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RESEARCH AND PRACTICE |
Samuel R. Friedman, Carey Maslow, Rebecca Young, and Theresa Perlis are with the National Development and Research Institutes Inc, New York, NY. Danielle C. Ompad is with New York Academy of Medicine. Patricia Case is with Harvard School of Public Health, Boston, Mass. Sharon M. Hudson is with Health Research Association, Los Angeles, Calif. Theresa Diaz is with the National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Ga; Global AIDS Program; and Center for Urban Epidemiologic Research, New York Academy of Medicine. Edward Morse is with Tulane Health Sciences Center, Department of Pediatrics, New Orleans, La. Susan Bailey is with the University of Illinois at Chicago Community Outreach Intervention Projects, Department of Epidemiology and Biostatistics, School of Public Health, Chicago, Ill. Don C. Des Jarlais is with the Edmond de Rothschild Chemical Dependency Institute, Beth Israel Medical Center; and National Development and Research Institutes Inc, New York. Amber Hollibaugh is with Senior Action in a Gay Environment, New York. Richard S. Garfein is with the Epidemiology Branch, Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta.
Correspondence: Requests for reprints should be sent to Samuel R. Friedman, PhD, National Development and Research Institutes, 71 W 23rd St, New York, NY 10010 (e-mail: friedman{at}ndri.org).
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INTRODUCTION |
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 TOP INTRODUCTION METHODSRESULTSDISCUSSIONReferences |
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Previous reports suggested that WSW IDUs may be particularly likely to engage in drug injection and sex with men who have sex with men (MSM)1,2,5,6,9,17–19 and to be subordinated and isolated within drug users’ social milieus and more generally.1,20,21 Historical and generational factors may have changed some relationships as a consequence of the HIV epidemic itself, however. Ethnographic data from New York City and Boston, Mass, suggest that many older MSM IDUs and WSW IDUs who injected drugs together may have died earlier in the epidemic, which might reduce the extent to which WSW IDUs currently engage in drug injection and sex with MSM. To further examine HIV risk among WSW IDUs, we compared social situations, injection and sexual networks, and behaviors of young WSW IDUs with those of other young women IDUs.
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METHODS |
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TOPINTRODUCTIONMETHODSRESULTSDISCUSSIONReferences |
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Women who reported having had sex with a woman during the preceding 6 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%–54%). Because sites also varied on many other variables, statistical analyses controlled for site.
Because predictors of HIV seroconversion among IDUs (and, therefore, prevalence among new injectors) differ by local prevalence,5 we analyzed HIV serostatus separately within 4 sites with HIV prevalence lower than 6% in the total sample and within 2 sites with HIV prevalence greater than 10%.
The questionnaire covered sociodemographic characteristics and sexual and drug-using behaviors and partnerships, usually for the 6 months before the interview. Sera were tested for antibody against HIV-1, hepatitis B virus, and hepatitis C virus; urine was tested for chlamydia and gonorrhea with ligase chain reaction.22–24
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RESULTS |
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TOPINTRODUCTIONMETHODSRESULTSDISCUSSIONReferences |
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). 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. They were less likely to receive most of their income from welfare, a relatively stable income source for young IDUs, and more likely to receive most of their income from selling sex.
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Significant associations were analyzed further, controlling for both site and receiving money or drugs for sex (Table 2). WSW IDUs remained significantly more likely to have been institutionalized, to have been homeless, to have engaged in receptive syringe sharing, to have shared rinse water, and to have had high-risk partners (such as MSM IDUs, older IDUs, WSW IDUs, and IDUs who had HIV or hepatitis) in their injection and sexual networks. In high-HIV-prevalence sites, WSW IDUs were more likely to have injected drugs with a person who is HIV positive (adjusted odds ratio = 3.95) and to be HIV seropositive (adjusted odds ratio = 2.55).
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DISCUSSION |
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TOPINTRODUCTIONMETHODSRESULTSDISCUSSIONReferences |
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Interpretation must take account of study limitations. Some data, including questions used to define WSW IDUs, were collected for other purposes. Analyses of interactions by site, sometimes limited by small cell numbers, indicate local variation in some relationships. Underreporting of same-sex sexual behavior or other variables may affect statistical associations. Reporting bias may have occurred if WSW IDUs were more likely than the non-WSW IDUs to know that their male injection or sexual partners have had sex with men.
Studies of drug users and other populations2,25–30 should consider sexual identity and sex between women, which may help explain variations in homelessness, institutionalization, behavior, networks, and infection rates. Research and interventions targeting IDUs should incorporate issues of sexual identity and same-sex sexual behaviors among women and find ways to deal with related social and economic issues.
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Acknowledgments |
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The authors would like to acknowledge Ian Williams, Mar Than, and Michael Purdy of the CDC Hepatitis Branch for providing hepatitis B and hepatitis C virus testing and interpretation of results; Carol Farshy of CDC, Division of AIDS, STD, TB Laboratory Research, for providing gonorrhea and chlamydia testing; and Andrea Swartzendruber and Roberto Valverde for ensuring the quality of the CIDUS II data and providing thoughtful review of this manuscript.
Human Participant Protection
Potential participants in the study received information about the study and provided informed consent in the local study office or mobile van. They were also given a small honorarium for their time and travel after completion of an interview. Face-to-face interviews were then conducted by trained research staff; thereafter, with informed consent, blood was drawn for testing. Institutional review boards for the Centers for Disease Control and Prevention and for each local site approved the study and its procedures.
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Footnotes |
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S. R. Friedman conceived of the brief and wrote it. D. C. Ompad, C. Maslow, and T. Perlis worked on analyses and interpretation. R. Young, P. Case, and A. Hollibaugh, who were part of an ethnographic study of women injection drug users who have sex with women, contributed to the initial conception for the brief and also to the analyses. S. M. Hudson, T. Diaz, E. Morse, S. Bailey, and D. C. Des Jarlais were site representatives for this multisite project and also provided constant feedback as we wrote the brief. R. S. Garfein was the Centers for Disease Control project officer for the multisite project; he was deeply involved in writing the questionnaire, in other aspects of study design, and in the process of writing the brief.
Accepted for publication January 8, 2003.
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References |
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TOPINTRODUCTIONMETHODSRESULTSDISCUSSIONReferences |
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2. Solarz A, ed. Lesbian Health: Current Assessment and Directions for the Future. Washington, DC: National Academy Press; 1999.
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R. M. Young and I. H. Meyer The Trouble With "MSM" and "WSW": Erasure of the Sexual-Minority Person in Public Health Discourse Am J Public Health, July 1, 2005; 95(7): 1144 - 1149. [Abstract] [Full Text] [PDF]
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| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
