HIV risk and the overlap of injecting drug use and high-risk sexual behaviours among men who have sex with men in Zanzibar (Unguja), Tanzania.
BACKGROUND
Men who have sex with men and inject drugs (MSM-IDU) are particularly vulnerable to HIV infection and have the potential to transmit HIV across multiple populations through their male and female sexual partners and injection drug-using partners.


METHODS
Respondent-driven sampling was used to recruit men who reported engaging in anal sex with another man in the past 3 months, aged ≥15 years, and living in Unguja, Zanzibar. Participants responded to a face-to-face interview about their HIV and injecting risk behaviours and were tested for HIV, Hepatitis B (HBV) and C (HCV) and syphilis.


RESULTS
Among the 509 MSM who enrolled in the survey, 14% (n=66) reported injecting drugs in the past 3 months among which 66% used heroin, 60% used a needle after someone else had and 68% passed a needle to someone else after using it. MSM-IDU were significantly more likely to have two or more non-paying male receptive sex partners and to have engaged in group sex in the past month, to have symptoms of a sexually transmitted infection in past 6 months, to have been arrested or beaten in the past 12 months and to be infected with HIV and co-infected with HIV and HCV compared to MSM who did not inject drugs. MSM-IDU were less likely to have used a condom at last sex with a non-paid female partner, to know where to get a confidential HIV test and to have ever been tested for HIV compared to MSM who did not inject drugs.


CONCLUSIONS
MSM-IDU, and MSM in general, in Unguja practice multiple high-risk behaviours that put them at risk for blood-borne and sexual transmission of HIV and HCV infection. Targeted interventions for MSM-IDU must account for the overlap of high-risk sexual and drug-using networks and integrate injection drug use and HIV services.
Johnston
Lisa G
LG
Tulane University, School of Public Health & Tropical Medicine, Department of International Health & Development, Center for Global Health Equity, New Orleans, LA, USA. lsjohnston.global@gmail.com
Holman
Abigail
A
Dahoma
Mohammed
M
Miller
Leigh Ann
LA
Kim
Evelyn
E
Mussa
Mahmoud
M
Othman
Asha A
AA
Kim
Andrea
A
Kendall
Carl
C
Sabin
Keith
K
D000328:Adult; D017280:Condoms / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D003625:Data Collection; D005260:Female; D015658:HIV Infections / Q000453:epidemiology* / Q000635:transmission; D006526:Hepatitis C / Q000453:epidemiology / Q000635:transmission; D018451:Homosexuality, Male; D006801:Humans; D008297:Male; D016485:Needle Sharing / Q000706:statistics & numerical data; D012309:Risk-Taking; D012725:Sexual Behavior / Q000706:statistics & numerical data; D012747:Sexual Partners; D015819:Substance Abuse, Intravenous / Q000150:complications* / Q000453:epidemiology; D013636:Tanzania / Q000453:epidemiology; D055815:Young Adult