This document summarizes a study of substance abuse, sexual behaviors, HIV/STD/HCV testing, and prevention service utilization among injection drug users in Dallas, Texas from 2005-2006. The study used respondent-driven sampling to obtain prevalence estimates among 597 injection drug users. Key findings include: most participants had unprotected sex and used drugs or alcohol before sex, though few were tested recently for STDs; using substances before sex was linked to riskier behaviors but not prevention service use; and effective prevention strategies are still needed to promote safer behaviors.

1. Substance Abuse, Sexual Behaviors, HIV/STD/HCV Testing, and Prevention Service Utilization among Injection Drug Users in Dallas, Texas, 2005-2006 Shane U. Sheu, MPH, Sonia Arbona, PhD, Erin Elbel, Doug Kershaw, Praveen R. Pannala, MD, MPH Sharon K. Melville, MD, MPH Texas Department of State Health Services May 25, 2010

3. Background

4. Persons Living with HIV/AIDS and New HIV/AIDS Cases, Texas, 2002-2008 Data Source: Texas HIV/AIDS Reporting System (HARS); 2002-2008

7. Methods

12. Implementing RDS at Multiple Sites for NHBS IDU1 Dallas

14. Results

17. NHBS IDU1 Recruitment Network of Participants by Race and Ethnicity White - homophily 0.401 Race and ethnicity Afr Am - homophily 0.545 Hispanic - homophily 0.330 Am Indian/Alaska Native - homophily -1 Multiracial - homophily 0.032 - Most participants recruited were African American - Four seeds recruited the majority of the participants Data Source: Texas National HIV Behavioral Surveillance- 2005-2006, IDU1 Data

18. NHBS IDU1 Prevalence Estimates of Unprotected Sex Data Source: Texas National HIV Behavioral Surveillance- 2005-2006, IDU1 Data N=597

19. NHBS IDU1 Prevalence Estimates of Using Drugs or Alcohol before or during Sex Data Source: Texas National HIV Behavioral Surveillance- 2005-2006, IDU1 Data N=597

20. NHBS IDU1 Prevalence Estimates of Testing Behaviors Data Source: Texas National HIV Behavioral Surveillance- 2005-2006, IDU1 Data N=597

21. NHBS IDU1 Prevalence Estimates of Prevention Service Utilization Data Source: Texas National HIV Behavioral Surveillance- 2005-2006, IDU1 Data N=597

22. NHBS IDU1 Participants Using Drugs or Alcohol before or during Sex by Unprotected Sex Data Source: Texas National HIV Behavioral Surveillance- 2005-2006, IDU1 Data N=597 69.3% 30.7% Not using drug or alcohol before or during sex (n=75) <.0001 19.7% 80.3% Using drug or alcohol before or during sex (n=522)  2 P value Sex with condom Sex without condom

23. NHBS IDU1 Participants Using Drugs or Alcohol before or during Sex by Sharing Injection Equipment Data Source: Texas National HIV Behavioral Surveillance- 2005-2006, IDU1 Data N=597 33.8% 66.2% Not using drug or alcohol before or during sex (n=74) 0.01 21.1% 78.9% Using drug or alcohol before or during sex (n=522)  2 P value Not sharing injection equipment Sharing injection equipment

24. NHBS IDU1 Participants Using Drugs or Alcohol before or during Sex by Syringe Sharing Data Source: Texas National HIV Behavioral Surveillance- 2005-2006, IDU1 Data N=597 71.2% 28.8% Not using drug or alcohol before or during sex (n=73) <.0001 45.1% 54.9% Using drug or alcohol before or during sex (n=521)  2 P value No syringe sharing Syringe Sharing

25. NHBS IDU1 Other Factors Found Not to be Statistically Significant with Participants Using Drugs or Alcohol before or during Sex 0.32 Used free kits 0.53 Talked to counselor one on one about HIV prevention in the past 12 months 0.81 Participated in group session about HIV prevention in the past 12 months 0.85 Received free kits in the past 12 months 0.90 Received free condoms in the past 12 months 0.69 Received sterile needles in past 12 months 0.72 Used free new sterile needles 0.38 Tested to check for syphilis in the past 12 months 0.67 Ever tested for HCV 0.29 Ever tested for HIV P-value Factors