Sexual behaviour in injecting drug users.

Abstract

A survey of the self-reported sexual behaviors of 1239 intravenous drug users recruited off the streets in Sydney, Australia, highlighted the impact of both sexual orientation and gender on the risk of human immunodeficiency virus (HIV) infection in this population. The sample included 908 men (mean age, 27.9 years) and 331 women (mean age, 26.3 years), the majority of whom were unemployed or receiving social security benefits. Among male respondents, 50 were homosexual, 117 were bisexual, and 719 were heterosexual; for females these numbers were 10, 95, and 220, respectively. Oral and vaginal sex were the most commonly reported practices among heterosexuals, while homosexuals primarily reported manual stimulation and oro-genital contact. The regular sexual partners of male intravenous drug users tended not to be addicts, while female drug users were primarily involved with male partners who also abused drugs. Among male respondents, condom use was highest among homosexuals, followed by bisexuals, and lowest among heterosexuals; there were no significant differences by sexual orientation in female respondents' condom use. Overall, condoms were most likely to be utilized in anal sex and least likely in the case of oral sex. Condom use was about 5% lower when a regular as opposed to casual sexual partner was involved. Most of the 64 HIV-positive respondents were homosexuals, suggesting that sexual orientation rather than drug abuse was the primary risk factor. Given the finding that there is substantial variation in condom use among subgroups of intravenous drug abusers, it is recommended that HIV prevention programs adopt a diversified rather than uniform approach.