AIDS and Behavior

, Volume 23, Issue 12, pp 3324–3330 | Cite as

Characterizing Men Who Have Sex with Men and Use Injection Drugs in Vancouver, Canada

  • Ayden Scheim
  • Rod Knight
  • Hennady Shulha
  • Ekaterina Nosova
  • Kanna Hayashi
  • M.-J. Milloy
  • Thomas Kerr
  • Kora DeBeckEmail author
Original Paper


We examined factors associated with reporting sex with men among men who inject drugs in Vancouver, Canada. Data were drawn from three open prospective cohorts of people who use drugs between 2005 and 2014. Generalized estimating equations were used to identify factors associated with reporting non-transactional sex with men (MSM) in the previous 6 months. Of 1663 men who used injection drugs, 225 (13.5%) were MSM over the study period. Sex with men was independently associated with younger age [Adjusted Odds Ratio (AOR) = 0.96], childhood sexual abuse (AOR = 2.65), sex work (AOR = 3.33), crystal methamphetamine use (AOR = 1.30), borrowing used syringes (AOR = 1.39), inconsistent condom use (AOR = 1.76), and HIV seropositivity (AOR = 3.82). MSM were less likely to be Hepatitis C-positive (AOR = 0.43) and to have accessed addiction treatment in the previous 6 months (AOR = 0.83) (all p < 0.05). Findings highlight vulnerabilities and resiliencies among MSM-PWID and indicate a need for trauma-informed and affirming harm reduction and substance use treatment services for MSM-PWID.


Men who have sex with men Injection drug use Substance use treatment Cohort study 



We wish to thank the study participants for their contribution to the research, as well as current and past researchers and staff. The study was supported by the US National Institutes of Health (U01DA038886; U01-DA021525). Dr. Ayden Scheim is supported by a Canadian Institutes of Health Research Fellowship. Dr. Rod Knight is supported by a Michael Smith Foundation for Health Research (MSFHR) Scholar Award. Dr. Kanna Hayashi is supported by a CIHR New Investigator Award (MSH-141971), a MSFHR Scholar Award and the St. Paul’s Foundation. Dr. M-J Milloy is supported by the United States National Institutes of Health (U01-DA0251525), a New Investigator Award from CIHR, and a MSFHR Scholar Award. His institution has received an unstructured gift from NG Biomed, Ltd., a private firm seeking a license to produce cannabis, to support him. Dr. Kora DeBeck is supported by a MSFHR/St. Paul’s Hospital Foundation–Providence Health Care Career Scholar Award and a Canadian Institutes of Health Research New Investigator Award.

Compliance with Ethical Standards

Conflict of interest

All authors declare that they have no conflict of interest.


  1. 1.
    Bluthenthal RN, Kral AH, Gee L, Lorvick J, Moore L, Seal K, et al. Trends in HIV seroprevalence and risk among gay and bisexual men who inject drugs in San Francisco, 1988 to 2000. J Acquir Immune Defic Syndr. 2001;28(3):264–9.CrossRefGoogle Scholar
  2. 2.
    Maslow CB, Friedman SR, Perlis TE, Rockwell R, Des Jarlais DC. Changes in HIV seroprevalence and related behaviors among male injection drug users who do and do not have sex with men: New York City, 1990–1999. Am J Public Health. 2002;92(3):382–4.CrossRefGoogle Scholar
  3. 3.
    Kral AH, Lorvick J, Gee L, Bacchetti P, Rawal B, Busch M, et al. Trends in human immunodeficiency virus seroincidence among street-recruited injection drug users in San Francisco, 1987–1998. Am J Epidemiol. 2003;157(10):915–22.CrossRefGoogle Scholar
  4. 4.
    Scheim AI, Nosova E, Knight R, Hayashi K, Kerr T. HIV incidence among men who have sex with men and inject drugs in a Canadian setting. AIDS Behav. 2018;22(12):3957–61.CrossRefGoogle Scholar
  5. 5.
    Strathdee SA, Sherman SG. The role of sexual transmission of HIV infection among injection and non-injection drug users. J Urban Health. 2003;80(Suppl 3):iii7–14.PubMedPubMedCentralGoogle Scholar
  6. 6.
    O’Connell JM, Lampinen TM, Weber AE, Chan K, Miller ML, Schechter MT, et al. Sexual risk profile of young men in Vancouver, British Columbia, who have sex with men and inject drugs. AIDS Behav. 2004;8(1):17–23.CrossRefGoogle Scholar
  7. 7.
    Ferreira AD, Caiaffa WT, Bastos FI, Mingoti SA. Profile of male Brazilian injecting drug users who have sex with men. Cadernos de saúde pública. 2006;22(4):849–60.CrossRefGoogle Scholar
  8. 8.
    Johnston LG, Holman A, Dahoma M, Miller LA, Kim E, Mussa M, et al. 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. Int J Drug Policy. 2010;21(6):485–92.CrossRefGoogle Scholar
  9. 9.
    Patel P, Borkowf CB, Brooks JT, Lasry A, Lansky A, Mermin J. Estimating per-act HIV transmission risk. AIDS. 2014;28(10):1509–19.CrossRefGoogle Scholar
  10. 10.
    Marshall BDL, Wood E, Li K, Kerr T. Elevated syringe borrowing among men who have sex with men: a prospective study. J Acquir Immune Defic Syndr. 2007;46(2):248–52.CrossRefGoogle Scholar
  11. 11.
    Deiss RG, Brouwer KC, Loza O, Lozada RM, Ramos R, Cruz MAF, et al. High-risk sexual and drug using behaviors among male injection drug users who have sex with men in 2 Mexico-US border cities. Sex Trans Dis. 2008;35(3):243–9.CrossRefGoogle Scholar
  12. 12.
    Semple SJ, Patterson TL, Grant I. A comparison of injection and non-injection methamphetamine-using HIV positive men who have sex with men. Drug Alcohol Depend. 2004;76(2):203–12.CrossRefGoogle Scholar
  13. 13.
    Ibanez GE, Purcell DW, Stall RD, Parsons JT, Gomez CA. Sexual risk, substance use, and psychological distress in HIV-positive gay and bisexual men who also inject drugs. AIDS. 2005;19:S49–55.CrossRefGoogle Scholar
  14. 14.
    Rietmeijer CA, Wolitski RJ, Fishbein M, Corby NH, Cohn DL. Sex hustling, injection drug use, and non-gay identification by men who have sex with men—associations with high-risk sexual behaviors and condom use. Sex Trans Dis. 1998;25(7):353–60.CrossRefGoogle Scholar
  15. 15.
    Ghanem A, Little SJ, Drumright L, Liu L, Morris S, Garfein RS. High-risk behaviors associated with injection drug use among recently HIV-infected men who have sex with men in San Diego, CA. AIDS Behav. 2011;15(7):1561–9.CrossRefGoogle Scholar
  16. 16.
    Lea T, Mao L, Bath N, Prestage G, Zablotska I, de Wit J, et al. Injecting drug use among gay and bisexual men in Sydney: prevalence and associations with sexual risk practices and HIV and hepatitis C infection. AIDS Behav. 2013;17(4):1344–51.CrossRefGoogle Scholar
  17. 17.
    Stall RD, Purcell DW. Intertwining epidemics: a review of research on substance use among men who have sex with men and its connection to the AIDS epidemic. AIDS Behav. 2000;4(2):181–92.CrossRefGoogle Scholar
  18. 18.
    Bull SS, Piper P, Rietmeijer C. Men who have sex with men and also inject drugs-profiles of risk related to the synergy of sex and drug injection behaviors. J Homosex. 2002;42(3):31–51.CrossRefGoogle Scholar
  19. 19.
    Kral AH, Lorvick J, Ciccarone D, Wenger L, Gee L, Martinez A, Edlin BR. HIV prevalence and risk behaviors among men who have sex with men and inject drugs in San Francisco. J Urban Health. 2005;82(Suppl 1):i43–50.CrossRefGoogle Scholar
  20. 20.
    Schneeberger AR, Dietl MF, Muenzenmaier KH, Huber CG, Lang UE. Stressful childhood experiences and health outcomes in sexual minority populations: a systematic review. Soc Psychiatry Psychiatr Epidemiol. 2014;49(9):1427–45.CrossRefGoogle Scholar
  21. 21.
    Marshall BDL, Galea S, Wood E, Kerr T. Longitudinal associations between types of childhood trauma and suicidal behavior among substance users: a cohort study. Am J Public Health. 2013;103(9):e69–75.CrossRefGoogle Scholar
  22. 22.
    Albuquerque GA. Access to health services by lesbian, gay, bisexual, and transgender persons: systematic literature review. BMC Int Health Hum Rights. 2016;16:2.CrossRefGoogle Scholar
  23. 23.
    Prangnell A, Ben D-G, Dong H, Nolan S, Milloy MJ, Wood E, et al. Factors associated with inability to access addiction treatment among people who inject drugs in Vancouver. Canada. Subst Abuse Treat Prev Policy. 2016;11:9.CrossRefGoogle Scholar
  24. 24.
    Strathdee SA, Palepu A, Cornelisse PG, Yip B, O’Shaughnessy MV, Montaner JS, et al. Barriers to use of free antiretroviral therapy in injection drug users. JAMA. 1998;280(6):547–9.CrossRefGoogle Scholar
  25. 25.
    Tyndall MW, Currie S, Spittal P, Li K, Wood E, O'Shaughnessy MV, et al. Intensive injection cocaine use as the primary risk factor in the Vancouver HIV-1 epidemic. AIDS. 2003;17(6):887–93.CrossRefGoogle Scholar
  26. 26.
    Wood E, Stoltz J-A, Montaner JSG, Kerr T. Evaluating methamphetamine use and risks of injection initiation among street youth: the ARYS study. Harm Reduct J. 2006;3(1):18.CrossRefGoogle Scholar
  27. 27.
    Scher CD, Stein MB, Asmundson GJ, McCreary DR, Forde DR. The childhood trauma questionnaire in a community sample: psychometric properties and normative data. J Trauma Stress. 2001;14(4):843–57.CrossRefGoogle Scholar
  28. 28.
    Hadland SE, Wood E, Dong H, Marshall BDL, Kerr T, Montaner JS, et al. Suicide attempts and childhood maltreatment among street youth: a prospective cohort study. Pediatrics. 2015;136(3):440–9.CrossRefGoogle Scholar
  29. 29.
    Rich AJ, Lachowsky NJ, Sereda P, Cui Z, Wong J, Wong S, et al. Estimating the size of the MSM population in metro Vancouver. Canada, using multiple methods and diverse data sources. 2018;95(2):188–95.Google Scholar
  30. 30.
    Lyons T, Shannon K, Richardson L, Simo A, Wood E, Kerr T. Women who use drugs and have sex with women in a Canadian setting: barriers to treatment enrollment and exposure to violence and homelessness. Arch Sex Behav. 2016;45(6):1403–10.CrossRefGoogle Scholar
  31. 31.
    Friedman MS, Marshal MP, Guadamuz TT, Wei C, Wong CF, Saewyc E, et al. A meta-analysis of disparities in childhood sexual abuse, parental physical abuse, and peer victimization among sexual minority and sexual nonminority individuals. Am J Public Health. 2011;101(8):1481–94.CrossRefGoogle Scholar
  32. 32.
    Senreich E. A comparison of perceptions, reported abstinence, and completion rates of gay, lesbian, bisexual, and heterosexual clients in substance abuse treatment. J Gay Lesbian Ment Health. 2009;13(3):145–69.CrossRefGoogle Scholar
  33. 33.
    Metzger DS, Woody GE, O’Brien C. Drug treatment as HIV prevention: a research update. J Acquir Immune Defic Syndr. 2010;55(Suppl 1):S32–6.CrossRefGoogle Scholar
  34. 34.
    Wood E, Spittal P, Li K, Kerr T, Miller CL, Hogg RS, et al. Inability to access addiction treatment and risk of HIV infection among injection drug users. J Acquir Immune Defic Syndr. 2004;36(2):750–4.CrossRefGoogle Scholar
  35. 35.
    Knight RE, Karamouzian M, Carson A, Edward J, Carrieri P, Shoveller J, et al. Interventions to address substance use and sexual risk among gay, bisexual and other men who have sex with men who use methamphetamine: a systematic review. Drug Alcohol Depend. 2019;194:410–29.CrossRefGoogle Scholar
  36. 36.
    Brennan DJ, Bauer GR, Bradley K, Tran OV. Methods used and topics addressed in quantitative health research on gay, bisexual and other men who have sex with men: a systematic review of the literature. J Homosex. 2017;64(11):1519–38.CrossRefGoogle Scholar
  37. 37.
    Salway T, Plöderl M, Liu J, Gustafson P. Effects of multiple forms of information bias on estimated prevalence of suicide attempts by sexual orientation: an application of a Bayesian misclassification correction method to data from a systematic review. Am J Epidemiol. 2019;188(1):239–49.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Ayden Scheim
    • 1
    • 2
  • Rod Knight
    • 3
    • 5
  • Hennady Shulha
    • 3
  • Ekaterina Nosova
    • 3
  • Kanna Hayashi
    • 3
    • 4
  • M.-J. Milloy
    • 3
    • 5
  • Thomas Kerr
    • 5
  • Kora DeBeck
    • 6
    • 7
    Email author
  1. 1.Division of Infectious Diseases and Global Public Health, Department of MedicineUniversity of California San DiegoLa JollaUSA
  2. 2.Li Ka Shing Knowledge Institute, St. Michael’s HospitalTorontoCanada
  3. 3.British Columbia Centre on Substance UseVancouverCanada
  4. 4.Faculty of Health SciencesSimon Fraser UniversityBurnabyCanada
  5. 5.Department of MedicineUniversity of British ColumbiaVancouverCanada
  6. 6.School of Public PolicySimon Fraser UniversityVancouverCanada
  7. 7.British Columbia Centre on Substance UseVancouverCanada

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