Dual HIV Risk: Receptive Syringe Sharing and Unprotected Sex Among HIV-Negative Injection Drug Users in New York City

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 ≥18years 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.