Trends in HIV and HCV Risk Behaviors and Prevalent Infection Among People Who Inject Drugs in New York City, 2005-2012.

BACKGROUND: We assess trends in HIV and hepatitis C virus (HCV) risk behaviors and prevalent infection among people who inject drugs (PWID) in New York City (NYC). METHODS: PWID in NYC were sampled using respondent-driven sampling in 2005, 2009, and 2012 (serial cross sections) for the Centers for Disease Control and Prevention-sponsored National HIV Behavioral Surveillance study. Participants were interviewed about their current (≤12 months) risk behaviors and tested for HIV and HCV. The crude and adjusted risk ratio (RR) and 95% confidence interval (95% CI) for linear time trends were estimated using generalized estimating equations regression with a modified Poisson model. RESULTS: The sample comprised 500, 514, and 525 participants in 2005, 2009, and 2012, respectively. Significant (P < 0.05) linear trends in risk behaviors included a decline in unsafe syringe sources (60.8%, 31.3%, 46.7%; RR = 0.86, 95% CI: 0.81 to 0.92), an increase in all syringes from syringe exchanges or pharmacies (35.4%, 67.5%, 50.3%; RR = 1.15, 95% CI: 1.09 to 1.22), and an increase in condomless vaginal or anal sex (53.6%, 71.2%, 70.3%; RR = 1.14, 95% CI: 1.09 to 1.19). Receptive syringe sharing (21.4%, 27.0%, 25.1%), sharing drug preparation equipment (45.4%, 43.4%, 46.7%), and having ≥2 sex partners (51.2%, 44.0%, 50.7%) were stable. Although HIV seroprevalence declined (18.1%, 12.5%, 12.2%), HCV seroprevalence was high (68.2%, 75.8%, 67.1%). In multivariate analysis, adjusting for sample characteristics significantly associated with time, linear time trends remained significant, and the decline in HIV seroprevalence gained significance (adjusted RR = 0.76, 95% CI: 0.64 to 0.91, P = 0.003). CONCLUSIONS: This trend analysis suggests declining HIV prevalence among NYC PWID. However, HCV seroprevalence was high and risk behaviors were considerable. Longitudinal surveillance of HIV and HCV risk behaviors and infections is needed to monitor trends and for ongoing data-informed prevention among PWID.

Time Since Migration and HIV Risk Behaviors Among Puerto Ricans Who Inject Drugs in New York City.

BACKGROUND: Among people who inject drugs (PWID) in the United States, those who initiated drug injection in Puerto Rico (immigrant Puerto Rican PWID) engage in more injection and sexual risk behaviors, and have higher HIV incidence than non-Hispanic whites. OBJECTIVE: Understand the persistence of these HIV behaviors. METHODS: In a cross-sectional study conducted in New York City (NYC) in 2012 (National HIV Behavioral Surveillance), PWID aged ≥18 years were recruited using Respondent-Driven Sampling, interviewed, and tested for HIV. Participants were categorized into 5 different groups: (1) US-born non-Hispanic PWID, (2) US-born Puerto Rican PWID, (3) recent immigrant Puerto Rican PWID (≤3 years in NYC), (4) medium-term immigrant Puerto Rican PWID (>3 and ≤10 years in NYC), and (5) long-term immigrant Puerto Rican PWID (>10 years in NYC). We examined the relationship between time since migrating on sexual and injection risk behaviors among immigrant Puerto Rican PWID, compared with U.S.-born Puerto Rican PWID and US-born non-Hispanic PWID. Adjusted odds ratios (aOR) and 95% confidence intervals (95% CI) were estimated using logistic regression. RESULTS: A total of 481 PWID were recruited. In adjusted analyses using US-born non-Hispanic PWID as the comparison group, syringe sharing was significantly more likely among medium-term immigrants; and unprotected sex with casual partners was more likely among recent and long-term immigrants. CONCLUSIONS: The risk-acculturation process for immigrant Puerto Rican PWID may be nonlinear and may not necessarily lead to risk reduction over time. Research is needed to better understand this process.

Community Sexual Bridging Among Heterosexuals at High-Risk of HIV in New York City.

Community sexual bridging may influence the socio-geographic distribution of heterosexually transmitted HIV. In a cross-sectional study, heterosexual adults at high-risk of HIV were recruited in New York City (NYC) in 2010 for the Centers for Disease Control and Prevention-sponsored National HIV Behavioral Surveillance system. Eligible participants were interviewed about their HIV risk behaviors and sexual partnerships and tested for HIV. Social network analysis of the geographic location of participants' recent sexual partnerships was used to calculate three sexual bridging measures (non-redundant ties, flow-betweenness and walk-betweenness) for NYC communities (defined as United Hospital Fund neighborhoods), which were plotted against HIV prevalence in each community. The analysis sample comprised 494 participants and 1534 sexual partnerships. Participants were 60.1 % male, 79.6 % non-Hispanic black and 19.6 % Hispanic race/ethnicity; the median age was 40 years (IQR 24-50); 37.7 % had ever been homeless (past 12 months); 16.6 % had ever injected drugs; in the past 12 months 76.7 % used non-injection drugs and 90.1 % engaged in condomless vaginal or anal sex; 9.6 % tested HIV positive (of 481 with positive/negative results). Sexual partnerships were located in 33 (78.6 %) of 42 NYC communities, including 13 "high HIV-spread communities", 7 "hidden bridging communities", 0 "contained high HIV prevalence communities", and 13 "latent HIV bridging communities". Compared with latent HIV bridging communities, the population racial/ethnic composition was more likely (p < 0.0001) to be black or Hispanic in high HIV-spread communities and to be black in hidden bridging communities. High HIV-spread and hidden bridging communities may facilitate the maintenance and spread of heterosexually transmitted HIV in black and Hispanic populations in NYC.

Bisexual Behavior Among Male Injection Drug Users in New York City.

Drug using men who have sex with men and women (MSMW) may be at high risk for HIV infection and transmitting HIV to sex partners. In 2012, injection drug users (IDUs) were sampled in New York City for the National HIV Behavioral Surveillance cross-sectional study using respondent-driven sampling. Logistic regression was used to calculate crude and adjusted odds ratios (aOR) and 95 % confidence intervals (95 %CI) to determine correlates of bisexual behavior in the past 12 months. Of 333 participants, 47(14.1 %) reported MSMW. Variables independently associated (p < 0.05) with MSMW included bisexual sexual identity (vs. "straight") (adjusted odds ratio (aOR) 92.6; 95 % CI 18.9, 454.5), Bronx residence [vs. Manhattan (aOR 8.4; 95 %CI 1.6,43.7)], past 12 month behaviors of having sex with ≥3 sex partners (aOR 18.1; 95 % CI 3.3,98.4), "sold" sex (aOR 8.5; 95 % CI 2.3, 31.5), "bought" sex (aOR 0.2; 95 % CI 0.1, 0.9), and injection methamphetamine use (aOR 20.5; 95 % CI 3.0, 139.7). MSM IDUs are an important subgroup to consider for HIV interventions, as they may not be reached through HIV prevention programming aimed at MSM.

It's Never Just HIV: Exposure to an HIV Prevention Media Campaign and Behavior Change Among Men Who Have Sex with Men Participating in the National HIV Behavioral Surveillance System in New York City.

PURPOSE: The aim of this study was to assess the exposure to and impact of the It's Never Just HIV mass media campaign aimed at HIV negative men who have sex with men (MSM) in New York City. METHODS: Questions about the campaign were included in the local questionnaire of the Centers for Disease Control and Prevention (CDC)-sponsored National HIV Behavioral Surveillance (NHBS) study of MSM in NYC conducted in 2011. Participants in this cross-sectional study were recruited using venue-based sampling. RESULTS: Among 447 NYC National HIV Behavioral Surveillance study participants who self-reported HIV negative or unknown status and answered questions about the NYC Department of Health and Mental Hygiene's It's Never Just HIV campaign, more than one-third (n = 173, 38.7%) reported having seen the campaign. Latinos (34.8%) and blacks (34.4%) were less likely to report seeing the campaign compared to whites (47.7%). Most of those who reported seeing the campaign saw it on the subway (80.1%). Only 9.4% of those who saw the campaign reported having changed their sexual or health behaviors in response to the campaign. CONCLUSIONS: These data suggest that thousands of HIV-uninfected MSM in NYC have been reached by the campaign and recalled its message.

Experiences of Discrimination and HIV Risk Among Men Who Have Sex With Men in New York City.

The extent of gay-related discrimination in New York City (NYC) and the demographic and behavioral factors correlated with experiences of gay-related discrimination are not well understood. The Centers for Disease Control and Prevention-sponsored National HIV Behavioral Surveillance System, a cross-sectional study, was conducted in NYC in 2011. Men who have sex with men were venue-sampled, interviewed, and offered HIV testing. Frequencies of types of gay-related discrimination experienced in the past 12 months were calculated. Associations between types of discrimination and demographic and HIV risk variables were examined through the estimation of prevalence ratios (PRs) and 95% confidence intervals (CIs). More than half (53.2%) of all study participants reported having experienced any gay-related discrimination in the past 12 months; 45.0% reported that they had been called names or insulted; 23.6% reported receiving poorer services than other people in restaurants, stores, other businesses, or agencies; 22.0% reported being treated unfairly at work or school; 15.1% reported being physically attacked or injured; and 6.7% reported being denied or given lower quality health care. HIV-positive status (adjusted PR [aPR] = 2.9; 95% CI = 1.5, 5.6) and drug use in the past 12 months (aPR = 0.3; 95% CI = 0.1, 0.7) were independently associated with reports of having been denied or given lower quality health care. High rates of reported gay-related discrimination suggest that greater efforts are needed to reduce gay-related discrimination in affected communities. Future research is needed to better understand the extent of gay-related discrimination in NYC, particularly with regard to the relationship between HIV status and health care access.

Estimating Vertex Measures in Social Networks by Sampling Completions of RDS Trees.

This paper presents a new method for obtaining network properties from incomplete data sets. Problems associated with missing data represent well-known stumbling blocks in Social Network Analysis. The method of "estimating connectivity from spanning tree completions" (ECSTC) is specifically designed to address situations where only spanning tree(s) of a network are known, such as those obtained through respondent driven sampling (RDS). Using repeated random completions derived from degree information, this method forgoes the usual step of trying to obtain final edge or vertex rosters, and instead aims to estimate network-centric properties of vertices probabilistically from the spanning trees themselves. In this paper, we discuss the problem of missing data and describe the protocols of our completion method, and finally the results of an experiment where ECSTC was used to estimate graph dependent vertex properties from spanning trees sampled from a graph whose characteristics were known ahead of time. The results show that ECSTC methods hold more promise for obtaining network-centric properties of individuals from a limited set of data than researchers may have previously assumed. Such an approach represents a break with past strategies of working with missing data which have mainly sought means to complete the graph, rather than ECSTC's approach, which is to estimate network properties themselves without deciding on the final edge set.

High risk and little knowledge: overdose experiences and knowledge among young adult nonmedical prescription opioid users.

BACKGROUND: Opioid-involved overdoses in the United States have dramatically increased in the last 15 years, largely due to a rise in prescription opioid (PO) use. Yet few studies have examined the overdose knowledge and experience of nonmedical PO users. METHODS: In depth, semi-structured, audio-recorded interviews were conducted with 46 New York City young adults (ages 18-32) who reported using POs nonmedically within the past 30 days. Verbatim interview transcripts were coded for key themes in an analytic process informed by grounded theory. RESULTS: Despite significant experience with overdose (including overdose deaths), either personally or within opioid-using networks, participants were relatively uninformed about overdose awareness, avoidance and response strategies, in particular the use of naloxone. Overdose experiences typically occurred when multiple pharmaceuticals were used (often in combination with alcohol) or after participants had transitioned to heroin injection. Participants tended to see themselves as distinct from traditional heroin users, and were often outside of the networks reached by traditional opioid safety/overdose prevention services. Consequently, they were unlikely to utilize harm reduction services, such as syringe exchange programs (SEPs), that address drug users' health and safety. CONCLUSIONS: These findings suggest that many young adult nonmedical PO users are at high risk of both fatal and non-fatal overdose. There is a pressing need to develop innovative outreach strategies and overdose prevention programs to better reach and serve young PO users and their network contacts. Prevention efforts addressing risk for accidental overdose, including opioid safety/overdose reversal education and naloxone distribution, should be tailored for and targeted to this vulnerable group.

Correlates of selling sex among male injection drug users in New York City.

BACKGROUND: Compared to female IDUs, the correlates of receiving money, drugs, or other things in exchange for sex ("selling sex") among male IDUs are not well understood. METHODS: In 2012, IDUs were sampled in New York City for the National HIV Behavioral Surveillance cross-sectional study using respondent driven sampling. Analyses were limited to male participants. Logistic regression was used to calculate crude and adjusted odds ratios (aOR) and 95% confidence intervals (95% CI) to determine the correlates of selling sex to (1) men and (2) women in the past 12 months. RESULTS: Of 394 males, 35 (8.9%) sold sex to men and 66 (16.8%) sold sex to women. Correlates of selling sex to men included bisexual/gay identity (aOR: 31.0; 95% CI: 8.1, 119.1), Bronx residence (vs. Manhattan) (aOR: 38.1; 95% CI: 6.2, 235.5), and in the past 12 months, being homeless (aOR: 9.9; 95% CI: 2.0, 49.6), ≥3 sex partners (aOR: 26.2; 95% CI: 4.7, 147.6), non-injection cocaine use (aOR: 5.4; 95% CI: 1.6, 18.2), and injecting methamphetamine (aOR: 36.9; 95% CI: 5.7, 240.0). Correlates of selling sex to women included, in the past 12 months, ≥3 sex partners (aOR: 14.6; 95% CI: 6.6, 31.9), binge drinking at least once a week (aOR: 3.1; 95% CI: 1.6, 6.1), non-injection crack use (aOR: 3.3; 95% CI: 1.6, 6.7), most frequently injected "speedball" (vs. heroin) (aOR: 2.1; 95% CI: 1.1, 4.2), and receptively shared syringes (aOR: 2.4; 95%CI: 1.2, 4.8). CONCLUSIONS: Among male IDUs, those who sold sex had more sex partners, which may facilitate the sexual spread of HIV among IDUs and to non-IDU male and female sex partners. HIV prevention interventions aimed at male IDUs who sell sex should consider both their sexual and parenteral risks and the greater risk of engaging in exchange sex associated with the use of injection and non-injection stimulant drugs.

Multilevel risk factors for greater HIV infection of black men who have sex with men in New York City.

BACKGROUND: There is a large and disproportionate burden of HIV in black men who have sex with men (MSM) which is not adequately explained by racial/ethnic differences in risk behaviors. However, social factors may account for this disparity in HIV infection. We examine the extent to which both individual risk behaviors and social factors reduce the effect of black race and may account for the disparity in HIV infection of black MSM. METHODS: In a cross-sectional study in New York City in 2011, MSM were venue sampled, interviewed, and HIV tested. Variables associated (P < 0.10) both with black race and testing HIV positive were analyzed using multivariate logistic regression. RESULTS: Of 416 participants who were HIV tested and did not self-report being positive, 19.5% were black, 41.1% were Hispanic, 30.5% were white, and 8.9% were of other race/ethnicity. Overall, 8.7% tested positive (24.7% of blacks, 7.6% of Hispanics, 1.0% of whites, and 5.4% of other). The effect of black race versus non-black race/ethnicity with testing HIV positive declined by 49.2%, (crude odds ratio, 6.5 [95% confidence interval, 3.2-13.3] vs. adjusted odds ratio, 3.3 [95% confidence interval, 1.5-7.5]), after adjustment for having a black last sex partner, not having tested for HIV in the past 12 months, Brooklyn residency, and having an annual income less than US$20,000. CONCLUSIONS: Greater HIV infection risk of black MSM may result from social factors and less frequent HIV testing than from differences in risk behaviors. To reduce the disparity in HIV infection of black MSM, multilevel interventions that both ameliorate social risk factors and increase the frequency of HIV testing are needed.

Trends in HIV prevalence and risk behavior among men who have sex with men in New York City, 2004-2011.

This study examined trends in HIV prevalence and HIV-related risk behaviors from 2004 through 2011 among men who have sex with men (MSM) in New York City. MSM were venue-sampled, interviewed, and offered HIV testing in serial cross-sectional studies. Significant differences in overall time trends were determined using the Spearman rank correlation and logistic regression models. There were 457 (2004-2005), 550 (2008), and 510 (2011) participants in each study round. There was no significant trend in HIV prevalence over time, and past 12 month unprotected anal intercourse remained steady. However, drug use and number of sex partners declined. Among those who did not self-report being HIV positive, the percentage that tested for HIV in the past 12 months increased. The results from this study suggest that from 2004 through 2011 more MSM in New York City are being tested for HIV and have declining drug use and fewer sex partners.

Spatial recruitment bias in respondent-driven sampling: Implications for HIV prevalence estimation in urban heterosexuals.

Respondent-driven sampling (RDS) is a study design used to investigate populations for which a probabilistic sampling frame cannot be efficiently generated. Biases in parameter estimates may result from systematic non-random recruitment within social networks by geography. We investigate the spatial distribution of RDS recruits relative to an inferred social network among heterosexual adults in New York City in 2010. Mean distances between recruitment dyads are compared to those of network dyads to quantify bias. Spatial regression models are then used to assess the impact of spatial structure on risk and prevalence outcomes. In our primary distance metric, network dyads were an average of 1.34 (95 % CI 0.82­1.86) miles farther dispersed than recruitment dyads, suggesting spatial bias. However, there was no evidence that demographic associations with HIV risk or prevalence were spatially confounded. Therefore, while the spatial structure of recruitment may be biased in heterogeneous urban settings, the impact of this bias on estimates of outcome measures appears minimal.

High HIV prevalence among low-income, Black women in New York City with self-reported HIV negative and unknown status.

BACKGROUND: Black women are disproportionally affected by human immunodeficiency virus (HIV). This study investigates factors associated with newly identified HIV infection among previously self-reported HIV negative or unknown status black women living in high risk areas (HRAs) of New York City (NYC). METHODS: Heterosexuals residing in or socially connected to NYC HRAs were recruited using respondent driven sampling for participation in the United States Centers for Disease Control-sponsored National HIV Behavioral Surveillance System in 2010. Eligible individuals were interviewed and offered an HIV test. The analysis reported here focused on black women with valid HIV results who did not report being HIV positive, and examined factors related to HIV infection in this group. RESULTS: Of 153 black women who did not report being HIV positive at enrollment, 15 (9.8%) tested HIV positive. Age ≥40 years, ever injected drugs, and in the last 12 months had unprotected vaginal sex, exchange sex, last sex partner used crack, non-injection crack use, and non-injection heroin use were significantly associated with HIV infection (p<0.05). Only ever injected drugs (prevalence ratio: 5.1; 95% confidence interval: 2.0, 12.9) was retained in the final model. CONCLUSIONS: Black women who had reported being either HIV negative or unaware of their serostatus had high HIV prevalence. Efforts to identify and treat HIV positive black women in HRAs should target those with a history of injection drug use. Frequent testing for HIV should be promoted in HRAs.

A reexamination of connectivity trends via exponential random graph modeling in two IDU risk networks.

Patterns of risk in injecting drug user (IDU) networks have been a key focus of network approaches to HIV transmission histories. New network modeling techniques allow for a reexamination of these patterns with greater statistical accuracy and the comparative weighting of model elements. This paper describes the results of a reexamination of network data from the SFHR and P90 data sets using Exponential Random Graph Modeling. The results show that "transitive closure" is an important feature of IDU network topologies, and provides relative importance measures for race/ethnicity, age, gender, and number of risk partners in predicting risk relationships.

Dual HIV risk: receptive syringe sharing and unprotected sex among HIV-negative injection drug users in New York City.

HIV-negative injection drug users (IDUs) who engage in both receptive syringe sharing and unprotected sex ("dual HIV risk") are at high risk of HIV infection. In a cross-sectional study conducted in New York City in 2009, active IDUs aged ≥18 years were recruited using respondent-driven sampling, interviewed, and tested for HIV. Participants who tested HIV-negative and did not self-report as positive were analyzed (N = 439). Adjusted odds ratios (aOR) and 95 % confidence intervals (95 % CI) were estimated using multinomial logistic regression. The sample was: 77.7 % male; 54.4 % Hispanic, 36.9 % white, and 8.7 % African-American/black. Dual risk was engaged in by 26.2 %, receptive syringe sharing only by 3.2 %, unprotected sex only by 49.4 %, and neither by 21.2 %. Variables independently associated with engaging in dual risk versus neither included Hispanic ethnicity (vs. white) (aOR = 2.0, 95 % CI = 1.0-4.0), married or cohabiting (aOR = 6.3, 95 % CI = 2.5-15.9), homelessness (aOR = 3.4, 95 % CI = 1.6-7.1), ≥2 sex partners (aOR = 8.7, 95 % CI = 4.4-17.3), ≥2 injecting partners (aOR = 2.9, 95 % CI = 1.5-5.8), and using only sterile syringe sources (protective) (aOR = 0.5, 95 % CI = 0.2-0.9). A majority of IDUs engaged in HIV risk behaviors, and a quarter in dual risk. Interventions among IDUs should simultaneously promote the consistent use of sterile syringes and of condoms.

Reciprocal sex partner concurrency and STDs among heterosexuals at high-risk of HIV infection.

Inconsistent findings on the relationship of sex partner concurrency to infection with HIV and other sexually transmitted diseases (STDs) may result from differences in how sex partner concurrency is conceptualized. We examine the relationship of reciprocal sex partner concurrency (RSPC) to diagnosed STDs among heterosexuals. Heterosexually active adults (N = 717) were recruited for a cross-sectional study using respondent-driven sampling (RDS) from high-HIV-risk areas in New York City (NYC, 2006-2007) and interviewed about their sexual risk behaviors, number of sex partners, last sex partners, and STD diagnoses (prior 12 months). RSPC was when both the participant and her/his last sex partner had sex with other people during their sexual relationship. Odds ratios (OR), adjusted odds ratios (aOR), and 95 % confidence intervals (95%CI) were estimated by logistic regression. The sample was 52.4 % female, 74.3 % Black; median age was 40 years. RSPC was reported by 40.7 % and any STD diagnoses by 23.4 %. Any STDs was reported by 31.5 % of those reporting RSPC vs. 17.9 % of those who did not (OR = 2.11, 95%CI = 1.49-3.0). Any STDs was independently associated with RSPC (aOR = 1.54, 95%CI = 1.02-2.32), female gender (aOR = 2.15, 95%CI = 1.43-3.23), having more than three sex partners (aOR = 1.72, 95%CI = 1.13-2.63), and unprotected anal sex (aOR = 1.65, 95%CI = 1.12-2.42). Heterosexuals in high-HIV-risk neighborhoods in sexual partnerships that involve RSPC are at greater risk of STDs and, potentially, HIV. RSPC, in addition to sexual risk behaviors and the number of sex partners, may facilitate the heterosexual spread of HIV through STD cofactors and linkage into larger STD/HIV sexual transmission networks.

Estimating the Size of the Methamphetamine-Using Population in New York City Using Network Sampling Techniques.

As part of a recent study of the dynamics of the retail market for methamphetamine use in New York City, we used network sampling methods to estimate the size of the total networked population. This process involved sampling from respondents' list of co-use contacts, which in turn became the basis for capture-recapture estimation. Recapture sampling was based on links to other respondents derived from demographic and "telefunken" matching procedures-the latter being an anonymized version of telephone number matching. This paper describes the matching process used to discover the links between the solicited contacts and project respondents, the capture-recapture calculation, the estimation of "false matches", and the development of confidence intervals for the final population estimates. A final population of 12,229 was estimated, with a range of 8235 - 23,750. The techniques described here have the special virtue of deriving an estimate for a hidden population while retaining respondent anonymity and the anonymity of network alters, but likely require larger sample size than the 132 persons interviewed to attain acceptable confidence levels for the estimate.

Estimating HIV incidence and the correlates of recent infection in venue-sampled men who have sex with men in New York City.

In a cross-sectional study, MSM aged ≥18 years were venue-sampled in New York City in 2008, interviewed, and tested for HIV using oral fluids. Participants who reported testing HIV negative at their last test in the previous 24 months were analyzed (n = 287 of 550 sampled). Those testing positive at the interview were defined as recently infected. HIV incidence was estimated using person-time at-risk methods and correlates of recent infection using proportional hazards regression. Thirty-two (11.1%) were recently infected. HIV incidence was 5.67/100 person-years at-risk. Independent correlates included: study recruitment in parks vs. bars, and in other venues vs. bars; black vs. non-black race/ethnicity; and reporting a last sex partner with a positive or unknown vs. negative HIV status. When assay-based methods are not feasible, cross-sectional HIV test results and self-reported HIV testing history and risk factor data can be used to estimate HIV incidence and the correlates of recent infection.

Sexual and injection-related risks in Puerto Rican-born injection drug users living in New York City: A mixed-methods analysis.

BACKGROUND: These data were collected as part of the National HIV Behavioral Surveillance (NHBS) study. NHBS is a cross-sectional study to investigate HIV behavioral risks among core risk groups in 21 U.S. cities with the highest HIV/AIDS prevalence. This analysis examines data from the NHBS data collection cycle with IDU conducted in New York City in 2009. We explored how the recency of migration from Puerto Rico (PR) to New York City (NYC) impacts both syringe sharing and unprotected sex among injection drug users (IDU) currently living in NYC. METHODS: We used a mixed-methods approach to examine differences in risk between US-born IDU, PR IDU who migrated to NYC more than three years ago (non-recent migrants), and PR IDU who migrated in the last three years (recent migrants). Respondent-driven sampling (RDS) was used to recruit the sample (n = 514). In addition, qualitative individual and group interviews with recent PR migrants (n = 12) and community experts (n = 2) allowed for an in-depth exploration of the IDU migration process and the material and cultural factors behind continued risk behaviors in NYC. RESULTS: In multiple logistic regression controlling for confounding factors, recent migrants were significantly more likely to report unprotected sexual intercourse with casual or exchange partners (adjusted odds ratio [AOR]: 2.81; 95% confidence intervals [CI]: 1.37-5.76) and receptive syringe sharing (AOR = 2.44; 95% CI: 1.20-4.97) in the past year, compared to US-born IDU. HIV and HCV seroprevalence were highest among non-recent migrants. Qualitative results showed that risky injection practices are partly based on cultural norms acquired while injecting drugs in Puerto Rico. These same results also illustrate how homelessness influences risky sexual practices. CONCLUSIONS: Poor material conditions (especially homelessness) may be key in triggering risky sexual practices. Cultural norms (ingrained while using drugs in PR) around injection drug use are perpetuated in their new setting following an almost natural flow. These norms may have a particular stronghold over risky drug injection practices. These results indicate that culturally appropriate HIV and HCV prevention and education services are needed. In addition, homelessness should be addressed to reduce risky sexual practices.

Recruitment-adjusted estimates of HIV prevalence and risk among men who have sex with men: effects of weighting venue-based sampling data.

OBJECTIVES: We investigated the impact of recruitment bias within the venue-based sampling (VBS) method, which is widely used to estimate disease prevalence and risk factors among groups, such as men who have sex with men (MSM), that congregate at social venues. METHODS: In a 2008 VBS study of 479 MSM in New York City, we calculated venue-specific approach rates (MSM approached/MSM counted) and response rates (MSM interviewed/MSM approached), and then compared crude estimates of HIV risk factors and seroprevalence with estimates weighted to address the lower selection probabilities of MSM who attend social venues infrequently or were recruited at high-volume venues. RESULTS: Our approach rates were lowest at dance clubs, gay pride events, and public sex strolls, where venue volumes were highest; response rates ranged from 39% at gay pride events to 95% at community-based organizations. Sixty-seven percent of respondents attended MSM-oriented social venues at least weekly, and 21% attended such events once a month or less often in the past year. In estimates adjusted for these variations, the prevalence of several past-year risk factors (e.g., unprotected anal intercourse with casual/exchange partners, ≥5 total partners, group sex encounters, at least weekly binge drinking, and hard-drug use) was significantly lower compared with crude estimates. Adjusted HIV prevalence was lower than unadjusted prevalence (15% vs. 18%), but not significantly. CONCLUSIONS: Not adjusting VBS data for recruitment biases could overestimate HIV risk and prevalence when the selection probability is greater for higher-risk MSM. While further examination of recruitment-adjustment methods for VBS data is needed, presentation of both unadjusted and adjusted estimates is currently indicated.