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Sexological Review 1993, Vol. 1, No. 1, 77-92 SEXUAL PARTNER CHOICE IN INJECTING DRUG USERS FROM A "CRITICAL INCIDENT" MEASURE: ITS IMPLICATIONS FOR ABSTRACT ASSESSING RISK OF HIV SPREAD Michael W. ROSS*, Alex WODAK**, M.E. MILLER***, Julian GOLD**** A critical incident (proportional percentage) measure was used to describe the nature and distribution of the last and second-last sexual partner in 1,245 injecting drug users (IDUs) interviewed in Sydney, Australia. Proportions were relatively stable across last and second-last contact. For males, last sexual contact was heterosexual non-prostitue female for three quarters, for females 85% of last contact was with a heterosexual non prostitute male. A greater proportion of the partners of females were IDUs (75%) compared with men (59%). Homosexual contact for the last sexual contact was 13% for males and 12% for females: no respondent described their contact as bisexual, suggesting that partners are characterized by act rather than identity. Only 4% of respondents had not had at least one sexual contact in the past year. These data indicate that it is possible to estirate proportions of risk for HIV spread from data on last sexual contact in IDUs. Keywords Intravenous drug us ers; sex; epidemiology; HIV; risk behaviour. INTRODUCTION Injecting drug users (IDUs) play a significant role in the transmission of HIV infection in many developed and more recently sore developing countries, accounting for more than half the heterosexual infection, as weIl as a substantial proportion of vertical transmission. Fordyce, Blum, Balanon and Stoneburner (1991) have reported that there is considerable transmission from male IDUs to * National Centre in HIV Social Research, University of New South Wales, 345 Crown Street, Surry Hills, NSW 2010, Sydney, AUSTRALIA. ** Alcohol and Drug Service, St. Vincent's Hospital, and the National Drug and Alcohol Research Centre, University of New South Wales. *** Directorate of the Drug Offensive, New South Wales Department of Health. **** Albion Street AlOS Centre, Sydney Hospital.
78 Revue sexoloSique / Sexolosical Review female sexual partners in New York City, with a ratio which is stable over time. They suggest that in this population, 1.5% of sexually active women between the ages of 15 and 44 will have intercourse with male IDUs per year (this estimate also takes account of the proportion of male IDUs who have female IDU partners). A second avenue of risk involves male prostitutes: Morse, Simon, Osofsky, Balson and Gaumer (1991) report that 52% of male street prostitutes interviewed in New Orleans were IDUs. Further, they note that 80% identified themselves as heterosexual or bisexual, that 42% had a regular female sexual partner, and that 70% never used condoms with their regular female partner. Risks for HIV transmission to and from other populations included the fact that 26% of these men had a steady partner who was an IDU, 45% reported unsafe needle practices, and one third of the clients were estimated by the prostitutes to be bisexual men (men who have sex with both men and women, who would thus have their own female partners). Sexual activity has often been assumed to be depressed in opioid users partly as a consequence of their pharmacological actions, but Klee, Faugier, Haynes, Boulton and Morris (1990) note that despite decreased libido, 81% of her sample of IDUs in Northern England had had sexual intercourse in the past six months, and 32% had done so with more than one partner (although there was no comparison with similar non-opioid users). While there are major gender and ethnie variations in high-risk sexual behaviour among IDUs (Lewis & Watters, 1991), most studies indicate that the majority of IDUs to be sexually active: Donoghoe, Stimson and Dolan (1989) reported that more than three quarters of clients at a London needle and syringe exchange had been sexually active in the past three months. Darke, Hall and Carless (1990) found a similar proportion (78%) of Sydney IDUs studied had had sex in the past month, 30% of the sample had had more than one partner and 21% reported sex with partners they described as "casual." Two thirds of their sample reportedly never used condoms with regular partner(s). Male IDUs are reportedly less likely to have partners who are IDUs than female IDUs. Sasse, Salmaso, Conti and Rezza (1991) found in an Italian study that women were more likely to have only IDU partners (as opposed to non-using or a combination of using and non-using partners: 43% versus 17% for males). Salmaso and Sasse (1991) concluded that IDU women in Italy are more likely to have shared injecting equipment and had sex with an HIV-seropositive partner. Sasse et al. have also reported that 90% of women who only have IDU
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REVUE SEXOLOGIQUE SEXOLOGICAL REVIE
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Comité de geston 1 Managing Board
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Articles Revue sexologique / Sexolo
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Sexological Revie 1993, Vol. 1, No.
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FIGURE 1 1 o Modèle d'analyse des
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Contraception et prophylaxie chez d
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Page 42 and 43: Perceptions of personal risk from s
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