Gender Differences in Sexual and Injection Risk Behavior Among Active Young Injection Drug Users in San Francisco (the UFO Study)

Abstract

Female injection drug users (IDUs) represent a large proportion of persons infected with HIV in the United States, and women who inject drugs have a high incidence of hepatitis B virus (HBV) and hepatitis C virus (HCV) infection

Differing HIV Risks and Prevention Needs among Men and Women Injection Drug Users (IDU) in the District of Columbia

“…Like other authors, we found that injection behaviors differ substantially by gender, [6][7][8][9][10][11][13][14][15]17,[38][39][40][41][42][43] with women more likely to be injected by a sexual partner than friends or acquaintances, share needles, and use a greater variety of drugs than men. We found that men experienced HIV risk behaviors as well, with increased homelessness and incarceration relative to women, though these differences were attenuated after adjustment for confounders; indeed, the constellation of psychosocial issues including depression was greater among women than men, as other authors have found.…”

“…Our findings echo those of other authors, with some differences: in a convenience sample of younger IDU, Doherty et al 15,16 found women had elevated risk of HIV and while they had similar patterns of injection initiation, women were no more likely to be injected by sex partners at injection initiation. Evans et al 17 found no significant differences between men and women with respect to education, race, housing, yet, as we also found, had increased odds of being injected by a sex partner relative to men. These findings suggest thatespecially in view of overlapping epidemics among IDU and heterosexual populations 23,24 -identifying new ways to reach women and provide services to address overall as well as HIV prevention needs is a critical step in slowing the HIV epidemic in the District of Columbia.…”

“…We found that men experienced HIV risk behaviors as well, with increased homelessness and incarceration relative to women, though these differences were attenuated after adjustment for confounders; indeed, the constellation of psychosocial issues including depression was greater among women than men, as other authors have found. 7,41,[44][45][46] Other authors have noted differences in injection rituals, practices, and injection partner selection between men and women 7,10,14,15,17,39 ; identification of needs that are fulfilled by such practices and that drive their selection, may inform development of innovative prevention approaches developed specifically for women. Our findings echo those of other authors, with some differences: in a convenience sample of younger IDU, Doherty et al 15,16 found women had elevated risk of HIV and while they had similar patterns of injection initiation, women were no more likely to be injected by sex partners at injection initiation.…”

“…However, men were more likely than females to report using marijuana. Men were younger at their first injection and had a longer injection career than females [median years 18 (IQR [16][17][18][19][20][21][22] vs. median 21 (IQR 17-28), pG0.0001] (data not shown in table). In terms of needle acquisition, women were more likely than men to report getting their needles from a friend or partner (73.9% vs. 59.5%, pG0.05); women were less likely to utilize sterile needles or cookers, cotton, or water from a NEP than men, Although transgender individuals are allowed in NHBS-IDU, not all behavioral information is collected for them and the very small sample size limits their analysis; thus for the purpose of this analysis, they were excluded.…”

“…[6][7][8][9][10][11][12][13][14][15][16][17] In DC, IDU, especially women IDU, are poorly characterized, contributing to difficulties in addressing their HIV prevention needs. For example, NEPs provide one of the most important methods of HIV prevention among IDU, [2][3][4][5] yet barriers to their utilization by women in DC have not yet been described in the literature.…”