Am J Psychiatry 1996; 153:794-798
Copyright © 1996 by American Psychiatric Association
Injection drug use and risk of HIV transmission among homeless men with mental illness
E Susser, M Miller, E Valencia, P Colson, B Roche and S Conover
HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, NY 10032, USA.
OBJECTIVE: The high seroprevalence of HIV that has been reported among
homeless individuals with mental illness indicates an urgent need to
examine HIV risk behavior in this population. METHOD: Injection drug use
and sexual behavior were assessed in comprehensive interviews with 218
homeless mentally ill men in a New York City shelter. First, the proportion
of men who had injected drugs was established. Then, among those who had
injected drugs, the injection drug use behaviors associated with HIV
transmission (i.e., whether they had ever engaged in high-risk behaviors
and had ever engaged in risk-reduction behaviors) and their current sexual
risk behaviors were examined. RESULTS: Fifty (23%) of the 218 men had
injected drugs. Among these 50, the great majority had engaged in high-risk
behaviors, including sharing needles (66%) and using shooting galleries
(64%). Few had engaged in risk-reduction behaviors, such as cleaning
needles with bleach (22%) and using a needle exchange program (2%). In the
past 6 months alone, the majority of the injection drug users had had
unprotected sex with women (48%) or with men (10%). CONCLUSIONS: This study
documents a high lifetime prevalence of injection drug use in a group of
homeless men with mental illness. The men who had injected drugs reported
injection drug use and sexual behaviors with high risk of HIV transmission
and gave scant evidence of risk-reduction behaviors. These individuals may
fall between service systems and may be difficult to reach but,
nonetheless, must be included in efforts to prevent transmission of HIV
infection.
