DETERMINANTS OF HIV RISK AMONG MEN WHO HAVE HOMOSEXUAL SEX AND INJECTDRUGS

Men with histories of both homosexual contact and injecting drug use ( IDU) are at increased risk of HIV infection over men who have only one such risk. Despite this, their special needs and circumstances have b een neglected by AIDS prevention programmes. A survey of a wide spectr um of homosexual male IDUs was carried out in Melbourne and Sydney in 1993 to inform the development of specific policy and programmes for H IV prevention in these subcultures. Of 169 men, self-reported HIV prev alence was 27%. Decreasing compliance with safe sex guidelines (as mea sured by numbers of casual partners, participation in anal intercourse and use of condoms) was associated with HIV seropositivity, increased age, and increased participation in sex work; having a regular male p artner was not protective against unsafe sexual behaviour, no matter t he length of the relationship. A substantial proportion (15%) reported inconsistent condom use during anal sex with more than two partners i n the preceding month: they were slightly more likely to be engaging i n sex work, less 'stable' and more likely to be HIV infected. Sexual r isk was not strongly associated with unsafe injecting, which was in ge neral safe. Men who both have homosexual sex and inject drugs are grou ps at high risk of HIV, more from unsafe sex than from shared injectin g equipment; men who believed themselves to be HIV infected were conti nuing to have sex in such a way that would allow transmission. These a re clearly groups in need of priority targeted interventions.