Clustered Drug and Sexual HIV Risk among a Sample of Older Injection Drug Users, Houston, Texas

Background: Recent studies reported clustered pattern of high risk drug using and sexual behaviors among younger injection drug users. This analysis examines the interplay and overlap of drug and sexual HIV risk among a sample of older, long-term injection drug users in Houston Texas.

Methods: Our study includes 523 eligible IDUs, recruited into the 2009 National HIV Behavioral Surveillance project. Eight separate multivariable regression models were built to examine the odds of reporting a given risk behavior. We constructed the most parsimonious multivariable model using a manual backward stepwise process.

Results: Participants were mostly male, older, and non-Hispanic Black. A majority of the sample reported needle sharing as well as unprotected sex and exchange partner at last sex. Unsafe injecting practices were associated with high risk sexual behaviors. IDUs who shared needles had higher odds of having anal sex (OR=2.89, 95%CI: 1.69-4.92) and unprotected sex (OR=2.66, 95%CI: 1.38-5.10) at last sex. Additionally, homelessness was associated with needle sharing (OR=2.24, 95% CI: 1.34-3.76) and cocaine use was associated with multiple sex partners (OR=1.82, 95% CI: 1.07-3.11).

Conclusions: Our results show that a majority of the sample IDUs are exposed to both sexual and drug-use modes of HIV transmission. Though temporality cannot be established due to the cross-sectional study design our findings indicate that choice of drug, homelessness and gender are associated with HIV risk. The observed clustering pattern of drug and sexual risk behavior among this population is alarming and deserve attention of HIV policy makers and planners.