Sexual transmission risk behavior reported among behaviorally bisexual HIV-positive injection drug-using men

BACKGROUND: Few research studies have examined the HIV transmission risk behaviors of HIV-positive injection drug users (IDUs) who are men who have sex with men and women (MSMW). METHODS: We compared unprotected vaginal or anal sex with an HIV-negative or unknown (UNK) status sexual partner of MSMW (n = 118) with men who have sex exclusively with women (MSW; n = 469) and men who have sex exclusively with men (MSM; n = 90) using baseline information from the Intervention for Seropositive Injectors-Research and Evaluation (INSPIRE) study, a 4-city randomized controlled trial. RESULTS: MSMW were twice as likely to report unprotected vaginal sex (P < 0.001) and 3 times as likely to report unprotected anal sex with an HIV-negative/UNK status female partner (P < 0.001) as MSW. MSMW did not differ in their report of unprotected insertive anal sex and were half as likely to report unprotected receptive anal sex with HIV-negative/UNK status men (P = 0.02) as MSM. MSMW were 2 times as likely to report engaging in transactional sex (buying or selling sex in exchange for money, drugs, or housing) than MSM or MSW (81%, 43%, and 36%, respectively; P < 0.001). CONCLUSIONS: Further research is needed to understand the contexts of unprotected sex among HIV-positive injection drug-using MSMW. Prevention programs should target the unique prevention needs of this population, particularly their risk with female partners.