Drug-Using Women Need Comprehensive Sexual Risk Reduction Interventions

In the United States, drug users have dramatically reduced drug-related risk behaviors but continue sexual behaviors that place them at risk for human immunodeficiency virus (HIV) infection. Successful interventions are likely to be those that intervene at multiple levels, yet, historically, sexual interventions for drug users have primarily addressed only personal factors, such as condom use. Sexual risk arises from personal factors (e.g., perceived vulnerability and protective behaviors); interpersonal factors (e.g., relationship type and a partner’s risk profile); social factors (e.g., gender roles and sexual mixing patterns among and between net-works); and, finally, community-level factors (e.g., access to preventive methods and the prevalence of a sexually transmitted pathogen within a network). For female drug users, multiple sources of risk plus concurrent drug use during sex pose additional prevention challenges that disproportionately elevate their risk of sexually acquired HIV infection. New, multimodal interventions need to be developed and tested to more effectively address the many sources of sexual risk facing female drug users. Injection drug users (IDUs) were identified early on as a high-risk group for acquiring HIV/AIDS in the United States [1, 2] and continue to be an important at-risk group [3]. Over the course of the epidemic, risky in-jection-related behaviors have diminished dramatically among IDUs, but risky sexual behaviors have persisted. This finding was observed early on across the United States [4] and with IDUs both in [5] and out of drug treatment [6, 7]. Observational studies throughout the second decade of the AIDS epidemic continued to doc-ument that there is a movement toward safer injection behavior but that resistance or inability among IDUs to make their sexual behavior safer is persistent [8, 9]. Early-generation intervention studies have also sug