Dual HIV Risk: Receptive Syringe Sharing and Unprotected Sex Among HIV-Negative Injection Drug Users in New York City Authors
First Online: 03 May 2013 DOI:
10.1007/s10461-013-0496-y Cite this article as: Neaigus, A., Reilly, K.H., Jenness, S.M. et al. AIDS Behav (2013) 17: 2501. doi:10.1007/s10461-013-0496-y Abstract
HIV-negative injection drug users (IDUs) who engage in both receptive syringe sharing and unprotected sex (“dual HIV risk”) are at high risk of HIV infection. In a cross-sectional study conducted in New York City in 2009, active IDUs aged ≥18 years were recruited using respondent-driven sampling, interviewed, and tested for HIV. Participants who tested HIV-negative and did not self-report as positive were analyzed (
N = 439). Adjusted odds ratios (aOR) and 95 % confidence intervals (95 % CI) were estimated using multinomial logistic regression. The sample was: 77.7 % male; 54.4 % Hispanic, 36.9 % white, and 8.7 % African-American/black. Dual risk was engaged in by 26.2 %, receptive syringe sharing only by 3.2 %, unprotected sex only by 49.4 %, and neither by 21.2 %. Variables independently associated with engaging in dual risk versus neither included Hispanic ethnicity (vs. white) (aOR = 2.0, 95 % CI = 1.0–4.0), married or cohabiting (aOR = 6.3, 95 % CI = 2.5–15.9), homelessness (aOR = 3.4, 95 % CI = 1.6–7.1), ≥2 sex partners (aOR = 8.7, 95 % CI = 4.4–17.3), ≥2 injecting partners (aOR = 2.9, 95 % CI = 1.5–5.8), and using only sterile syringe sources (protective) (aOR = 0.5, 95 % CI = 0.2–0.9). A majority of IDUs engaged in HIV risk behaviors, and a quarter in dual risk. Interventions among IDUs should simultaneously promote the consistent use of sterile syringes and of condoms. Keywords HIV Injection drug users IDU Syringe sharing Unprotected sex New York City References
Centers for Disease Control and Prevention. HIV surveillance report, 2010. Report no. 22. 2012.
New York City Department of Health and Mental Hygiene. New York City HIV/AIDS annual surveillance statistics, 2011. 2012.
Kaplan EH, Heimer R. A model-based estimate of HIV infectivity via needle sharing. J Acquir Immune Defic Syndr. 1992;5(11):1116–8.
Des Jarlais DC, Perlis T, Friedman SR, Chapman T, Kwok J, Rockwell R, et al. Behavioral risk reduction in a declining HIV epidemic: injection drug users in New York City, 1990–1997. Am J Public Health. 2000;90(7):1112–6.
Huo D, Ouellet LJ. Needle exchange and injection-related risk behaviors in Chicago: a longitudinal study. J Acquir Immune Defic Syndr. 2007;45(1):108–14.
Semaan S, Des Jarlais DC, Sogolow E, Johnson WD, Hedges LV, Ramirez G, et al. A Meta-analysis of the effect of HIV prevention interventions on the sex behaviors of drug users in the United States. J Acquir Immune Defic Syndr. 2002;30(Suppl. 1):S73–93.
Strathdee SA, Sherman SG. The role of sexual transmission of HIV infection among injection and non-injection drug users. J Urban Health. 2003;80(4 Suppl 3):7–14.
McCoy CB, Lai S, Metsch LR, Messiah SE, Zhao W. Injection drug use and crack cocaine smoking: independent and dual risk behaviors for HIV infection. Ann Epidemiol. 2004;14(8):535–42.
El-Bassel N, Wechsberg WM, Shaw SA. Dual HIV risk and vulnerabilities among women who use or inject drugs: no single prevention strategy is the answer. Curr Opin HIV AIDS. 2012;7(4):326–31.
Noor SW, Ross MW, Lai D, Risser JM. Clustered drug and sexual HIV risk among a sample of middle-aged injection drug users, Houston, Texas. AIDS Care 2012 Oct 24.
Lau JT, Cheng F, Tsui HY, Zhang Y, Zhang J, Wang N, et al. Clustering of syringe sharing and unprotected sex risk behaviors in male injecting drug users in China. Sex Transm Dis. 2007;34(8):574–82.
Chikovani I, Bozicevic I, Goguadze K, Rukhadze N, Gotsadze G. Unsafe injection and sexual risk behavior among injecting drug users in Georgia. J Urban Health. 2011;88(4):736–48.
Strathdee SA, Galai N, Safaiean M, Celentano DD, Vlahov D, Johnson L, et al. Sex differences in risk factors for HIV seroconversion among injection drug users: a 10-year perspective. Arch Intern Med. 2001;161(10):1281–8.
Miller CL, Spittal PM, LaLiberte N, Li K, Tyndall MW, O’Shaughnessy MV, et al. Females experiencing sexual and drug vulnerabilities are at elevated risk for HIV infection among youth who use injection drugs. J Acquir Immune Defic Syndr. 2002;30(3):335–41.
Spittal PM, Craib KJ, Wood E, LaLiberte N, Li K, Tyndall MW, et al. Risk factors for elevated HIV incidence rates among female injection drug users in Vancouver. CMAJ. 2002;166(7):894–9.
Lowndes CM, Alary M, Platt L. Injection drug use, commercial sex work, and the HIV/STI epidemic in the Russian Federation. Sex Transm Dis. 2003;30(1):46–8.
Wechsberg WM, Krupitsky E, Romanova T, Zvartau E, Kline TL, Browne FA, et al. Double jeopardy–drug and sex risks among Russian women who inject drugs: initial feasibility and efficacy results of a small randomized controlled trial. Subst Abuse Treat Prev Policy. 2012;7:1.
Evans JL, Hahn JA, Page-Shafer K, Lum PJ, Stein ES, Davidson PJ, et al. Gender differences in sexual and injection risk behavior among active young injection drug users in San Francisco (the UFO Study). J Urban Health. 2003;80(1):137–46.
Des Jarlais DC, Arasteh K, Hagan H, McKnight C, Perlman DC, Friedman SR. Persistence and change in disparities in HIV infection among injection drug users in New York City after large-scale syringe exchange programs. Am J Public Health. 2009;99(Suppl 2):S445–51.
Des Jarlais DC, Bramson HA, Wong C, Gostnell K, Cepeda J, Arasteh K, et al. Racial/ethnic disparities in HIV infection among people who inject drugs: an international systematic review and meta-analysis. Addiction. 2012;107(12):2087–95.
Rondinelli AJ, Ouellet LJ, Strathdee SA, Latka MH, Hudson SM, Hagan H, et al. Young adult injection drug users in the United States continue to practice HIV risk behaviors. Drug Alcohol Depend. 2009;104(1–2):167–74.
Marshall BD, Kerr T, Shoveller JA, Patterson TL, Buxton JA, Wood E. Homelessness and unstable housing associated with an increased risk of HIV and STI transmission among street-involved youth. Health Place. 2009;15(3):753–60.
Booth RE, Watters JK, Chitwood DD. HIV risk-related sex behaviors among injection drug users, crack smokers, and injection drug users who smoke crack. Am J Public Health. 1993;83(8):1144–8.
Chaisson RE, Bacchetti P, Osmond D, Brodie B, Sande MA, Moss AR. Cocaine use and HIV infection in intravenous drug users in San Francisco. J Am Med Assoc. 1989;261(4):561–5.
DeBeck K, Kerr T, Li K, Fischer B, Buxton J, Montaner J, et al. Smoking of crack cocaine as a risk factor for HIV infection among people who use injection drugs. CMAJ. 2009;181(9):585–9.
Le MC, Evans J, Page K, Davidson PJ, Hahn JA. Hazardous alcohol consumption among young adult IDU and its association with high risk behaviors. Drug Alcohol Depend. 2012;127(1–3):143–9.
Neaigus A, Friedman SR, Goldstein MF, Ildefonso G, Curtis R, Jose B. Using dyadic data for a network analysis of HIV infection and risk behaviors among injecting drug users. NIDA Res Monogr. 1995;151:20–37.
Latkin CA, Kuramoto SJ, Davey-Rothwell MA, Tobin KE. Social norms, social networks, and HIV risk behavior among injection drug users. AIDS Behav. 2010;14(5):1159–68.
Friedman SR, Neaigus A, Jose B, Curtis R, Goldstein MF, Ildefonso G, et al. Sociometric risk networks and risk for HIV infection. Am J Public Health. 1997;87(8):1289–96.
Gyarmathy VA, Neaigus A. The effect of personal network exposure on injecting equipment sharing among IDUs in Budapest, Hungary. Connections. 2006;15(1):29–42.
Neaigus A, Zhao M, Gyarmathy VA, Cisek L, Friedman SR, Baxter RC. Greater drug injecting risk for HIV, HBV, and HCV infection in a city where syringe exchange and pharmacy syringe distribution are illegal. J Urban Health. 2008;85(3):309–22.
Metzger DS, Woody GE, O’Brien CP. Drug treatment as HIV prevention: a research update. J Acquir Immune Defic Syndr. 2010;55(Suppl 1):S32–6.
Wolitski RJ, MacGowan RJ, Higgins DL, Jorgensen CM. The effects of HIV counseling and testing on risk-related practices and help-seeking behavior. AIDS Educ Prev. 1997;9(3 Suppl):52–67.
Gallagher KM, Sullivan PS, Lansky A, Onorato IM. Behavioral surveillance among people at risk for HIV infection in the US: the national HIV behavioral surveillance system. Public Health Rep. 2007;122(Suppl 1):24–31.
Lansky A, Sullivan PS, Gallagher KM, Fleming PL. HIV behavioral surveillance in the US: a conceptual framework. Public Health Rep. 2007;122(Suppl 1):S2–8.
Heckathorn DD. Respondent-driven sampling: a new approach to the study of hidden populations. Soc Probl. 1997;44(2):174–99.
Heckathorn DD. Respondent-driven sampling II: deriving valid population estimates from chain-referral samples of hidden populations. Soc Probl. 2002;49(1):11–34.
Heckathorn D. Extensions of respondent-driven sampling: analyzing continuous variables and controlling for differential recruitment. Sociol Methodol. 2007;37(1):151–207.
Johnston LG, Malekinejad M, Kendall C, Iuppa IM, Rutherford GW. Implementation challenges to using respondent-driven sampling methodology for HIV biological and behavioral surveillance: field experiences in international settings. AIDS Behav. 2008;12(4 Suppl):S131–41.
Johnston L, O’Bra H, Chopra M, Mathews C, Townsend L, Sabin K, et al. The associations of voluntary counseling and testing acceptance and the perceived likelihood of being HIV-infected among men with multiple sex partners in a South African township. AIDS Behav. 2010;14(4):922–31.
Goel S, Salganik MJ. Assessing respondent-driven sampling. Proc Natl Acad Sci USA. 2010;107(15):6743–7.
Wejnert C, Pham H, Krishna N, Le B, DiNenno E. Estimating design effect and calculating sample size for respondent-driven sampling studies of injection drug users in the United States. AIDS Behav. 2012;16(4):797–806.
Marshall BD, Kerr T, Qi J, Montaner JS, Wood E. Public injecting and HIV risk behaviour among street-involved youth. Drug Alcohol Depend. 2010;110(3):254–8.
Miller M, Neaigus A. Networks, resources and risk among women who use drugs. Soc Sci Med. 2001;52:967–78.
Miller M, Neaigus A. Sex partner support, drug use and sex risk among HIV-negative non-injecting heroin users. AIDS Care. 2002;14(6):801–13.
Deren S, Kang SY, Colon HM, Robles RR. The Puerto Rico-New York airbridge for drug users: description and relationship to HIV risk behaviors. J Urban Health. 2007;84(2):243–54.
Gelpi-Acosta C, Hagan H, Jenness SM, Wendel T, Neaigus A. Sexual and injection-related risks in Puerto Rican-born injection drug users living in New York City: a mixed-methods analysis. Harm Reduct J. 2011;8:28.
Freeman RC, Williams ML, Saunders LA. Drug use, AIDS knowledge, and HIV risk behaviors of Cuban-, Mexican-, and Puerto-Rican-born drug injectors who are recent entrants into the United States. Subst Use Misuse. 1999;34(13):1765–93.
Magis-Rodriguez C, Lemp G, Hernandez MT, Sanchez MA, Estrada F, Bravo-Garcia E. Going North: Mexican migrants and their vulnerability to HIV. J Acquir Immune Defic Syndr. 2009;51(Suppl 1):S21–5.
Des Jarlais DC, Perlis T, Arasteh K, Hagan H, Milliken J, Braine N, et al. “Informed altruism” and “partner restriction” in the reduction of HIV infection in injecting drug users entering detoxification treatment in New York City, 1990–2001. J Acquir Immune Defic Syndr. 2004;35(2):158–66.
Bennett GA, Velleman RD, Barter G, Bradbury C. Gender differences in sharing injecting equipment by drug users in England. AIDS Care. 2000;12(1):77–87.
Latkin CA, Mandell W, Knowlton AR, Doherty MC, Vlahov D, Suh T, et al. Gender differences in injection-related behaviors among injection drug users in Baltimore, Maryland. AIDS Educ Prev. 1998;10(3):257–63.
Lum PJ, Sears C, Guydish J. Injection risk behavior among women syringe exchangers in San Francisco. Subst Use Misuse. 2005;40(11):1681–96.
Strathdee SA, Shoptaw S, Dyer TP, Quan VM, Aramrattana A. Towards combination HIV prevention for injection drug users: addressing addictophobia, apathy and inattention. Curr Opin HIV AIDS. 2012;7(4):320–5.
Rockwell R, Des Jarlais DC, Friedman SR, Perlis TE, Paone D. Geographic proximity, policy and utilization of syringe exchange programmes. AIDS Care. 1999;11(4):437–42.
El-Bassel N, Gilbert L, Witte S, Wu E, Hunt T, Remien RH. Couple-based HIV prevention in the United States: advantages, gaps, and future directions. J Acquir Immune Defic Syndr. 2010;55(Suppl 2):S98–101.
El-Bassel N, Gilbert L, Wu E, Witte SS, Chang M, Hill J, et al. Couple-based HIV prevention for low-income drug users from New York City: a randomized controlled trial to reduce dual risks. J Acquir Immune Defic Syndr. 2011;58(2):198–206.
Baeten JM, Donnell D, Ndase P, Mugo NR, Campbell JD, Wangisi J, et al. Antiretroviral prophylaxis for HIV prevention in heterosexual men and women. N Engl J Med. 2012;367(5):399–410.
Neaigus A. The network approach and interventions to prevent HIV among injection drug users. Public Health Rep. 1998;113(Suppl 1):140–50.
Dickson-Gomez J, McAuliffe T, Convey M, Weeks M, Owczarzak J. Access to housing subsidies, housing status, drug use and HIV risk among low-income US urban residents. Subst Abuse Treat Prev Policy. 2011;6:31.
Centers for Disease Control and Prevention. Syringe exchange programs—United States, 2008. MMWR Morb Mortal Wkly Rep. 2010;59(45):1488–91.
Metzger DS, Zhang Y. Drug treatment as HIV prevention: expanding treatment options. Curr HIV/AIDS Rep. 2010;7(4):220–5.
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