Clustered drug and sexual HIV risk among a sample of middle-aged injection drug users, Houston, Texas

Abstract

Recent studies have reported a clustered pattern of high-risk drug using and sexual behaviors among younger injection drug users (IDUs), however, no studies have looked at this clustering pattern in relatively older IDUs. This analysis examines the interplay and overlap of drug and sexual HIV risk among a sample of middle-aged, long-term IDUs in Houston, Texas. Our study includes 452 eligible IDUs, recruited into the 2009 National HIV Behavioral Surveillance project. Four separate multiple logistic regression models were built to examine the odds of reporting a given risk behavior. We constructed the most parsimonious multiple logistic regression model using a manual backward stepwise process. Participants were mostly male, older (mean age: 49.5±6.63), and nonHispanic Black. Prevalence of receptive needle sharing as well as having multiple sex partners and having unprotected sex with a partner in exchange for money, drugs, or other things at last sex were high. Unsafe injecting practices were associated with high-risk sexual behaviors. IDUs, who used a needle after someone else had injected with it had higher odds of having more than three sex partners (odds ratio (OR) = 2.10, 95% confidence interval (CI): 1.40–3.12) in last year and who shared drug preparation equipment had higher odds of having unprotected sex with an exchange partner (OR = 3.89, 95% CI: 1.66–9.09) at last sex. Additionally, homelessness was associated with unsafe injecting practices but not with high-risk sexual behaviors. Our results show that a majority of the sample IDUs are practicing sexual as well as drug-using HIV risk behaviors. The observed clustering pattern of drug and sexual risk behavior among this middle-aged population is alarming and deserve attention of HIV policy-makers and planners.

Keywords:

• clustered HIV risk
• injection drug user
• dual HIV exposure
• cocaine
• homeless
• Houston
• Texas

Acknowledgements

The authors would like to acknowledge Houston Department of Health and Human Services for their continuing support. This project was partially supported by the CDC Cooperative Agreement PS00097. All authors listed have contributed sufficiently to be included as authors, and are qualified for authorship according to ICMJE standards. Syed W.B. Noor, Michael W. Ross, and Jan M. Risser conceptualized this analysis and drafted the manuscript. Syed W.B. Noor and Dejian Lai analyzed the data. All authors read and commented on drafts of the manuscript and assisted in interpreting results. They also critically revised the manuscript.