Focusing on interventions that address high-risk sexual behaviors and injection practices may reduce HIV transmission rates among individuals who are HIV-positive and inject drugs, according to study results published in the Centers for Disease Control and Prevention (CDC)’s Morbidity and Mortality Weekly Report.
Researchers used a 2-stage sampling method to evaluate injection practices, sexual behaviors, and medical service needs among adults from 23 jurisdictions in the United States diagnosed with HIV. Researchers conducted telephone or in-person interviews with participants between June 2015 and May 2017 to obtain self-reported information on injection practices, sexual behavior, and whether participants needed or received drug or alcohol treatment within the previous 12 months. Of these individuals, 233 reported injecting drugs and 7397 reported not injecting drugs. Rao-Scott chi-square tests were used to compare characteristics, such as condomless sex, associated with a high risk for sexual transmission of HIV in both groups.
Results revealed that among the participants in the HIV-positive group who injected drugs, 11% shared syringes, 10% shared other injection equipment, and 61% of all individuals in the group injected drugs before or during sex. An estimated 57% of participants with HIV who injected drugs reported needing treatment for drug or alcohol use, and 80% of individuals in this group did not receive drug or alcohol treatment during the past 12 months. Approximately 48% of participants with HIV who injected drugs had a detectable viral load compared with 35% of those who did not inject drugs (P =.008). In addition, condomless sex (63%), exchange sex (17%), and high-risk sex (18%) were all more prevalent among participants with HIV who injected drugs compared with those who did not inject drugs (31%, 2%, and 6%, respectively; P <.001).
There were 3 primary limitations to this study. First, characteristics were self-reported by participants and may be subject to information bias. Second, not all sampled individuals participated in the CDC’s Medical Monitoring Project, but researchers adjusted results for nonresponse using standard methodology. Third, the sample size of participants with HIV who injected drugs was limited.
The study researchers concluded that increased focus on interventions that address injection practices and high-risk sexual behaviors, such as expanding access to sterile syringes and educating on condom use, may help reduce HIV transmission risk among HIV-positive individuals who inject drugs.
Dasgupta S, Tie Y, Lemons A, Wu K, Burnett J, Shouse RL. Injection practices and sexual behaviors among persons with diagnosed HIV infection who inject drugs — United States, 2015–2017. MMWR Morb Mortal Wkly Rep. 2019;68:653–657.