HIV Prevalence and Risk Among Heterosexual Methamphetamine Injectors in California

Abstract

This study funded by Centers for Disease Control compares HIV prevalence and risk behavior among heterosexual methamphetamine (n = 428) and nonmethamphetamine (n = 878) injectors in California, USA, during 2001–2003. While HIV was not highly prevalent among methamphetamine injectors (3%), sexual and injection risk behaviors were highly prevalent (ranging from 21% to 72%). In multivariate analyses, methamphetamine injectors had higher odds than nonmethamphetamine injectors of unprotected vaginal intercourse and sex with five or more sexual partners in the past 6 months and of distributive and receptive syringe sharing in the past 30 days. There was no significant difference in HIV sero-status by methamphetamine use. Suggestions are made for designing HIV prevention programs. The study's limitations are noted.

RÉSUMÉ

Cette étude financée par le CDC compare la prévalence du VIH et le comportement à risque parmi les injecteurs hétérosexuels de méthamphétamine (n = 428) et ceux ne s'injectant pas de méthamphétamine (n = 878) en Californie, États-Unis, de 2001 à 2003. Alors que la prévalence du VIH parmi les injecteurs de méthamphétamine était plutôt faible (3%), cette population affichait par contre une prévalence très élevée en matière de comportements sexuels et d'injections à risque (allant de 21% à 72%). Dans des analyses à plusieurs variables, les injecteurs de méthamphétamine affichaient des probabilités plus élevées d'avoir des rapports vaginaux non protégés et des relations sexuelles avec cinq partenaires ou plus au cours des six derniers mois, par rapport à ceux ne s'injectant pas de méthamphétamine; il en était de même concernant le partage de seringues de manière distributive et réceptive sur le mois écoulé. Aucune différence significative n'a été observée pour le statut sérologique au VIH du fait de la consommation de méthamphétamine. Des suggestions sont faites pour concevoir des programmes de prévention du VIH.

RESUMEN

Este estudio, patrocinado por el CDC, compara la prevalencia del VIH y comportamientos arriesgados entre heterosexuales inyectadores de metanfetamina (n = 428) y inyectadores que no usan metanfetamina (n = 878) en California, EEUU durante 2001–2003. Aunque la prevalencia de VIH no fue alta entre inyectadores de metanfetamina (3%), la prevalencia del compartimiento arriesgado sexual y de inyección fue alta (entre 21% a 72%). En análisis multivariados, las posibilidades (odds) de sexo vaginal no protegido, de sexo con cinco o más parejas sexuales en los últimos seis meses, y de jeringas distribuidas o recibidas compartidas en los últimos treinta días, fueron más altas entre los inyectadores de metanfetamina que entre inyectadores que no usan metanfetamina. No hubo diferencia significativa en estatus de VIH por uso de metanfetamina. Se presentan sugerencias para el diseño de programas para la prevención del VIH.

Keywords :

• methamphetamine
• IDU
• HIV
• heterosexual
• epidemiology
• sexual risk

THE AUTHORS

Alex H. Kral, Ph.D., is Director of the Urban Health Program in the RTI International's San Francisco Regional Office, as well as Associate Adjunct Professor of epidemiology in the Department of Family and Community Medicine at the University of California, San Francisco. Dr. Kral is an infectious disease epidemiologist with expertise in community-based research with urban poor populations. The majority of his research focuses on the nexus of substance use, mental health, poverty, and HIV.

Jennifer Lorvick, M.P.H., is Associate Director of the Urban Health Program at the RTI International and a doctoral student in public health at the University of California, Berkeley. In the area of drug use and HIV, her work focuses on community-based social epidemiological studies and evaluations of innovative intervention programs. She is currently conducting research on MA use, sexual risk, and HIV/STIs among women.

Alexis Martinez, Ph.D., is Assistant Professor of sociology at the San Francisco State University. Previously, Dr. Martinez held a postdoctoral fellowship in AIDS prevention research at the Center for AIDS Prevention Studies of the University of California, San Francisco. She has a Ph.D. in medical sociology and an M.P.H. in infectious disease epidemiology. Since 1998 she has been conducting community-based research with urban poor populations such as drug users.

Megan A. Lewis, Ph.D., is a Senior Research Scientist in the Health Communication Program at the RTI International. Dr. Lewis’ research interests focus on how couple members communicate with each other and influence each other's health practices. She has examined both individual and dyadic determinants of health compromising and health enhancing behaviors, across many different couple types. Her research has been widely published in social and health psychology literatures and funded by multiple National Institutes of Health.

W. Alexander Orr, M.P.H., is a Senior Analyst at Abt Associates. His research interests include qualitative studies of health behavior among high-risk populations, specifically individuals who are homeless; gay, lesbian, bisexual, transgendered, or queer; substance-abusing; or who have or are at high risk for HIV/AIDS.

Rachel Anderson's professional focus is to advocate for the human rights of drug users and to decrease and document the adverse consequences associated with injecting drug use through interventions and research. Ms. Anderson was a Staff Research Associate in the Division of Immunological and Infectious Diseases, School of Medicine, University of California, Davis, from 1989 to 2005. Currently she is the Executive Director of Safer Alternatives thru Networking & Education (SANE), a community-based organization she cofounded in 1993 to provide syringe exchange and other harm reduction services to drug users in the Sacramento region.

Dr. Neil N. Flynn, M.D., M.P.H., is Professor of clinical medicine at the University of California, Davis’ School of Medicine, has devoted the past 18 years of his career to HIV-1 clinical care, epidemiology and prevention of HIV-1 infection among IDUs, and conducting clinical trials. He has been instrumental in the development of the Center for AIDS Research & Education Services in Sacramento, California, serving as its Medical Director for 6 years and currently as its Research Director. He is the Medical Director of the Joan Viteri Memorial Clinic, a student-run, mobile medical clinic costaffed with outreach workers from Harm Reduction Services.

Ricky N. Bluthenthal, Ph.D., is Professor at the University of Southern California. Dr. Bluthenthal's major research contributions have been in the areas of HIV epidemiology and prevention for drug injectors; racial/ethnic differences in alcohol consumption, consequences, and treatment outcomes; and community approaches to health promotion. He received his doctoral degree in sociology from the University of California, Berkeley, in 1998.