A study by the CDC has made several findings around injection practices and sexual behaviors among HIV-positive persons who inject drugs.

While it's widely understood that certain injection and sexual behaviors among HIV-positive people who participate in injected drug use can increase risk of transmission, the study contributed new statistics to better understand those practices. By understanding the injection and sexual practices of those diagnosed with HIV, researchers indicated that they hope to demonstrate the further need for access to sterile injection equipment, drug treatment services, and education around safe practices.

The study, "Injection Practices and Sexual Behaviors Among Persons with Diagnosed HIV Infection Who Inject Drugs," utilized data collected between 2015 and 2017 from the Medical Monitoring Project (MMP). The MMP is an annual cross-sectional survey that reports nationally representative estimates of clinical and behavioral characteristics among United States adults diagnosed with HIV.

Injection Drug Use and HIV Risk
During 2016, the study said, 6% of people in the United States who received a positive HIV diagnosis had their infection attributed to injection drug use. Injection practices and sexual behaviors among this population can have a large impact on the likelihood of HIV transmission.

Among HIV-positive persons who participated in injection drug use, 80% received no treatment and 57% self-reported needing drug or alcohol treatment.

Injection practices in the report included distributed sharing of syringes, with 10% engaged in distributive sharing of other injection equipment, and 61% injected before or during sex. Sources of acquiring injection syringes included from a pharmacy or drug store (63%); from a friend, relative, or sex partner (50%); from a syringe services program (32%); and from a dealer or off the street (20%). 

Sexual Practices and HIV Risk
Sexual behaviors including condomless sex and sex in exchange for money or goods were analyzed, in addition to a dichotomous measure indicative of high risk for sexual HIV transmission.

In all analyzed sexual practices, persons who injected drugs were more likely to engage in risky sexual behaviors.
  • Approximately 35% of those with a detectable viral load said they do not inject drugs, as opposed to nearly 50% who said they do.
  • Roughly 30% of those who participate in condomless sex said they do not inject drugs, while nearly 65% said they do.
  • Less than 5% of those who do not inject drugs exchange sex for money or goods. Nearly 20% of those who do inject drugs said they also exchange sex for money or goods.
  • Roughly 5% of those who engage in high-risk sex said they do not inject drugs, as opposed to over 20% who said they do.
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 pre-exposure prophylaxis (PrEP).

Implications
The authors of the study concluded that their results demonstrate a need for increased access and referrals to treatment services. In addition, they said a multipronged approach is necessary, including providing access to sterile equipment, education around safe practices, and access to treatment programs.

Syringe services programs (SSPs) are a possible prevention strategy for those who inject drugs and are HIV positive. The study specified that recent guidelines from the U.S. Department of Health and Human Services allow for the use of federal funds to support SSPs when there is documented need and when the SSPs are in compliance with local laws. 

The study was subject to some limitations. Firstly, because all characteristics were based on self-reported data, they could be subject to information bias. Secondly, not all of the sampled persons participated in MMP. To compensate, however, the results were adjusted for nonresponse using standard methodology. Finally, the sample size of HIV-positive persons who injected drugs was limited.

Despite these limitations, the data demonstrates that focusing HIV prevention strategies on populations with high-risk sexual behaviors and injection practices could contribute to reducing the risk of HIV transmission.


Reference

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 Morbidity and Mortality Weekly Report. 2019;68(30):653-657. doi:10.15585/mmwr.mm6830a1.