual experiences at a younger age with both men and women; were more likely to be HIV-positive at baseline; and were more likely to seroconvert during the course of the study.

CONCLUSIONS:

Unsafe sex appears to be a primary risk factor for HIV infection among MSM/IDU. The disinhibiting effects of drugs, learned associations between drugs and sex, and lower socio-economic status - which has been associated with continued involvement in unsafe sexual behaviours, including exchanging sex for money or drugs - may be barriers to reducing sexual risk behaviours among MSM/IDU.

In addition to current efforts aimed at reducing needle sharing, HIV-prevention efforts targeting MSM/IDU should promote safer sex and examine the interplay between drug use and sexuality.

REFERENCES:

1. Paul JP, Stall R, Davis F: Sexual risk for HIV transmission among gay/bisexual men in substance-abuse treatment. AIDS Education & Prevention 1993,5(1):11-24.

2. Calsyn DA, Saxon AJ, Wells EA, Greenberg DM: Longitudinal sexual behavior changes in injecting drug users. Aids 1992,6(10):1207-11.