Injection Practices and Sexual Behaviors Among Persons with Diagnosed HIV Infection Who Inject Drugs — United States, 2015–2017

Abstract

sex, and methods for injection syringe acquisition and disposal. Participants self-reported need for, and receipt of, alcohol or drug treatment. Persons who reported receiving, or not receiving but needing, drug or alcohol treatment were considered to have a need for this service. Enrollment in a medication-assisted treatment program for opioid use disorder was also assessed. Sexual behaviors were assessed, including 1) condomless sex; 2) exchange of sex for money or goods; and 3) a dichotomous measure indicative of high risk for sexual HIV transmission (defined as having one or more detectable viral loads in the past 12 months and having high-risk sex). High-risk sex was defined as condomless sex with an HIV-negative partner or a partner whose HIV status was unknown and who was not known to be on preexposure prophylaxis (PrEP). † Viral loads from the preceding 12 months were abstracted from medical records. Weighted percentages of characteristics with corresponding 95% confidence intervals (CIs) were reported to account for complex survey design using standard methodology (2). Rao-Scott chi-square tests were used to compare characteristics associated with a high risk for sexual HIV transmission between HIV-positive persons who injected drugs (233) and those who did not inject drugs (7,397); p< 0.05 indicated statistical significance. All analyses were conducted using SAS (version 9.4; SAS Institute). An estimated 3% (95% CI = 2%-3%) of persons with diagnosed HIV infection injected drugs in the preceding † https://www.cdc.gov/hiv/risk/prep/index.html. 12 months. Among HIV-positive persons who injected drugs, 11% engaged in distributive sharing of syringes, and 10% engaged in distributive sharing of other injection equipment; 61% injected before or during sex (Table). Common sources of injection syringes included a pharmacy or drug store (63%); a friend, relative, or sex partner (50%); a syringe services program (SSP) (32%); or a needle or drug dealer, shooting gallery, or off the street (21%). Common methods for syringe disposal were in the trash, on the street, or in a nonmedical waste container (53%); a medical waste container (50%); an SSP (30%); or keeping the syringe to reuse it (29%). An estimated 57% percent of HIV-positive persons who injected drugs reported needing alcohol or drug use treatment; 80% of HIV-positive persons who injected drugs did not obtain treatment in the preceding year. Eight percent of HIV-positive persons who injected drugs enrolled in a medication-assisted treatment program. A higher percentage of HIV-positive persons who injected drugs had a detectable viral load than did those who did not inject drugs (48% versus 35%; p = 0.008) (Figure). Condomless sex, exchange sex, and high-risk sex were all more prevalent among HIV-positive persons who injected drugs (63%, 17%, and 18%, respectively), than among those who did not inject drugs (31%, 2%, and 6%, respectively) (p<0.001). Discussion Substantial high-risk injection practices and sexual behaviors associated with HIV transmission were observed among