Sexual Transmission of HIV-1 Among Injection Drug Users in San Francisco, USA

Risk-Factor Analysis

Published in: The Lancet, v. 357, May 5, 2001, p. 1397-1401

Posted on RAND.org on December 31, 2000

by Alex H. Kral, Ricky N. Bluthenthal, Jennifer Lorvick, Lauren Gee, Peter Bacchetti, Brian R. Edlin

Read More

Access further information on this document at www.sciencedirect.com

This article was published outside of RAND. The full text of the article can be found at the link above.

BACKGROUND: Many new HIV-1 infections in the USA occur in injection drug users (IDUs). HIV-1 seroconversion of IDUs is mainly associated with injection-related risk factors. Harm reduction programmes concentrate on injection-risk behaviour. The authors aimed to establish whether injection or sexual risk factors, or both, were associated with HIV-1 antibody seroconversion of street-recruited IDUs in San Francisco, from 1986 to 1998. METHODS: IDUs were enrolled every 6 months from four community sites. The authors did a nested case control study comparing 58 respondents who seroconverted between visits with 1134 controls who remained seronegative. Controls were matched with cases by sex and date. Adjusted odds ratios and 95% CI were calculated for men and women by use of conditional logistic regression. FINDINGS: Men who had sex with men were 8.8 times as likely to seroconvert (95% CI 3.7-20.5) as heterosexual men. Women who reported having traded sex for money in the past year were 5.1 times as likely as others to seroconvert (95% CI 1.9-13.7). Women younger than 40 years were more likely to seroconvert than those 40 years or older (2.8 [1.05-7.6]), and women who reported having a steady sex-partner who injected drugs were less likely to seroconvert than other women (0.32 [0.11-0.92]). INTERPRETATION: HIV-1 seroconversion of street-recruited IDUs in San Francisco is strongly associated with sexual behaviour. HIV-1 risk might be reduced by incorporation of innovative sexual-risk-reduction strategies into harm-reduction programmes.

This report is part of the RAND Corporation external publication series. Many RAND studies are published in peer-reviewed scholarly journals, as chapters in commercial books, or as documents published by other organizations.

The RAND Corporation is a nonprofit institution that helps improve policy and decisionmaking through research and analysis. RAND's publications do not necessarily reflect the opinions of its research clients and sponsors.