High-Risk Sexual and Drug Using Behaviors Among Male Injection Drug Users Who Have Sex With Men in 2 Mexico-US Border Cities

Abstract

Objectives-The population of Latino men who have sex with men (MSM) and who are also injection drug users (IDUs) is understudied. We explored risk behaviors of MSM/IDUs compared with other male IDUs in 2 Mexican border cities.Study Design-In 2005, IDUs who had injected within the previous 30 days were recruited using respondent-driven sampling (RDS) in Tijuana and Ciudad Juárez. They underwent antibody testing for HIV, HCV, and syphilis and interviewer-administered surveys. Men were categorized as MSM if they reported ≥1 lifetime male partners. Logistic regression was used to compare MSM/IDUs with non-MSM/IDUs.Results-A third (31%) of 377 male IDUs were categorized as MSM (47% in Tijuana and 13% in Ciudad Juárez, P <0.01). Combined RDS-adjusted prevalence of HIV and Hepatitis C was 3% (95% CI: 1, 5) and 96%, (95% CI: 94, 99) respectively, while 17% (95% CI: 2, 36) of MSM and 8% (95% CI: 3,12) of non-MSM tested positive for syphilis antibody. In multivariate logistic regression adjusted for site, MSM/IDUs were more likely than non-MSM/IDUs to have ever used inhalants (OR: 3.4; 95% CI: 1.8, 6.2) or oral tranquilizers (OR: 2.4; 95% CI: 1.3, 4.6), received treatment for a drug problem (OR:1.9; 95% CI: 1.1, 3.2) shared needles in the last six months (OR: 2.1; 95% CI: 1.0, 4.2) and also had higher numbers of lifetime female partners (log-transformed continuous variable, OR: 1.6; 95% CI: 1.2, 2.1).Conclusions-In these Mexican cities, the proportion of MSM among male IDUs was high. Compared with other male IDUs, MSM/IDUs were more likely to engage in behaviors placing them at risk of acquiring HIV/STIs. Culturally appropriate interventions targeting Latino MSM/IDUs are warranted.The profile of Latino injection drug users (IDUs) who are also men who have sex with other men (MSM) has been understudied. Two US studies found that homosexual/bisexual behavior This study sought to characterize and compare the sexual and drug use behaviors and prevalence of HIV, syphilis, and hepatitis C among male IDUs who reported sex with other males versus those who did not in 2 Mexico-US border cities. An advantage of the current study was the use of respondent-driven sampling (RDS), 21 which facilitated the rapid recruitment of the "hidden" IDUs population and enabled the calculation of less biased estimates of self-reported homosexual/bisexual activity and risk behaviors in this study. Materials and MethodsWe conducted a cross-sectional study of behavioral and contextual factors associated with HIV, HCV, and syphilis infections among IDUs in the Mexican border cities of Tijuana (population 1.3 million) and Ciudad Juárez, México (population 1.2 million). 22 Both cities are located on major drug trafficking routes and have large, predominantly male IDUs populations. 23 Eligibility criteria for the study included having injected illicit drugs within the past 30 days, confirmed by inspection of injection stigmata (track marks); aged 18 years or older; willing and able to provide informed consent; and not having previously been inte...

Vulnerability in the context of HIV and syphilis infection in a population of men who have sex with men (MSM) in Salvador, Bahia State, Brazil

“…Some RDS studies have found fewer sexual partners than in this study 24,28,39,40 , but our findings are close to other results of RDS studies with MSM 6,25,27,30 . Still, such differences may be due to the lack of a standardized period for which the number of partners was computed, varying widely in the literature, or to characteristics like the size of MSM social networks, age, schooling, and social class, factors that may be associated with the number of sexual partners in this sample.…”

“…As for syphilis, the prevalence found in Salvador is close to that reported in the international literature 2,5,7,8,9 , including RDS studies with MSM 6,30 , and shows the high prevalence of syphilis among MSM interviewed.…”

“…The latter was more common in this study when compared to patterns in other countries 1 : two RDS studies showed lower percentages 25,41 than in Salvador. However, regarding casual partners, other RDS showed similar percentages to those found in this research 27,30 , indicating high exposure of MSM in Salvador, since the probability of HIV infection can reach 40.4% per sexual partner in unprotected receptive anal sex 37 .…”

“…Thus, prevention and interven- tions targeting MSM should be broad and comprehensive, including social policies aimed at reducing stigma and improving living conditions and access to health services. Among the individual vulnerability factors associated with HIV infection and a positive rapid test for syphilis, MSM in this study had an average age of 25 years old, close to that of the MSM in the ten Brazilian cities study (27.5 years) 3 , but they were younger when compared to MSM in RDS studies in other countries, where the mean age ranged from 30 to 41 years 2,4,25,28,30,31 . This could be considered a recruitment bias in our study, but it might also reflect aspects of the male population in Salvador, with a high proportion in the 15 to 39-year age group according to the 2010 Population Census 32 .…”

Differing HIV Risks and Prevention Needs among Men and Women Injection Drug Users (IDU) in the District of Columbia

“…For NHBS-IDU-2, a sample of IDU was recruited between August and November 2009 via respondent-driven sampling (RDS), a chain-referral method which accesses hard to reach populations and provides estimates generalizable to the population of networks from which they are drawn; this method has been used in populations of IDU by other authors. [25][26][27][28][29][30][31][32][33][34][35][36] Non-randomly identified "seeds" are given coupons to recruit three people from their social and/or sexual networks to join the study, and each subsequent eligible person completing the interview is provided with up to three coupons with which to recruit their network members. Eligible individuals lived in the metropolitan DC area, were 18 years old and older, and injected drugs in the past 12 months based on verification of injection sites or successful completion of a knowledge screener specific to IDU.…”