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

Focus groups and individual structured interviews were conducted in six cities 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 participant's drug use and sexual activity and addressed outreach and HIV prevention issues pertinent to this population. Narrative summaries developed from verbatim focus group transcripts identified seven themes: (a) sexual orientation and gender identity; (b) interactions within and between MSM networks; (c) drug use, sexual activity and personal relationships; (d) HIV transmission bridges; (e) preferred HIV information sources; (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 sex in conjunction with drug use and a distinct preference for having sex when high. For most participants, drug use rather than sexual orientation formed the core of personal identity. Participants reported associating primarily with other drug users, usually MSM, and had limited contact with people who did not use drugs and the mainstream gay community. Participants' sexual 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.

Correlates of drug abuse among homeless and transient people in the Washington, DC, metropolitan area in 1991.

Sociodemographic correlates of drug use among the general household population may have less accuracy and utility for describing risk factors for drug use among non household populations like the homeless and transient. This analysis examines correlates of past year use of marijuana, cocaine, and needles among homeless and transient people in the Washington, DC, metropolitan statistical area (DC MSA) and discusses them vis-a-vis traditional indicators of drug use among the general household population. Data are from a study conducted in the DC MSA in 1991 that used a multistage sampling design and surveyed a random sample of 908 homeless and transient people ages 12 years and older. The analysis uses multiple logistic regression to assess the independent effect of demographic and other predictors on selected drug use measures among this population. Three key socioeconomic correlates of drug use among the general household population (educational attainment, employment status, and marital status) were nonsignificant predictors of drug use among the homeless. However, other factors were significant, including past year institutionalization, location within the DC MSA, and stage of homelessness. The age group at greatest risk for use of marijuana and cocaine in the past year were the homeless ages 26 to 34, but the oldest group (35 years and older) had the highest risk of needle use. Although men were more likely to have used marijuana and cocaine in the past year, there were no sex differences in the use of needles in the past year. Only past year use of cocaine differed significantly by race or ethnicity, with a greater likelihood among homeless blacks than among homeless whites. Measures of social achievement and socioeconomic status related to the prevalence and risks of drug use among the general household population have but limited applicability in predicting drug use among people who are homeless and transient. Along with other indicators of behavioral and health risks,history of institutionalization, urbanization, and chronicity of homelessness should be considered to improve the epidemiologic assessment of this population.