title: Using respondent-driven sampling in a hidden population at risk of HIV infection: who do HIV-positive recruiters recruit?
abstract: BACKGROUND
  Respondent-driven sampling (RDS) is a network-based method used to recruit hidden populations. Since it is respondent-driven, RDS is prone to bias. However, these biases could facilitate recruitment of high-risk networks. We examined recruitment patterns of human immunodeficiency virus (HIV)-positive injection drug users (IDUs) and identified factors associated with being recruited by an HIV-positive IDU in a RDS-based study.
  
  
  METHODS
  IDUs aged > or =18, who injected within the last month and resided in Tijuana, Mexico, were recruited using RDS and underwent interviews and testing for HIV, syphilis, and tuberculosis. Weighted logistic regression was used to identify predictors of being recruited by an HIV-positive IDU.
  
  
  RESULTS
  Of 1056 IDUs, HIV-positive subjects comprised 4.4% of the sample and generated 4.7% of recruits, indicating that recruitment effectiveness did not vary by HIV-status. However, 10% of the subjects recruited by HIV-positive recruiters were infected with HIV as compared to 4.1% of subjects recruited by HIV-negative recruiters, (P = 0.06), a difference that, after controlling for whether the recruiter and recruit injected drugs together, attained statistical significance (P = 0.04), indicating that recruitment patterns differed by HIV-status. Factors independently associated with being recruited by an HIV-positive IDU included lifetime syphilis infection, ever having sex with an HIV-positive person, knowing someone with HIV/AIDS, being recruited at a shooting gallery, having recently used the local needle exchange program, and having a larger number of recent arrests for track marks.
  
  
  CONCLUSIONS
  HIV-positive IDUs have different recruitment patterns than HIV-negative IDUs, with HIV-positive IDUs tending to recruit other HIV-positive IDUs. Social and environmental factors along with risk behaviors were independently associated with being the recruit of an HIV-positive IDU in Tijuana. Although the goal of this study was not to recruit HIV+ or other high-risk persons, our results suggest that RDS has the potential to successfully be used in the identification of HIV+ or other high risk individuals.
authors.affiliation: Department of Medicine, University of California San Diego, La Jolla, CA, USA.
authors.forename: Daniela
authors.initials: D
authors.lastname: Abramovitz
authors.forename: Erik M
authors.initials: EM
authors.lastname: Volz
authors.forename: Steffanie A
authors.initials: SA
authors.lastname: Strathdee
authors.forename: Thomas L
authors.initials: TL
authors.lastname: Patterson
authors.forename: Alicia
authors.initials: A
authors.lastname: Vera
authors.forename: Simon D W
authors.initials: SD
authors.lastname: Frost
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D003625:Data Collection / Q000379:methods*; D005260:Female; D015483:HIV Antibodies / Q000097:blood; D015658:HIV Infections / Q000175:diagnosis / Q000453:epidemiology / Q000821:virology; D006679:HIV Seropositivity; D015497:HIV-1 / Q000276:immunology; D006801:Humans; D008297:Male; D008800:Mexico / Q000453:epidemiology; D009010:Monte Carlo Method; D018579:Patient Selection; D012306:Risk; D012307:Risk Factors; D012494:Sampling Studies; D015819:Substance Abuse, Intravenous / Q000150:complications*; D013588:Syphilis Serodiagnosis; D014376:Tuberculosis / Q000175:diagnosis
chemical_list: D015483:HIV Antibodies
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