title: Evidence of high-risk sexual behaviors among injection drug users in the Kenya PLACE study.
abstract: BACKGROUND
  Injection drug users (IDUs) in resource poor settings are at high risk for HIV transmission through unsafe needle-sharing and sexual practices. We report on the injecting and sexual behavior of a sample of IDUs from Malindi, Kenya.
  
  
  METHODS
  A Priority for Local AIDS Control Efforts (PLACE) study was conducted from April to May 2010 to identify areas where HIV transmission is most likely to occur and specific venues where people meet new sexual partners. Community informants (n=202) listed 157 unique venues from which 29 were randomly selected using a systematic fixed interval sampling strategy with probability of selection proportional to venue size. Twenty patrons and four workers were interviewed at each venue. Drug use practices were elicited in a staff-administered interview.
  
  
  RESULTS
  Between 40% and 50% of IDUs reported needle-sharing, taking drugs from a common reservoir, using a ready-made solution without boiling, and not exchanging a used for a new syringe in the past month. Most could inconsistently or never get new syringes. In multivariate logistic regression models controlling for age, education, residence, and poverty status, IDUs were twice as likely as non-IDUs to report multiple partners in the past year (OR 1.94, 95% CI 1.26-3.00, p<.01) and multiple new partners in the past year (OR 2.11, 95% CI 1.30-3.42, p<.01).
  
  
  CONCLUSIONS
  High prevalence of multiple sexual partnerships and risky injecting behaviors among IDUs and unavailability of new injecting needles are likely facilitating HIV transmission in Malindi, Kenya.
authors.affiliation: MEASURE Evaluation, Carolina Population Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27516-2524, USA. brodish@unc.edu
authors.forename: Paul
authors.initials: P
authors.lastname: Brodish
authors.forename: Kavita
authors.initials: K
authors.lastname: Singh
authors.forename: Agnes
authors.initials: A
authors.lastname: Rinyuri
authors.forename: Carol
authors.initials: C
authors.lastname: Njeru
authors.forename: Nzioki
authors.initials: N
authors.lastname: Kingola
authors.forename: Patrick
authors.initials: P
authors.lastname: Mureithi
authors.forename: William
authors.initials: W
authors.lastname: Sambisa
authors.forename: Sharon
authors.initials: S
authors.lastname: Weir
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000517:prevention & control; D000293:Adolescent; D000328:Adult; D055030:Drug Users; D004812:Epidemiologic Methods; D005260:Female; D006678:HIV; D015658:HIV Infections / Q000453:epidemiology* / Q000517:prevention & control / Q000523:psychology / Q000635:transmission; D006801:Humans; D007406:Interview, Psychological; D007630:Kenya; D008297:Male; D016485:Needle Sharing; D009339:Needles; D012309:Risk-Taking; D012725:Sexual Behavior; D012747:Sexual Partners; D015819:Substance Abuse, Intravenous / Q000453:epidemiology* / Q000473:pathology / Q000523:psychology; D055815:Young Adult