Role of sexual transmission of HIV among young non-injection and injection opiate users: A respondent driven sampling study

Background/ Objectives: Little research has investigated sexual transmissibility of HIV among young drug users in China. The objective of this study was to examine the role of sexual transmission of HIV infection among injection drug users (IDUs) and non-injection drug users (NIDUs). Methods: Respondent-driven sampling (RDS) was used to recruit 426 young drug users in Yunnan, China. Interrelationships among risky sexual behaviors, drug-use modes, and drug-use practices were examined in a logistic regression model. Results: The RDS-adjusted proportion of NIDUs was 51%. Substantial proportions of NIDUs and IDUs reported engaging in risky sexual behaviors including: (1) having multiple sexual partners (42% of NIDUs vs. 37% of IDUs); (2) conducting concurrent sexual partnerships (48% vs. 46%); and (3) engaging commercial sex partners (23% vs. 24%) and sex partners who were NIDUs (14% vs. 17 %). Both NIDUs and IDUs reported low levels of condom use with non-regular partners (48% vs. 42%) and regular partners (24% vs. 27%). Compared to IDUs, NIDUs reported having had fewer sex partners who were IDUs, fewer IDU network peers, more NIDU network peers, and having lower levels of HIV knowledge and self-perceived HIV risk. Only 3% of IDUs shared needles for half or more episodes of injections. Conclusion: Generalization of the HIV epidemic from high-risk groups to the general population may be driven by risky sexual behavior among drug users. Reducing sexual transmission of HIV among both IDUs and NIDUs is the next major challenge for HIV intervention among drug users in China.