Understanding HIV risks of chronic drug-using men who have sex with men

Focus groups and individual structured interviews were conducted in six cit ies with 98 predominantly street-recruited men who had a recent history of smoking crack or injecting drugs and who reported having had sex with other men (MSM) in the past year. Twenty-six focus groups explored the cultural and social context of participants' drug use and sexual activity and addres sed outreach and HIV prevention issues pertinent to this population. Narrat ive summaries developed from verbatim focus group transcripts identified se ven themes: (a) sexual orientation and gender identity; (b) interactions wi thin and between MSM networks; (c) drug use, sexual activity and personal r elationships; (d) HIV transmission bridges; (e) preferred HIV information s ources; (f) HIV knowledge, prevention practices and risk behaviours; and (g ) availability of HIV and drug-related services. Of the 98 MSM drug users, 42% identified publicly as gay or homosexual; 35% identified publicly, but only 21% privately, as heterosexual. A total of 51% had one or more female sex partners in the past year. There was a high frequency of unprotected se x in conjunction with drug use and a distinct preference for having sex whe n high. For most participants, drug use rather than sexual orientation form ed the core of personal identity. Participants reported associating primari ly with other drug users, usually MSM, and had limited contact with people who did not use drugs and the,mainstream gay community. Participants' sexua l and drug-injecting activities were judged to be a bridge for transmission of HIV to both people who used drugs and those who did not.