INJECTION-DRUG USE AND RISK OF HIV TRANSMISSION AMONG HOMELESS MEN WITH MENTAL-ILLNESS

Objective: The high seroprevalence of HIV that has been reported among homeless individuals with mental illness indicates an urgent need to examine HIV risk behavior in this population. Method: Infection drug u se and sexual behavior were assessed in comprehensive interviews with 218 homeless mentally ill men in a New York City shelter. First, the p roportion of men who had injected drugs was established Then, among th ose who had injected drugs, the injection drug use behaviors associate d with HIV transmission (i.e., whether they had ever engaged in high-r isk behaviors and had ever engaged in risk-reduction behaviors) and th eir current sexual risk behaviors were examined. Results: Fifty (23%) of the 218 men had injected drugs. Among these 50, the great majority had engaged in high-risk behaviors, including sharing needles (66%) an d using shooting galleries (64%). Few had engaged in risk-reduction be haviors, such as cleaning needles with bleach (22%) and using a needle exchange program (2%). In the past 6 months alone, the majority of th e injection drug users had had unprotected sex with women (48%) or wit h men (10%). Conclusions: This study documents a high lifetime prevale nce of injection drug use in a group of homeless men with mental illne ss. The men who had injected drugs reported injection drug use and sex ual behaviors with high risk of HIV transmission and gave scant eviden ce of risk-reduction behaviors. These individuals may fall between ser vice systems and may be difficult to reach but, nonetheless, must be i ncluded in efforts to prevent transmission of HIV infection.