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J Acquir Immune Defic Syndr. 2007 Nov 1;46 Suppl 2:S80-7. doi: 10.1097/QAI.0b013e3181576828.

Sexual transmission risk behavior reported among behaviorally bisexual HIV-positive injection drug-using men.

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Center for AIDS Prevention Studies, Department of Medicine, University of California at San Francisco, San Francisco, CA 94110-1372, USA.



Few research studies have examined the HIV transmission risk behaviors of HIV-positive injection drug users (IDUs) who are men who have sex with men and women (MSMW).


We compared unprotected vaginal or anal sex with an HIV-negative or unknown (UNK) status sexual partner of MSMW (n=118) with men who have sex exclusively with women (MSW; n=469) and men who have sex exclusively with men (MSM; n=90) using baseline information from the Intervention for Seropositive Injectors-Research and Evaluation (INSPIRE) study, a 4-city randomized controlled trial.


MSMW were twice as likely to report unprotected vaginal sex (P<0.001) and 3 times as likely to report unprotected anal sex with an HIV-negative/UNK status female partner (P<0.001) as MSW. MSMW did not differ in their report of unprotected insertive anal sex and were half as likely to report unprotected receptive anal sex with HIV-negative/UNK status men (P=0.02) as MSM. MSMW were 2 times as likely to report engaging in transactional sex (buying or selling sex in exchange for money, drugs, or housing) than MSM or MSW (81%, 43%, and 36%, respectively; P<0.001).


Further research is needed to understand the contexts of unprotected sex among HIV-positive injection drug-using MSMW. Prevention programs should target the unique prevention needs of this population, particularly their risk with female partners.

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