The Context of HIV Risk Among Drug Users and Their Sexual Partners

with 34.6 percent of gay men and 28.6 percent of bisexual men HIV
seropositive compared with 13.2 percent of men reporting no male sexual
partners (Battjes, unpublished data). In the NADR study, gay IDUs were
similarly more likely to be HIV seropositive (34.6 percent), while
bisexual male IDUs were slightly less likely to be HIV seropositive
(16.4 percent) compared with males reporting no male sexual partners
(18.7 percent). Assessing gay and bisexual men together in the
Cooperative Agreement program, 39.3 percent of these men were HIV
seropositive compared with 10.7 percent of men reporting no male sexual
partners (Needle, unpublished data).
Stall and Ostrow (1989) also found that gay and bisexual male IDUs were
more likely to report high-risk sexual activity at study entry
(67.7 percent) than non-IDU gay and bisexual men (45.1 percent).
Comparing the sexual risk of gay and bisexual IDUs with male IDUs
reporting no male sexual partners in the HIV Seroprevalence Survey,
28.9 percent of gay and 46.4 percent of bisexual males reported receiving
payment for sex, compared with 7.0 percent of other men. Yet gay IDUs
also were more likely to use condoms, with 20.7 percent reporting always
using condoms, compared with 11.8 percent of bisexual male IDUs and
8.0 percent of other male IDUs (Battjes, unpublished data). Similarly in
the NADR study, 35.8 percent of gay IDUs and 64.3 percent of bisexual
male IDUs reported receiving payment for sex, compared with
6.8 percent of other male IDUs. Also, 18.8 percent of gay IDUs reported
always using condoms, compared with 8.5 percent of bisexual male IDUs
and 8.3 percent of other male IDUs (Needle, unpublished data).
This dual risk group of gay and bisexual IDUs is important not only in its
own right, but also because persons reporting dual risk may serve as a
bridge for HIV transmission between heterosexual and lesbian IDUs and
non-IDU gay and bisexual men. For example, in a study of IDUs
entering methadone treatment in four low HIV prevalence areas, Battjes
and colleagues (1989) found that the only behavioral difference between
HIV seropositive and seronegative IDUs was self-reported sharing of
needles or syringes with gay or bisexual men. Of seropositives,
25.0 percent reported such needle sharing, compared with 3.1 percent of
seronegatives (adjusted odds ratio = 5.44). In Chicago, Lampinen and
colleagues (1991) found that almost all of the earliest IDU-associated
AIDS cases (diagnosed between 1982 and 1986) were among men who
also reported sex with other men, suggesting that they may have acquired
their infection sexually rather than parenterally. They further found that
the geographic distribution of AIDS cases within Chicago suggested two
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