Skip to main content
NCBI home page
Journal of Urban Health : Bulletin of the New York Academy of Medicine logoLink to Journal of Urban Health : Bulletin of the New York Academy of Medicine
. 2003 Sep;80(Suppl 3):iii7–iii14. doi: 10.1093/jurban/jtg078

The role of sexual transmission of HIV infection among injection and non-injection drug users

Steffanie A Strathdee 1,✉, Susan G Sherman 1
PMCID: PMC3456264  PMID: 14713667

Abstract

Many early studies of injecting drug users (IDUs) suggested that most HIV infections in this population were due to needle sharing and that sexual transmission was negligible or was overshadowed by parenteral routes. A few of the early studies suggested a potentially important role for heterosexual transmission, but these tended to be limited to cross-sectional data or had only a few years of prospective follow-up. Studies of sexual risk factors for HIV infection among non-injecting drug users (NIDUs) are similarly sparse. Recently, investigators prospectively examined both drug-related and sexual risk factors for HIV seroconversion among male and female IDUs with an adequate number of person-years to identify statistically significant associations. Other studies among never and former IDUs have identified associations suggesting that sexual transmission accounts for a substantial number of HIV seroconversions in these populations. Herein, highlights are discussed from recent investigations among IDUs in Baltimore, Maryland, and corroborating findings from the literature. Results from a 10-year prospective analysis of the ALIVE study and an analysis of the REACH studies spanning a 7-year period indicate that sexual risk factors for HIV infection are important in both female and male IDUs. These findings underscore the need for HIV interventions among drug users that incorporate sexual risk reduction. Based on the existing literature, a narrow focus on injection-related risks is an ineffective prevention strategy. Interventions that target specific subgroups of high-risk IDUs, such as men who have sex with men and inject drugs (MSM-IDUs), sex worker-IDUs and HIV-infected IDUs, deserve special attention.

Keywords: HIV/AIDS, Injection drug use, Sexual risk behavior, HIV interventions for drug users

Full Text

The Full Text of this article is available as a PDF (63.9 KB).

References

  • 1.Jarlais DC, Friedman SR, Hopkins W. Risk reduction for the acquired immunodeficiency syndrome among intravenous drug users. Ann Intern Med. 1985;103:755–759. doi: 10.7326/0003-4819-103-5-755. [DOI] [PubMed] [Google Scholar]
  • 2.Chaisson RE, Moss AR, Onishi R, et al. Human immunodeficiency virus infection in heterosexual intravenous drug users in San Francisco. Am J Public Health. 1987;77:169–172. doi: 10.2105/ajph.77.2.169. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 3.Schoenbaum EE, Hartel D, Selwyn PA, et al. Risk factors for human immunodeficiency virus infection in intravenous drug users. N Engl J Med. 1989;321:874–879. doi: 10.1056/NEJM198909283211306. [DOI] [PubMed] [Google Scholar]
  • 4.Ameijden EJC, Coutinho RA. Maximum impact of HIV prevention measures targeted at injecting drug users. AIDS. 1998;12:625–633. doi: 10.1097/00002030-199806000-00012. [DOI] [PubMed] [Google Scholar]
  • 5.Marx R, Aral SO, Rolfs RT, et al. Crack, sex, and STDs. Sex Transm Dis. 1991;18(2):92–101. doi: 10.1097/00007435-199118020-00008. [DOI] [PubMed] [Google Scholar]
  • 6.Battjes RJ, Pickens RW, Amsel Z, et al. Heterosexual transmission of human immunodeficiency virus among intravenous drug users. J Infect Dis. 1990;162(5):1007–1011. doi: 10.1093/infdis/162.5.1007. [DOI] [PubMed] [Google Scholar]
  • 7.Jarlais DC, Paone D, Milliken J, et al. Audio-computer interviewing to measure risk behavior for HIV among injecting drug users: a quasi-randomized trial. Lancet. 1999;353(9165):1657–1661. doi: 10.1016/S0140-6736(98)07026-3. [DOI] [PubMed] [Google Scholar]
  • 8.Metzger DS, Koblin B, Turner C, et al. Randomized controlled trial of audio computerassisted self-interviewing: utility and acceptability in longitudinal studies. HIVNET Vaccine Preparedness Study Protocol Team. Am J Epidemiol. 2000;152(2):99–106. doi: 10.1093/aje/152.2.99. [DOI] [PubMed] [Google Scholar]
  • 9.Macalino GE, Celentano DD, Latkin C, et al. Risk’ behaviors by audio computerassisted self-interviews among HIV-seropositive and HIV-seronegative injecting drug users. AIDS Educ Prev. 2002;14(5):367–378. doi: 10.1521/aeap.14.6.367.24075. [DOI] [PubMed] [Google Scholar]
  • 10.Doherty MC, Garfein RS, Monterroso E, et al. Correlates of HIV infection among young adult short-term injection drug users. AIDS. 2000;14(6):717–726. doi: 10.1097/00002030-200004140-00011. [DOI] [PubMed] [Google Scholar]
  • 11.Patrick DM, Strathdee SA, Archibald CP, et al. Determinants of HIV seroconversion in injection drug users during a period of rising prevalence in Vancouver. Int J STD AIDS. 1997;8:437–445. doi: 10.1258/0956462971920497. [DOI] [PubMed] [Google Scholar]
  • 12.Tortu S, Beardsley M, Deren S, et al. The risk of HIV infection in a national sample of women with injection drug-using partners. Am J Public Health. 1994;84(8):1243–1249. doi: 10.2105/AJPH.84.8.1243. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 13.Kral A, Bluthenthal R, Lorvick J, et al. Sexual transmission of HIV-1 among injection drug users in San Francisco, USA: risk-factor analysis. Lancet. 2001;9266(357):1397–1401. doi: 10.1016/S0140-6736(00)04562-1. [DOI] [PubMed] [Google Scholar]
  • 14.Strathdee SA, Galai N, Safoiean M. Gender differences in risk factors for HIV seroconversion among injection drug users: a ten-year perspective. Arch Int Med. 2001;161:1281–1288. doi: 10.1001/archinte.161.10.1281. [DOI] [PubMed] [Google Scholar]
  • 15.Vlahov D, Anthony JC, Munoz A, et al. The ALIVE Study: a longitudinal study of HIV-1 infection in intravenous drug users: description of methods. J Drug Issues. 1991;21:759–776. [PubMed] [Google Scholar]
  • 16.Strathdee SA, Safaeian M, Doherty M, et al. Correlates of HIV infection among young new initiates to injection drug use in Baltimore, Maryland: 1994–2000. XIV International Conference on AIDS, Barcelona Spain, July 2002, Abstract number: WePeD6366.
  • 17.Page-Shafer KA, Hahn JA, Lum P, et al. Prevalence and correlates of HIV infection among young injection drug users in San Francisco. J Acquir Immune Defic Syndr. 2002;31:422–431. doi: 10.1097/00126334-200212010-00009. [DOI] [PubMed] [Google Scholar]
  • 18.Nelson KE, Vlahov D, Solomon L, et al. Temporal trends of incident human immunodeficiency virus infection in a cohort of injecting drug users in Baltimore, MD. Arch Intern Med. 1995;155:1305–1311. doi: 10.1001/archinte.155.12.1305. [DOI] [PubMed] [Google Scholar]
  • 19.Spittal PM, Craib KJ, Wood E, et al. Risk factors for elevated HIV incidence rates among female injection drug users in Vancouver. Can Med Assoc J. 2002;166(7):894–899. [PMC free article] [PubMed] [Google Scholar]
  • 20.Celentano DD, Vlahov D, Cohn S, Anthony JC, Solomon I, Nelson KE. Risk factors for shooting gallery use and cessation among intravenous drug users. Am J Public Health. 1991;81(10):1291–1295. doi: 10.2105/ajph.81.10.1291. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 21.Strathdee SA, Patrick DM, Archibald CP, et al. Social determinants predict needle sharing behavior among injection drug users in Vancouver, Canada. Addiction. 1997;92(10):1291–1295. doi: 10.1111/j.1360-0443.1997.tb02852.x. [DOI] [PubMed] [Google Scholar]
  • 22.Bluthenthal RN, Kral AH, Gee L, et al. Trends in HIV seroprevalence and risk among gay and bisexual men who inject drugs in San Francisco, 1988 to 2000. J Acquir Immune Defic Syndr. 2001;28(3):264–269. doi: 10.1097/00042560-200111010-00010. [DOI] [PubMed] [Google Scholar]
  • 23.Shoptaw S, Reback CJ, Freese TE. Patient characteristics, HIV serostatus, and risk behaviors among gay and bisexual males seeking treatment for methamphetamine abuse and dependence in Los Angeles. J Addict Dis. 2002;21(1):91–105. doi: 10.1300/J069v21n01_08. [DOI] [PubMed] [Google Scholar]
  • 24.Neaigus A, Miller M, Friedman, et al. Sexual transmission risk among noninjecting heroin users infected with human immunodeficiency virus or hepatitis C virus. J Inf Dis. 2001;184(3):359–363. doi: 10.1086/322020. [DOI] [PubMed] [Google Scholar]
  • 25.Gyarmathy VA, Neaigus A, Miller M, et al. Risk correlates of prevalent HIV, hepatitis B virus, and hepatitis C virus infections among noninjecting heroin users. J Acquir Immune Defic Syndr. 2002;30(4):448–456. doi: 10.1097/00042560-200208010-00011. [DOI] [PubMed] [Google Scholar]
  • 26.Poulin C, Alary M, Bernier F, et al. Prevalence of Chlamydia trachomatis and Neisseria gonorrhoeae among at-risk women, young sex workers, and street youth attending community organizations in Quebec City, Canada. Sex Transm Dis. 2001;28(8):437–443. doi: 10.1097/00007435-200108000-00002. [DOI] [PubMed] [Google Scholar]
  • 27.Latkin CA, Mandell W, Knowlton AR, et al. Gender differences in injection-related behaviors among injection drug users in Baltimore, Maryland. AIDS Educ Prev. 1998;10:257–263. [PubMed] [Google Scholar]
  • 28.Miller M, Neaigus A. Sex partner support, drug use and sex risk among HIV-negative non-injecting heroin users. AIDS Care. 2002;14(6):801–813. doi: 10.1080/0954012021000031877. [DOI] [PubMed] [Google Scholar]
  • 29.Walden, Margaret Vivien, Kondwani Mwangulube, et al. Measuring the impact of a behavior change intervention for commercial sex workers and their potential clients in Malawi. Health Educ Res. 1999;14(4):545–554. doi: 10.1093/her/14.4.545. [DOI] [PubMed] [Google Scholar]
  • 30.MAP (Monitoring the AIDS Pandemic) Symposium Report: The status and trends of the HIV/AIDS epidemic in the world. XIV International AIDS Conference; Barcelona; July 2–4, 2002.
  • 31.Strathdee SA. Sexual HIV transmission in the context of injection drug use: implications for interventions. Int J Drug Policy. 2003;14:79–81. doi: 10.1016/S0955-3959(02)00211-6. [DOI] [Google Scholar]
  • 32.Saidel TJ, Des Jarlais D, Peerapatanapokin W, et al. Potential impact of HIV among injection drug users on heterosexual transmission in Asian settings: the Asian epidemic model. Int J Drug Policy. In press.

Articles from Journal of Urban Health : Bulletin of the New York Academy of Medicine are provided here courtesy of New York Academy of Medicine

RESOURCES