Gender, sexual orientation identity, and initiation of amphetamine injecting among people who inject drugs: Examination of an expanding drug era in Montreal, Canada, 2011-19

BACKGROUND

Amphetamine injection is expanding in North America and has been associated with male homosexuality among people who inject drugs (PWID). Applying subcultural evolution theory, we examined overall and gender-stratified trends in amphetamine injection and assessed sexual orientation as a gender-specific predictor of initiation among PWID in Montreal, Canada.

METHODS

Data were from HEPCO, an open prospective cohort of PWID. Gender and sexual orientation were self-identified at enrolment. Interviewer-administered questionnaires at three-monthly (HCV RNA-negative participants) or yearly (RNA-positive) intervals captured past three-month amphetamine injection and covariates. Annual prevalence and linear trends in amphetamine injection were estimated using GEE. Incidence was computed among naïve individuals and hazard ratios for initiation estimated using gender-stratified, time-varying Cox regression models.

RESULTS

803 participants contributed 8096 observations between March 2011 and December 2019. Annual prevalence of amphetamine injecting increased from 3.25% [95%CI: 2.06-4.43%] to 12.7% [9.50-16.0] (trend p<0.001). Bivariate Cox regression models suggested similar and divergent predictors of initiation by gender. Incidence was 3.27 per 100 person-years [95%CI: 2.51-4.18] among heterosexual men, 7.18 [3.50-13.2] among gay/bisexual men, 1.93 [0.78-4.02] among heterosexual women and 5.30 [1.69-12.8] among gay/bisexual women. Among men, gay/bisexual identity doubled risk of initiation after adjusting for age, ethnicity, calendar year (aHR 2.16 [1.07-4.36]) and additional covariates (2.56 [1.24-5.30]). Among women, evidence for an association with gay/bisexual identity was inconclusive (aHR 2.63 [0.62-11.2]) and sample size precluded further adjustment CONCLUSIONS: Prevalence of amphetamine injection among PWID increased four-fold from 2011 to 2019, with elevated risk of initiation in gay and bisexual men.

HIV Pre-Exposure Prophylaxis Prevention Awareness, Willingness, and Perceived Barriers among People Who Inject Drugs in Los Angeles and San Francisco, CA, 2016-2018

BACKGROUND

Pre-exposure prophylaxis (PrEP) for HIV prevention is indicated for people who inject drugs (PWID), yet most studies do not focus on PWID. This study examines factors associated with PrEP awareness and willingness, and identifies perceived barriers to PrEP among PWID. Methods: PWID were interviewed in Los Angeles and San Francisco, CA from 2016 to 2018. We analyzed data from self-reported HIV-negative participants who had injected drugs within the past 6 months (n = 469). Questions on PrEP included awareness, willingness, barriers, and uptake. Multiple logistic regression models of factors associated with awareness of, and willingness to, take PrEP were developed. Descriptive statistics on perceived PrEP barriers are reported. Results: Among HIV-negative PWID, 40% were aware of PrEP, 59% reported willingness to take PrEP, and 2% were currently taking PrEP. In multivariable analysis, PrEP awareness was associated with study site and sexual minority status, higher educational attainment, and HIV testing in the last 6 months. Willingness to take PrEP was associated with self-reported risk (paying sex partner in the last 6 months, sharing drug paraphernalia, and being injected by another PWID) and perceived HIV risk. The most common perceived barriers to PrEP were copays, concerns about increased HIV or sexually transmitted risk with PrEP, and concerns about reduction of medication efficacy without daily use. Conclusion: PrEP awareness among PWID remains inadequate. Willingness to take PrEP was moderate and was most desired by PWID who engaged in high-risk behaviors. Interventions to increase PrEP awareness and willingness, and to facilitate PrEP uptake among PWID are needed.

The Association between Intentional Overdose and Same-Sex Sexual Intercourse in a Cohort of People who Inject Drugs in Melbourne, Australia

BACKGROUND

People who inject drugs (PWID) are at disproportionately high risk of suicidal behaviors, as are individuals who report same-sex attraction or experience. However, there is little evidence of compounded risk of suicide for individuals who report same-sex sexual intercourse (SSI) and are PWID.

OBJECTIVES

To explore the associations of lifetime intentional overdose amongst a cohort of PWID, with particular attention to those reporting SSI.

METHODS

The sample included 529 participants, from an ongoing cohort of 757 PWID. An "ever" SSI variable was created for participants who reported sexual intercourse with a same-sex partner at any longitudinal interview. We explored the adjusted associations between SSI and lifetime intentional overdose using logistic regression.

RESULTS

Ninety-one (17%) participants reported ever experiencing an intentional overdose. Forty-one (8%) participants reported SSI at any interview. Three hundred and sixty (68%) participants reported diagnosis of a mental health condition. Diagnosis of a mental health condition (AOR = 2.02, 95% CIs: 1.14, 3.59) and SSI (AOR = 2.58, 95% CIs: 1.22, 5.48) significantly increased the odds of lifetime intentional overdose. Conclusions/Importance: We found a heightened risk of intentional overdose amongst PWID reporting SSI, after controlling for diagnosis of a mental health condition. Services need to be aware of this heightened risk and target interventions appropriately.

Violent Victimization and Substance Dependency: Comparing Rural Incarcerated Heterosexual and Sexual Minority Women

This exploratory study examines the relationship between sexual identity and violent victimization experiences as predictors of differences in illicit substance and alcohol use and substance use problems among a sample of incarcerated women in rural Appalachia (N = 400). Results indicated that, compared to heterosexual women, sexual minority women were more likely to have a lifetime history of weapon, physical, and sexual assault, and were younger at the time of their first violent victimization. Sexual minority women were younger than heterosexual women at the age of onset for intravenous drug use and at the time they first got drunk, and were more likely to report having overdosed. Multivariate analysis found violent victimization to be the strongest predictor of a history of overdose and substance use problems.

Global Epidemiology of HIV Among Women and Girls Who Use or Inject Drugs: Current Knowledge and Limitations of Existing Data

BACKGROUND

Women and girls who use and inject drugs are a critical population at risk of HIV. In this article, we review data on the epidemiology of drug use and injection among women globally and HIV prevalence among women and girls who use and inject drugs.

RESULTS

Women and girls comprise one-third of people who use and inject drugs globally. There is substantial variation in HIV prevalence in this population, between and within countries. There is a pronounced lack of data examining HIV risk among particularly vulnerable subpopulations of women who use and inject drugs, including women who have sex with women, transgender women, racial and ethnic minority women, and young women. Women who use and inject drugs experience stigma and discrimination that affect access to services, and high levels of sexual risk exposures.

CONCLUSIONS

There are significant gaps in our understanding of the epidemiology of drug use and injecting among women and girls and HIV risk and prevalence in this population. Women are frequently underrepresented in studies of drug use and HIV risk and prevalence among people who inject drugs, limiting our understanding of possible sex differences in this population. Most research originates from developed countries and may not be generalizable to other settings. A great deal of work is needed to improve understanding of HIV among particularly vulnerable subpopulations, such as transgender women who use drugs. Better data are critical to efforts to advocate for the needs of women and girls who use and inject drugs.

HIV Risk, Health, and Social Characteristics of Sexual Minority Female Injection Drug Users in Baltimore

Female injection drug users (IDU) who report sex with women are at increased risk for HIV and social instability, but it is important to assess whether these disparities also exist according to sexual minority identity rather than behaviorally defined categories. Within a sample of current IDU in Baltimore, about 17 % of female study participants (n = 307) identified as gay/lesbian/bisexual. In controlled models, sexual minorities were three times as likely to report sex exchange behavior and four times as likely to report a recent STI. Injection risk did not differ significantly, but sexual minority women reported higher prevalence of socio-economic instability, negative health indicators, and fewer network financial, material, and health support resources. There is a need to identify and address socio-economic marginalization, social support, and health issues among female IDUs who identify as lesbian or bisexual.

Developing effective health interventions for women who inject drugs: key areas and recommendations for program development and policy

Women who inject drugs face multiple gender-specific health risks and barriers to healthcare access. These gendered factors may contribute to elevated rates of HIV for this population. Though few countries systematically collect gender-disaggregated data related to injecting drug use, evidence indicates that there are large populations of women who inject drugs and who are in need of improved health services, including HIV prevention. Research on the effectiveness of interventions specifically tailored for women who inject drugs, along with the experience of programs working with this subpopulation, suggests that HIV risk practices need to be addressed within the larger context of women's lives. Multifaceted interventions that address relationship dynamics, housing, employment, and the needs of children may have more success in reducing risky practices than interventions that focus exclusively on injecting practices and condom use. Improved sexual and reproductive healthcare for women who use drugs is an area in need of development and should be better integrated into basic harm reduction programs.

HIV risk behaviors among young drug using women who have sex with women (WSWs) in New York City

Previous research has suggested that multiple stressors may work in tandem to affect the health of women who have sex with women (WSWs). WSWs have been a part of the HIV epidemic in New York City since the beginning, making it an ideal setting to further explore these women's risk. Among a sample of 375 heroin, crack and/or cocaine using women recruited from economically disadvantaged communities in New York City, we examined HIV seroprevalence and risk behaviors among WSWs as compared to women who have sex with men only (WSMOs). We also explore differences between WSWs and WSMOs with respect to potential stressors (i.e., decreased access to resources and health care utilization and violence victimization) that might contribute overall HIV risk. The study's limitations are noted.

Relationship characteristics associated with anal sex among female drug users

BACKGROUND

Anal sex is an important yet little studied HIV risk behavior for women.

METHODS

Using information collected on recent sexual encounters, we examined the influence of sex partner and relationship characteristics on the likelihood of engaging in anal sex among women with a high risk of HIV infection.

RESULTS

Anal sex was nearly 3 times more common among actively bisexual women (OR = 2.96, 95% CI: 2.17-4.03). Women were more likely to have anal sex with partners who injected drugs (OR = 2.32, 95% CI: 1.44-3.75), were not heterosexual (OR = 1.85, 95% CI: 1.18-2.90), and with whom they exchanged money or drugs for sex (OR = 1.79, 95% CI: 1.10-2.90). The likelihood of anal sex also increased with the number of nights sleeping together (OR = 1.15, 95% CI: 1.06-1.24). In contrast, emotional closeness and social closeness were not associated with anal sex. Condom use during anal sex was uncommon, and did not vary according to partner or relationship characteristics.

CONCLUSIONS

Our findings support the need for HIV prevention interventions that target anal sex among heterosexuals, particularly in drug-using populations residing in neighborhoods with elevated levels of HIV prevalence.

Present but not accounted for: exploring the sexual risk practices and intervention needs of nonheterosexually identified women in a prevention program for women with HIV/AIDS

Nonheterosexually identified (NHI) women may be present, but not accounted for, in HIV and sexually transmitted infection (STI) prevention interventions. This study used quantitative and qualitative methods to examine the sexual risk behaviors and intervention needs of NHI women in Protect and Respect, a safer sex intervention for HIV-positive women. Study participants (n=32) were predominantly Black, low income, and between 28 and 51 years old. Although NHI participants were more likely than heterosexual participants (p < .05) to report obtaining their income from sex work, hustling, or selling drugs; and having a higher median number of male sex partners, qualitative analyses revealed that the intervention often neglected NHI women's experiences and unique safer sex needs. Heterosexist HIV and STI prevention programs may hinder NHI women's ability to protect themselves and their partners from reinfection and infection respectively. We discuss the implications of our research for future HIV/AIDS and STI research, services and interventions for NHI women.

Some data-driven reflections on priorities in AIDS network research

Risk networks can transmit HIV or other infections; social networks can transmit social influence and thus help shape norms and behaviors. This primarily-theoretical paper starts with a review of network concepts, and then presents data from a New York network study to study patterns of sexual and injection linkages among IDUs and other drug users and nonusers, men who have sex with men, women who have sex with women, other men and other women in a high-risk community and the distribution of HIV, sex at group sex events, and health intravention behaviors in this network. It then discusses how risk network microstructures might influence HIV epidemics and urban vulnerability to epidemics; what social and other forces (such as "Big Events" like wars or ecological disasters) might shape networks and their associated norms, intraventions, practices and behaviors; and how network theory and research have and may continue to contribute to developing interventions against HIV epidemics.

Sexual and drug risk behaviors among women who have sex with women

OBJECTIVES

We examined risk behaviors of female drug users, comparing those who reported recently having had sex with women (recent WSW), those who reported previously having had sex with women (former WSW), and those who reported never having had sex with women (never WSW).

METHODS

We used data from the Risk Evaluation and Assessment of Community Health III Study. Adjusted odds for predictors of WSW status were determined via multinomial logistic regression analyses.

RESULTS

Of the participants, 75% were never WSW, 12% were former WSW, and 13% were recent WSW. In comparison with never WSW status, significant predictors of recent WSW status were living away from one's parents as a child (adjusted odds ratio [OR]=3.05; 95% confidence interval [CI]=1.07, 8.67) and recently having been paid for sex by men (adjusted OR=4.02; 95% CI=1.67, 9.68). Also, recently having been paid for sex by men was a significant predictor of former WSW status as opposed to never WSW status (adjusted OR=3.97; 95% CI=1.65, 9.59).

CONCLUSIONS

The recency with which they had sex with women is one of the facets influencing the risk profile of WSW. The diverse characteristics of the WSW population need to be incorporated into future studies and risk interventions targeting this group.

Behavior change and health-related interventions for heterosexual risk reduction among drug users

Prevention of heterosexual transmission of HIV between and from drug users is important for controlling the local and global HIV heterosexual epidemic. Sex risk reduction interventions and health-related interventions are important for reducing the sex risk behaviors of drug users. Sex risk reduction interventions address individual-level, peer-level, and structural-level determinants of risk reduction. Health-related interventions include HIV counseling and testing, prevention and treatment of sexually transmitted diseases, and delivery of highly active antiretroviral therapy. It is important to adapt effective interventions implemented in resource-rich countries to the realities of the resource-constrained settings and to address relevant contextual factors.

Who is epidemiologically fathomable in the HIV/AIDS epidemic? Gender, sexuality, and intersectionality in public health

This paper examines the shifting nature of contemporary epidemiological classifications in the HIV/AIDS epidemic. It first looks at assumptions that guide a discourse of vulnerability and circulate around risk categories. It then examines the underlying emphasis in public health on the popular frame of "vulnerable women" who acquire HIV through heterosexual transmission. Drawing on work on gender, sexuality, and intersectionality, the paper asks why a discourse of vulnerability is infused into discussions of heterosexually-active women's HIV risks but not those pertaining to heterosexually-active men's. The paper then moves to current surveillance categories that are hierarchically and differentially applied to women's and men's risks in the HIV epidemic. Here, the focus is on the way in which contemporary classifications allow for the emergence of the vulnerable heterosexually-active woman while simultaneously constituting lack of fathomability concerning bisexual and lesbian transmission risk. Lastly, theories of intersectionality, are used to examine current research on woman-to-woman transmission, and to suggest future more productive options.

Sexually transmitted disease/HIV risk behaviour among women who have sex with women

OBJECTIVE

To analyse the epidemiological aspects of sexually transmitted diseases (STD) among women who have sex with women (WSW) in São Paulo, Brazil.

METHOD

A cross-sectional study with interviews and analysis of clinical and gynaecological tests in women, by means of a convenience sample. Characteristics were gathered according to age, sociobehavioural profile, reproductive life and sexuality.

RESULTS

The study included 145 women. They started sexual activity at an average age of 16.9 years, and 23.4% of them had had heterosexual relations during the preceding year, with a relatively low frequency of condom use. In sexual relations with women, 54.5% used condoms when they shared sex toys. A previous STD was reported by 38% of them. The following STD were diagnosed: trichomonas (3.8%), bacterial vaginosis (33.8%), fungi (25.6%), Chlamydia (1.8%), hepatitis B (7%), hepatitis C (2.1%), abnormal Pap smear (7.7%), human papillomavirus (6.2%) and HIV (2.9%).

CONCLUSION

In this study, many WSW did not report a single risk behaviour, but often reported a combination of several potential risk factors. Therefore, one cannot speak of high or low-risk behaviour for STD/HIV, but rather of multiple-risk behaviour. It is evident that there is a need for healthcare professionals to be correctly informed and sensitive towards the healthcare of WSW.

The trouble with "MSM" and "WSW": erasure of the sexual-minority person in public health discourse

Men who have sex with men (MSM) and women who have sex with women (WSW) are purportedly neutral terms commonly used in public health discourse. However, they are problematic because they obscure social dimensions of sexuality; undermine the self-labeling of lesbian, gay, and bisexual people; and do not sufficiently describe variations in sexual behavior.MSM and WSW often imply a lack of lesbian or gay identity and an absence of community, networks, and relationships in which same-gender pairings mean more than merely sexual behavior. Overuse of the terms MSM and WSW adds to a history of scientific labeling of sexual minorities that reflects, and inadvertently advances, heterosexist notions. Public health professionals should adopt more nuanced and culturally relevant language in discussing members of sexual-minority groups.

Changes in women's sexual risk behaviors after therapeutic community treatment

This study examines sexual risk behaviors among 197 women mandated to substance abuse treatment in therapeutic communities. The women's risk behaviors after treatment are compared with their behaviors prior to treatment, and risk behaviors among those who completed treatment are compared with those who did not. The women had a high prevalence of sexual risk behaviors (i.e., multiple partners, unprotected sex, sex trade, not asking partners to use condoms, sex with injection drug users [IDUs]) and relationship violence and conflict before treatment and a significant decrease in unprotected sex, sex trade, sex with multiple partners, and relationship violence or conflict after treatment. Those who completed treatment were significantly less likely to participate in sex trade or have sex with IDUs and were more likely to have a new sexual partner and only one sexual partner after treatment as compared with those who did not complete treatment. The present study shows that therapeutic community treatment is associated with the reduction of sexual risk behaviors among female substance abusers mandated to treatment.

Exploring an HIV paradox: an ethnography of sexual minority women injectors

HIV risk and infection are markedly increased among sexual minority women injectors compared to other injecting drug users. Our ethnographic exploration of this well-documented but poorly understood phenomenon included 270 interviews and over 350 field observations with 65 sexual minority women injectors in New York City and Boston. We discuss findings in relation to four preliminary hypotheses. Neither the presence of gay or bisexual men in risk networks, nor a sense of invulnerability due to lesbian (or other sexual minority) identity seem to be plausible explanations of increased HIV among sexual minority women injectors. However, multiple marginalization was found to be pervasive and to have severe consequences that can be traced to increased HIV risk for many women in the study.

HIV/STI associated risk behaviors among self-identified lesbian, gay, bisexual, and transgender college students in the United States

An Internet survey was conducted during the 2001-2002 academic year to examine the health risk behaviors, including HIV/STI associated behaviors, of self-identified lesbian, gay, bisexual, and transgender (LGBT) college students in the United States. A total of 450 LGBT college students completed the entire online survey. Most respondents attended a 4-year (96.9%), coeducational (98.6%), non-religiously affiliated (87.5%), public (68.6%) institution. Eighty-nine percent reported having sex with someone of the same sex and 45% had multiple (6 or more) sex partners during their lifetime. Most reported using a condom consistently during penile-vaginal (61%) and anal sex (63%). However, only 4% used a condom or other barrier consistently during oral sex and 28% used a condom or other barrier during their last sexual encounter. Injection drug use and needle-sharing behavior was low (2.1% and 1.1%, respectively). Comparisons with heterosexual college students' HIV/STI associated risk behaviors are included. Results may be useful for HIV/STI prevention programs targeting LGBT college students.

Puerto Rican drug users experiences of physical and sexual abuse: comparisons based on sexual identities

This study integrates the results of quantitative and qualitative methods to elucidate the association between sexual identity and physical and sexual abuse among Puerto Rican drug users. A structured questionnaire was administered to 800 subjects in New York and 399 in Puerto Rico. A total of 93 subjects (7.9%) self-identified as homosexual or bisexual. Gay males were significantly more likely than heterosexual males to report first occurrence of physical abuse by a family member in childhood. Both gay and bisexual males were more likely than their heterosexual counterparts to report first experiencing unwanted sex in childhood and intimate partner physical abuse later in life. Lesbians were more likely than female heterosexuals to report unwanted sex in childhood. Qualitative data were collected through in-depth life histories with 21 subjects and suggest that gay and lesbian subjects perceive antihomosexual prejudice on the part of family members as one cause of childhood physical and sexual abuse.

Nuances and shifts in lesbian women's constructions of STI and HIV vulnerability

This study examines the subjective side of vulnerability as a social construct rooted in interpersonal relationships and community membership. Analysis is based on a survey of an especially diverse sample of 162 lesbian women, 67 of whom also participated in depth interviews. Another 24 of the original sample also participated in transcribed focus groups. One third were African American, Latina, and Asian, and two thirds were white. This sample reported an overall infection rate of 23%. Three subjective stances, or risk frames, are identified: essentially invulnerable, socially inoculated, and fundamentally vulnerable. Some women describe shifts in their interpretations of their own vulnerability, moving from one stance to another in response to obtaining information, becoming infected, having friends or acquaintances who become infected, and becoming involved with new partners. It is suggested that these shifts comprise a subjective "vulnerability career". The significance of lesbian women's constructions of vulnerability is examined, and the implications of this study for a better understanding of their risk for STIs are discussed.

Abuse, Social Support, and Depression Among HIV-Positive Heterosexual, Bisexual, and Lesbian Women

SUMMARY A nonprobability sample of HIV-positive mostly African American and Puerto Rican women in New York City were surveyed regarding abusive experiences, social support, and depressive symptoms. Seventy-five percent reported experiencing physical or sexual abuse at some point in their lives. Multiple regression analyses controlling for relevant sociodemographic variables indicated that child physical and sexual abuse and adult sexual abuse were significantly associated with depressive symptomatology (i.e., CES-D scores). HIV-related social support had a significant negative correlation with CES-D scores but did not have a moderating impact on the effects of physical or sexual abuse. Lesbian/bisexual women reported higher rates of lifetime sexual and physical abuse than heterosexual women. However, there were no differences between the groups in total CES-D scores. Lesbian/bisexual women had significantly greater support from friends and groups/organizations than the heterosexual women. The implications of the findings for future research and the provision of services for HIV-positive women are considered.

Women in contact with Sydney's gay and lesbian community: sexual identity, practice and HIV risks

Total rates are low, but sex with a man remains the main risk for HIV transmission to women in Australia. In February 1998, 774 women in contact with gay, bisexual and lesbian communities completed a two-page questionnaire. Almost all respondents had some social contact with gay men. Two-thirds (503) thought of themselves as lesbian/dyke/homosexual/gay, 13% (100) as bisexual and 17% (133) as heterosexual/straight. In total, 212 women (27%) said they had ever had sex with a gay or bisexual man; 51 women (7%) had done so in the past six months. About 2% of the lesbians said they had recently had sex with a gay/bi man, as had 8% of the heterosexuals and 25% of the bisexuals; 25 women had recently had unprotected vaginal or anal intercourse with a male gay/bi partner. Forty-eight women (6%) had done sex work. Asked about drug use, 61 women (8%) said they had injected in the past six months. Twenty-three women had shared injecting equipment with someone, and five had shared with a gay/bi man. Compared with other women, these women have high rates of injecting drug use. If they have sex with men, these men are more likely to be gay or bisexual than are the male sexual partners of women moving in largely heterosexual milieux. For a case of so-called 'heterosexual' transmission of HIV to occur, neither person need be heterosexual.

Sexuality and safer sex: the issues for lesbians and bisexual women

Nursing interventions to help women reduce their risk of contracting HIV must be designed from an in-depth understanding of the complex sociocultural patterns of sexuality in particular communities and among specific subgroups.

OBJECTIVE

In this data collection phase of a community-based HIV prevention project, the objective was to understand HIV risk-taking and HIV risk-reduction activities of lesbians and bisexual women.

DESIGN

Qualitative field study.

SETTING

Data were collected in women's bars and dance clubs and at selected lesbian/bisexual community events in San Francisco.

PARTICIPANTS

Interviews were conducted with 1,189 racially diverse, socially and sexually active lesbians and bisexual women.

RESULTS

Inductive content analysis produced two themes: realities of sexual behavior and sexual expressions and their meanings. Realities of sexual behavior included an assumption that women who have sex with other women cannot get HIV, a lack of familiarity with HIV prevention strategies, inconsistent practice of safer sex with men and/or women, and the negative effect of alcohol or drug use on safer sex efforts. Sexual expressions and their meaning included trust in monogamy, a sense that safer sex practices detracted from intimacy and eroticism, the difficulty of negotiating sexual behaviors with men or women, and dealing with partner resistance to safer sex practices.

CONCLUSIONS

Specific recommendations for practice are the need for nurses to understand the range and diversity of women's sexual behaviors, to develop skills in conducting inclusive sexual histories, and to develop a comprehensive approach to sexual health.

Sexual orientation and HIV infection prevalence among young Latino injection drug users in Harlem

Among injection drug users (IDUs), those at highest risk for HIV infection include Latinos, young women, and young men who have sex with men (homosexual men). We examined how HIV infection prevalence is affected by gender and sexual orientation among young Latino IDUs in New York City. We used baseline data from a cohort study of young (18-30 years) IDUs in Harlem, New York City, conducted from 1997 through 1999. Participants were asked about drug use and sexual behaviors, and blood was taken for HIV, hepatitis B, and hepatitis C viral antibody testing. Of 156 participants who self-identified as Latino, 145 (94%) were Puerto Rican. Overall, 101 (65%) were heterosexual men, 11 (7%) were men who have sex with men (MSM), 32 (20%) were heterosexual women, and 12 (8%) were women who have sex with women (WSW). Of the whole cohort, 17 (11%) were HIV positive. HIV infection rates were higher among WSW (42%, p < 0.05), heterosexual women (16%, p < 0.05), and homosexual men (18%, p = 0.09) than heterosexual men (5%). Compared with heterosexual men, homosexual men were significantly (p < 0.05) more likely to have received money or drugs for sex (64% versus 33%), and WSW were significantly more likely to have had unprotected sex with an IDU 5 years or more older (50% versus 16%). Multivariate analysis showed being a WSW (adjusted odds ratio [AOR] = 8.68, 95% confidence interval [CI] 1.78-42.26) and having unprotected sex with an older IDU (AOR = 7.01, 95% CI 2.23-21.96) to be associated with HIV infection. Sexual transmission may account for many HIV infections among young Latino IDUs. The high prevalence of HIV infection among WSW may, in part, be due to their having unprotected sex with older men, but studies with larger sample sizes are needed to confirm this.