HIV infection and patterns of risk among women drug injectors and crack users in low and high sero-prevalence sites

As AIDS cases among US women continue to increase, a better understanding o f women's behavioural risk patterns is needed to inform intervention effort s. Data were from 2,945 women drug injectors and crack users. Statistical a nalyses compared sociodemographic variables, lifetime behavioural risk patt erns, HIV sero-prevalence and history of sexually transmitted diseases, and determined predictors of HIV infection separately in 16 low and four high sero-prevalence sites. Based on risk patterns, four behaviourally-defined s ub-groups were constructed, and rates of HIV sero-prevalence were compared. In comparisons between low and high sero-prevalence sires, there were sign ificant differences on most variables examined, and in the relative importa nce of the sociodemographic characteristics and risk patterns predicting HI V. Drug injection and sex exchange were each independent, significant, beha vioural predictors of infection, with no significant difference between the odds ratios attributed to each predictor. HIV sero-prevalence was signific antly different among four sub groups. Interventions must be tailored to ad dress observed differences among women in low and high sero-prevalence site s. Injection drug use and exchanging sex each play a major role in the tran smission of HIV infection to US women. Prevention efforts targeted at women should address differences in behavioural risk patterns. Aggressive and in novative interventions are needed for women who exchange sex. AIDS research must investigate how socioeconomic factors impact women's risk for HIV inf ection.