Measures of sexual health
were assessed during 2008–2009 in a New York City sample of 102 injection and
noninjection users of heroin, cocaine, or crack. There was considerable overlap
and transitioning between crack smoking and injecting. Crack users were also
significantly more likely to be gay, lesbian, or bisexual than other drug
users. In multivariate analysis, HIV infection was independently associated
with crack use and with being gay or bisexual. In New York City, HIV prevention
for drug users has focused on syringe access, safe injection, and drug user
treatment, but further progress in HIV control will require strategies to
address sexual health among people who use drugs. The study’s limitations are
noted.
...The drug users recruited for this study would appear to be
the ideal target of a sexual health intervention. Among the 102 drug users
recruited in the first stage, 62% were eligible for the intervention; i.e.,
they reported recent unprotected sex with more than one partner. In this
second-stage sample, 66% of NIDUs and 33% of IDUs were HIV positive, and only
64% of HIV positives were aware of their status. In addition, 75% had antibody
to HSV-2, and only 12% had ever been told they had genital herpes. Thus, this
method of recruitment led to a set of individuals who may greatly benefit from
an intervention that seeks to reduce both HIV acquisition and transmission to
uninfected partners and among whom efforts to address HSV-2 facilitation of HIV
acquisition and transmission may be particularly important. The high prevalence
of HSV-2 in this population is very similar to the rate (60%) observed in
another New York City study of drug users and to the rates reported in other
studies of crack users (Des Jarlais, Hagan, et al., 2007; Jones et al., 1998;Ross, Hwang, Leonard, Teng, & Duncan, 1999).
Although it is understood that HSV-2 facilitates HIV transmission, it is
unclear at this stage how to manage HSV-2 infection to reduce this risk (Celum et al., 2010).
The high prevalence of HIV in this sample was
unexpected, as it was substantially higher than rates observed in other New
York City studies of opiate users of 15%–20% (Des Jarlais, Arasteh, et al., 2007). The
sample was also unique in the degree to which injectors, former injectors,
noninjectors, and sexual minorities overlapped. Gay, lesbian, and bisexual
participants were more likely to be crack users than were heterosexuals, and
bisexuals were more likely to be involved in sex trade. As noted by Des Jarlais
et al. in this issue, many injectors in New York City have stopped injecting
and returned to smoking or inhaling drugs. This transition to noninjection drug
use may have led to new social and sexual linkages between former injectors
with high HIV prevalence and lower-prevalence noninjection users. Crack use,
along with the buying and using of other drugs, may create linkages between
sexual minorities and heterosexuals in New York. Crack use, in particular,
appears to identify very high-risk subsets of drug users in New York City. This
finding of great overlap between gay, lesbian, bisexual, and heterosexual
injection and noninjection users of heroin and cocaine has several implications
for the development of interventions, including that strategies should use
social, sexual, and drug-use-related linkages to locate and intervene with
persons at high risk of HIV acquisition and transmission. In addition,
interventions should address multiple sources of risk for HIV exposure in a
linked population...
Below: Diagram showing relative overlap among drug injection, crack cocaine use, and gay or bisexual orientation among heroin and cocaine users, New York City
Full article at: http://goo.gl/9zI5A0
By: Holly Hagan,1 David C. Perlman,2 and Don C. Des Jarlais3
1College of Nursing, New York University,
New York, New York, USA
2Department of Medicine, Beth Israel
Medical Center, New York, New York, USA
3Chemical Dependency Institute, Beth Israel
Medical Center, New York, New York, USA
Address correspondence to Dr. Holly Hagan, New York
University College of Nursing, 726 Broadway, 10th Floor, New York, NY 10003; Email:ude.uyn@05hh
More at: https://twitter.com/hiv
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