"Why I am not infected with HIV": implications for long-term HIV risk reduction and HIV vaccine trials.

ABSTRACT

PIP: Both New York City and Bangkok have experienced rapid, large-scale HIV epidemics among their IV drug using populations. The authors surveyed 58 HIV-seronegative IV drug users (IVDUs) participating in HIV vaccine preparation cohort studies in the two cities to gain insight into their beliefs about remaining HIV-seronegative. The 28 IVDUs in New York City and 30 IVDUs in Bangkok were recruited from ongoing cohort studies of HIV incidence among IVDUs in these cities. The New York cohort subjects were 76% male, 30% White, 27% Black, 43% Latino, and of median age 42 years. The majority had injected both heroin and cocaine. The Bangkok cohort subjects were 94% male, 100% Thai, of mean age 32 years, and almost all had injected heroin only. 89% of the subjects in New York City and 90% in Bangkok believed that their own efforts to practice safer injection methods and safer sex were very important in avoiding HIV infection. However, 4% of New York subjects and 30% of Bangkok subjects thought that they would probably become infected with HIV in the future. 70% of New York subjects and 3% of Bangkok subjects believed that having an immune system strong enough to avoid becoming infected with HIV despite exposure was very important in avoiding HIV infection. This latter belief among New York subjects was associated with having previously engaged in high-risk behaviors with partners known to be HIV-seropositive. Risk reduction programming for such populations and within HIV vaccine trials must take into account the prevailing belief systems about avoiding HIV infection.