HIV Prevalence, Risk Behaviors, and High-Risk Sexual and Injection Networks Among Young Women Injectors Who Have Sex With Women

Women injection drug users who have sex with women (WSW IDUs) comprise 20 percent to 30 percent of American women IDUs. Compared to other women IDUs, WSW IDUs have higher HIV prevalence and incidence rates and a greater likelihood of engaging in high-risk injection and sexual practices with men.

Previous studies have suggested that WSW IDUs may be especially likely to engage in drug injection and sex with men who have sex with men (MSM) and to be subordinated and isolated within drug users' social milieus and more generally. However, historical and generational factors may have changed some relationships as a consequence of the HIV epidemic itself. To further examine HIV risk among WSW IDUs, the authors compared social situations, injection and sexual networks, and behaviors of young WSW IDUs with those of other young women IDUs.

A post hoc analysis was conducted of data collected from July 1997 to March 1999 from street-recruited women IDUs (predominantly heroin and cocaine injectors) ages 18 to 30 in five US cities. Trained research staff conducted face-to-face interviews and collected blood and urine samples. The questionnaire covered sociodemographic characteristics and sexual and drug-using behavior and partnerships, usually for the six months before the interview.

Women who reported having had sex with a woman in the preceding six months or who self-identified as lesbian or bisexual were classified as WSW (n=274). Classifications as WSW or non-WSW could be made for 803 participants. Proportions of WSW among women IDUs varied by site (20 percent-54 percent).

Because predictors of HIV seroconversion among IDUs (and, therefore, prevalence among new injectors) differ by local prevalence, the authors analyzed HIV serostatus separately within four sites with HIV prevalence lower than 6 percent in the total sample and within two sites with HIV prevalence greater than 10 percent.

Of the 803 women IDUs, 45 percent reported having been homeless in the prior six months, and 28 percent reported having received money for sex during this period. WSW IDUs were more likely to have been recently homeless, to have ever been institutionalized in a mental health facility, and to have ever been incarcerated. WSW IDUs were more likely to have positive test results for hepatitis B virus (but not for hepatitis C virus, chlamydia, or gonorrhea) and were more likely to be infected with HIV in high-prevalence, but not low-prevalence, sites. WSW IDUs were more likely to engage in high-risk behaviors (receptive syringe sharing, sharing rinse water, and sex trading) and reported having more male sexual partners. WSW IDUs were also more likely to report having unprotected sex with MSM; having sex with an IDU or someone they knew or thought was infected with HIV. Significant associations were analyzed further, controlling for both site and receiving money or drugs for sex.

Compared to other young women IDUs, WSW IDUs were more likely to have engaged in riskier behaviors, to have had high-risk sexual and injection networks, to have been homeless or institutionalized, and to have been anti-hepatitis B virus-positive. In high-HIV-prevalence sites, they were more likely to have been infected with HIV. These differences cannot be accounted for by their greater involvement in sex work. "Studies of drug users and other populations should consider sexual identity and sex between women, which may help explain variations in homelessness, institutionalization, behavior, networks, and infection rates. Research and interventions should also incorporate issues of sexual identity and same-sex sexual behaviors among women and find ways to deal with related social and economic issues."