Bisexual Behavior Among Male Injection Drug Users in New York City

BACKGROUND:  Surveillance data are not routinely collected on men who have sex with men and women (MSMW).  Drug using MSMW may be at especially high risk for HIV infection and transmitting HIV to both their male and female sex partners.

METHODS:  In 2012, injection drug users (IDUs) were sampled in New York City for the National HIV Behavioral Surveillance cross-sectional study using respondent-driven sampling.  Analyses were limited to male participants who reported sex with a woman in the past 12 months.  Logistic regression was used to calculate crude and adjusted odds ratios (aOR) and 95% confidence intervals (95% CI) to determine the correlates of bisexual behavior in the past 12 months.

RESULTS:  Of 333 participants, 47 (14.1%) reported as MSMW.  Variables independently associated (p<0.05) with MSMW included bisexual sexual identity (vs. “straight”) (adjusted odds ratio (aOR): 92.6; 95% CI: 18.9, 454.5), Bronx residence (vs. Manhattan (aOR: 8.4; 95% CI: 1.6, 43.7)), past 12 month behaviors of having sex with ≥3 sex partners (aOR: 18.1; 95% CI: 3.3, 98.4), “sold” sex (aOR: 8.5; 95% CI: 2.3, 31.5), “bought” sex (aOR: 0.2; 95% CI: 0.1, 0.9), and injection methamphetamine use (aOR: 20.5; 95% CI: 3.0, 139.7).

CONCLUSIONS:  The prevalence of bisexual behavior was substantial among this sample of IDUs in NYC.  MSMW engaged in greater sexual risk behaviors compared with men who have sex with women only (MSWO) and may serve to bridge the HIV epidemic to women and syringe sharing partners.  MSMW IDUs are an important subgroup to consider for HIV interventions, as they may not be reached through HIV prevention programming aimed at MSM.