title: Men who have sex with men and also inject drugs-profiles of risk related to the synergy of sex and drug injection behaviors.
abstract: OBJECTIVE
  Men who have sex with men and also inject drugs (MSM-IDU) are among the groups at highest risk for acquiring and transmitting HIV in Colorado and the US. We conducted formative research and a survey among MSM-IDU in Denver to better understand sexual and drug HIV risk behaviors and how they interact.
  
  
  METHODS
  Formative data were collected with 30 persons who work, live or otherwise interact with MSM-IDU using a semi-structured interview instrument. Survey data on sexual and drug risk behaviors were collected with 100 MSM-IDU; eligible participants have had sex with men and injected drugs within the past six months.
  
  
  RESULTS
  Results from formative research were used to generate the survey instrument. The survey results demonstrate high-risk sexual behaviors with multiple partners of both genders; 82% of the sample had primary and non-primary male partners, 20% had non-primary female partners, and 15% exchanged money or drugs for sex. Condom use was inconsistent and infrequent for all types of sex (vaginal, anal and oral) and with all types of partners. Drug risk behaviors highlight that the injection drugs of choice for this sample (90% shoot cocaine and 59% shoot methamphetamine) stimulate sexual desire and cocaine injection increases opportunities for injection risk behavior. Forty-five percent of the sample were HIV-infected. Significant differences between HIV infected and non-infected men were not observed with regard to many sexual and drug risk behaviors.
  
  
  CONCLUSIONS
  These data show that MSM-IDU are engaging in multiple risk behaviors that may have a synergistic effect on HIV transmission, and that their injection drug of choice contributes to their risk. That there do not appear to be consistent differences in preventive behaviors between men with or without HIV infection suggests a greatly increased risk for HIV transmission in this group of men and their partners. Because MSM-IDU do not identify strongly with either MSM because they may not gay identify or IDU because they do not use heroin, targeted HIV prevention strategies for this group are urgently needed.
authors.affiliation: AMC Cancer Research Center, Department of Public Health, Denver 80214, USA. bulls@amc.org
authors.forename: Sheana Salyers
authors.initials: SS
authors.lastname: Bull
authors.forename: Patrick
authors.initials: P
authors.lastname: Piper
authors.forename: Cornelis
authors.initials: C
authors.lastname: Rietmeijer
mesh_terms: D000328:Adult; D003120:Colorado / Q000453:epidemiology; D003625:Data Collection; D005260:Female; D015658:HIV Infections / Q000453:epidemiology / Q000635:transmission; D018451:Homosexuality, Male / Q000523:psychology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012309:Risk-Taking; D021841:Safe Sex; D015819:Substance Abuse, Intravenous / Q000150:complications / Q000453:epidemiology / Q000523:psychology*