title: HIV prevalence and risk behaviors among men who have sex with men and inject drugs in San Francisco.
abstract: The dual risks of male-to-male sex and drug injection have put men who have sex with men and inject drugs (MSM-IDU) at the forefront of the HIV epidemic, with the highest rates of infection among any risk group in the United.States. This study analyzes data collected from 357 MSM-IDU in San Francisco between 1998 and 2002 to examine how risk behaviors differ by HIV serostatus and self-identified sexual orientation and to assess medical and social service utilization among HIV-positive MSM-IDU. Twenty-eight percent of the sample tested HIV antibody positive. There was little difference in risk behaviors between HIV-negative and HIV-positive MSM-IDU. Thirty percent of HIV-positive MSM-IDU reported distributive syringe sharing, compared to 40% of HIV negatives. Among MSM-IDU who reported anal intercourse in past 6 months, 70% of positives and 66% of HIV negatives reported unprotected anal intercourse. HIV status varied greatly by self-identified sexual orientation: 46% among gay, 24% among bisexual, and 14% among heterosexual MSM-IDU. Heterosexual MSM-IDU were more likely than other MSM-IDU to be homeless and to trade sex for money or drugs. Gay MSM-IDU were more likely to have anal intercourse. Bisexual MSM-IDU were as likely as heterosexual MSM-IDU to have sex with women and as likely as gay-identified MSM-IDU to have anal intercourse. Among MSM-IDU who were HIV positive, 15% were currently on antiretroviral therapy and 18% were currently in drug treatment, and 87% reported using a syringe exchange program in the past 6 months. These findings have implications for the development of HIV interventions that target the diverse MSM-IDU population.
authors.affiliation: Urban Health Studies, Department of Family and Community Medicine, University of California, San Francisco, 3180 18th Street Suite 302, San Francisco, CA 94110, USA. alkral@itsa.ucsf.edu
authors.forename: Alex H
authors.initials: AH
authors.lastname: Kral
authors.forename: Jennifer
authors.initials: J
authors.lastname: Lorvick
authors.forename: Daniel
authors.initials: D
authors.lastname: Ciccarone
authors.forename: Lynn
authors.initials: L
authors.lastname: Wenger
authors.forename: Lauren
authors.initials: L
authors.lastname: Gee
authors.forename: Alexis
authors.initials: A
authors.lastname: Martinez
authors.forename: Brian R
authors.initials: BR
authors.lastname: Edlin
mesh_terms: D000293:Adolescent; D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000453:epidemiology* / Q000635:transmission; D006679:HIV Seropositivity / Q000150:complications / Q000453:epidemiology; D006296:Health Services / Q000706:statistics & numerical data; D006703:Ill-Housed Persons; D018451:Homosexuality, Male; D006801:Humans; D008297:Male; D008875:Middle Aged; D012309:Risk-Taking; D012495:San Francisco / Q000453:epidemiology; D011477:Sex Work; D012725:Sexual Behavior; D015819:Substance Abuse, Intravenous / Q000150:complications / Q000453:epidemiology*
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