Homelessness and HIV-Associated Risk Behavior Among African American Men Who Inject Drugs and Reside in the Urban South of the United States

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Abstract
This study determined whether homeless injection drug users (IDUs) were more likely than stably housed IDUs to engage in HIV-associated risk behaviors. Respondent driven sampling was used to recruit 343 African American male IDUs. About 69% of men had been homeless in the past year and 13% were HIV positive. Controlling for age and income, homeless men as compared to stably housed men were 2.6 times more likely to report sharing needles, 2.4 times more likely to have 4 or more sex partners and 2.4 times more likely to have had sex with other men. Homeless men were also twice as likely to report having unprotected sex with a casual partner and about two-thirds less likely to report never using sterile needles. Self-reported HIV status was an effect modifier of these associations such that the observed relationships applied mostly only to men who were not knowingly HIV positive.