Gender differences in sexual and injection risk behavior among active young injection drug users in San Francisco (the UFO study)
Female injection drug users (IDUs) represent a large proportion of persons infected with HIV in the United States, and women who inject drugs have a high incidence of hepatitis B virus (HBV) and hepatitis C virus (HCV) injection. Therefore, it is important to understand the role of gender in injection risk behavior and the transmission of blood-borne virus. In 2000–2002, 844 young (<30 years old) IDUs were surveyed in San Francisco. We compared self-reported risk behavior between 584 males and 260 female participants from cross-sectional baseline data. We used logistic regression to determine whether demographic, structural, and relationship variables explained increased needle borrowing, drug preparation equipment sharing, and being injected by another IDU among females compared to males. Females were significantly younger than males and were more likely to engage in needle borrowing, ancillary equipment sharing, and being injected by someone else. Females were more likely than males to report recent sexual intercourse and to have IDU sex partners. Females and males were not different with respect to education, race/ethnicity, or housing status. In logistic regression models for borrowing a used needle and sharing drug preparation equipment, increased risk in females was explained by having an injection partner who was also a sexual partner. Injecting risk was greater in the young female compared to male IDUs despite equivalent frequency of injecting. Overlapping sexual and injection partnerships were a key factor in explaining increased injection risk in females. Females were more likely to be injected by another IDU even after adjusting for years injecting, being in a relationship with another IDU, and other potential confounders. Interventions to reduce sexual and injection practices that put women at risk of contracting hepatitis and HIV are needed.
KeywordsEpidemiology Gender differences Homeless Injection drug use Youth
Public health and injection drug use.MMWR Morb Mortal Wkly Rep.
Gibbs DA, Hamill DN, Magruder-Habib K. Populations at increased risk of HIV infection: current knowledge and limitations.J Acquir Immune Defic Syndr.
Substance Abuse and Mental Health Services Administration.Summary of Findings from the 2000 National Household Survey on Drug Abuse
. NHDSA Series H-13. Rockville, MD: Office of Applied Studies; 2001. DHHS Publication No. (SMA) 01-3549.Google Scholar
Drug-Associated HIV Transmission Continues in the United States
. Atlanta, GA: Centers for Disease Control and Prevention; March 2002.Google Scholar
Garfein RS, Doherty MC, Monterroso ER, Thomas DL, Nelson KE, Vlahov D. Prevalence and incidence of hepatitis C virus infection among young adult injection drug users.J Acquir Immune Defic Syndr Hum Retrovirol.
1998;18(suppl 1):S11-S19.PubMedGoogle Scholar
Hagan H, Des Jarlais DC. HIV and HCV infection among injecting drug users.Mt Sinai J Med
. 2000;67:423–428.PubMedGoogle Scholar
Thomas DL, Vlahov D, Solomon, L, et al. Correlates of hepatitis C virus infections among injection drug users.Medicine (Baltimore)
. 1995;74(4):212–220.CrossRefGoogle Scholar
Bennett GA, Velleman RD, Barter G, Bradbury C. Gender differences in sharing injecting equipment by drug users in England.AIDS Care.
Montgomery SB, Hyde J, De Rosa CJ, et al., Gender differences in HIV risk behaviors among young injectors and their social network members.Am J Drug Alcohol Abuse
. 2002;28:453–475.CrossRefPubMedGoogle Scholar
Dwyer R, Richardson D, Ross MW, Wodak A, Miller ME, Gold J. A comparison of HIV risk between women and men who inject drugs.AIDS Educ Prev.
Clements K, Gleghorn A, Garcia D, Katz M, Marx R. A risk profile of street youth in northern California: implications for gender-specific human immunodeficiency virus prevention.J Adolesc Health.
Gollub EL, Rey D, Obadia Y, Moatti JP. Gender differences in risk behaviors among HIV+ persons with an IDU history. The link between partner characteristics and women's higher drug-sex risks. The Manif 2000 Study Group.Sex Transm Dis.
Latkin CA, Mandell W, Knowlton AR, et al. Gender differences in injection-related behaviors among injection drug users in Baltimore, Maryland.AIDS Educ Prev.
Miller M, Neaigus A. Networks, resources and risk among women who use drugs.Soc Sci Med.
Vidal-Trecan G, Coste J, Coeuret M, Delamare N, Varescon-Pousson I, Boissonnas A. [Risk behaviors of intravenous drug users: are females taking more risks of HIV and HCV transmission?].Rev Epidemiol Sante Publique
. 1998;46(3):193–204.PubMedGoogle Scholar
Davies AG, Dominy NJ, Peters AD, Richardson AM. Gender differences in HIV risk behaviour of injecting drug users in Edinburgh.AIDS Care
. 1996;8:517–527.CrossRefPubMedGoogle Scholar
Baker A, Kochan N, Dixon J, Wodak A, Heather N. Drug use and HIV risk-taking behaviour among injecting drug users not currently in treatment in Sydney, Australia.Drug Alcohol Depend
. 1994;34(2):155–160.CrossRefPubMedGoogle Scholar
Garfein RS, Vlahov, D, Galai N, Doherty MC, Nelson KE. Viral infections in short-term injection drug users: the prevalence of the hepatitis C, hepatitis B, human immunodeficiency, and human T-lymphotropic viruses.Am J Public Health
. 1996;86:655–661.PubMedCrossRefGoogle Scholar
Diaz T, Des Jarlais DC, Vlahov D, et al. Factors associated with prevalent hepatitis C: differences among young adult injection drug users in lower and upper Manhattan, New York City.Am J Public Health
. 2001;91(1):23–30.PubMedGoogle Scholar
Hagan H, Thiede H, Weiss NS, Hopkins SG, Duchin JS, Alexander ER. Sharing of drug preparation equipment as a risk factor for hepatitis C.Am J Public Health
. 2001;91(1):42–46.PubMedGoogle Scholar
Hahn JA, Page-Shafer K, Lum PJ, Ochoa K, Moss AR. Hepatitis C virus infection and needle exchange use among young injection drug users in San Francisco.Hepatology
. 2001;34(1):180–187.CrossRefPubMedGoogle Scholar
Hahn JA, Page-Shafer K, Lum PJ, et al. Hepatitis C virus seroconversion among young injection drug users: relationships and risk.J Infect Dis.
Doherty MC, Garfein RS, Monterroso E, Latkin C, Vlahov D. Gender differences in the initiation of injection drug use among young adults.J Urban Health
. 2000;77:396–414.CrossRefPubMedGoogle Scholar
Kral AH, Bluthenthal RN, Erringer EA, Lorvick J, Edlin BR. Risk factors among IDUs who give injections to or receive injections from other drug users.Addiction
. 1999;94:675–683.CrossRefPubMedGoogle Scholar
Epele ME. Gender, violence and HIV: women's survival in the streets.Cult Med Psychiatry
. 2002;26(1):33–54.CrossRefPubMedGoogle Scholar
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