HIV and Hepatitis C Virus Infection and Risk Behaviors among Heterosexual, Bisexual, and Lesbian Women Who Inject Drugs in Australia
PURPOSE:
Women
who inject drugs (WWID) are vulnerable to a range of harms, including exposure to
sexually transmitted and blood-borne infections, abusive relationships,
physical and sexual violence and mental health issues. Lesbians and bisexual
women are at greater risk than heterosexual women for substance use disorders.
This study aimed to compare a large sample of heterosexual, bisexual, and
lesbian WWID and to identify correlates of sexual orientation.
METHODS:
The
Australian Needle and Syringe Program (NSP) Survey is an annual cross-sectional
survey. People who inject drugs (PWID) who attend NSP services are invited to
complete a brief self-administered questionnaire and provide a capillary dried
blood spot. Of 22,791 survey respondents between 2004-2013, one third were
women (n=7,604). Analyses were restricted to the first participation record for
each respondent.
RESULTS:
Of the
5,378 individual women, 4,073 (76%) identified as heterosexual, 1,007 (19%)
identified as bisexual, and 298 (6%) identified as lesbian. HIV prevalence was
low (<1.0%). More than half (56%) had been exposed to hepatitis C virus
(HCV), with prevalence highest among bisexual women (59%). In adjusted
analysis, bisexual women had significantly greater odds of initiating injection
at a younger age (AOR 1.44, 95% CI 1.19-1.73), and reporting public injection
(AOR 1.44, 95% CI 1.21-1.73) and receptive sharing of drug preparation
equipment (AOR 1.20, 95% CI 1.00-1.44). Bisexual women (AOR 1.42, 95% CI
1.07-1.88) and lesbians (AOR 1.63, 95% CI 1.10-2.44) had significantly greater
odds of reporting sex work than their heterosexual counterparts.
CONCLUSION:
Results
contribute to the literature on HIV and HCV transmission risk among WWID.
Analysis of the relationship between sexual orientation and risk behavior
identified bisexual orientation as independently associated with increased
risk. Services that target PWID need to recognise and address a broad range of
sexual identities and behaviors. Future research should explore reasons for
increased risk in sexual minority women.
- 1 Viral Hepatitis Epidemiology and Prevention Program, The Kirby Institute, Faculty of Medicine, University of New South Wales Australia , Sydney, Australia .
- 2 Program of International Research and Training, National Drug and Alcohol Research Centre, University of New South Wales Australia , Sydney, Australia .
- 3 Alcohol and Drug Service, St. Vincent's Hospital , Sydney, Australia .
- 4 Faculty of Medicine, University of New South Wales Australia , Sydney, Australia
- LGBT Health. 2015 Jun;2(2):127-134. Epub 2015 Apr 16.
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