Jenkins Wiley D, Beach Lauren B, Schneider John, Friedman Samuel R, Pho Mai T, Walters Suzan, Ezell Jerel, Young April M, Hennessy Caitie, Miller William C, Go Vivian F, Sun Christina, Seal David W, Westergaard Ryan P, Crane Heidi M, Fredericksen Rob J, Ruderman Stephanie A, Fletcher Scott, Ma Jimmy, Delaney J A, Plaisance Karma, Feinberg Judith, Smith Gordon S, Korthuis P Todd, Stopka Thomas J, Friedmann Peter D, Zule William, Winer Mike
Department of Public Health Sciences, Clemson University, Clemson, SC, United States of America.
Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America.
J Subst Use Addict Treat. 2025 Apr;171:209629. doi: 10.1016/j.josat.2025.209629. Epub 2025 Jan 26.
People who use drugs (PWUD) are at risk of HIV infection, but the frequency and distribution of transmission-associated behaviors within rural communities is not well understood. Further, while interventions designed to more explicitly affirm individuals' sexual orientation and behaviors may be more effective, descriptions of behavior variability by orientation are lacking. We sought to describe how disease transmission behaviors and overdose risk vary by sexual orientation and activity among rural PWUD.
From 01/2018-03/2020, rural PWUD participating in the Rural Opioid Initiative were surveyed across 8 sites. Collected data included: demographics; experiences with drug use, overdose, and healthcare; stigma; gender identity; and sexual orientation and partners. Participants were categorized as: monosexual by orientation and behavior (Mono-only), monosexual by orientation but behaviorally bisexual (Mono/Bi), and bisexual by orientation (Bi+). Analyses included descriptive summaries, bivariate examination (chi-square), and logistic regression (relative risk [RR] and 95 % confidence interval [CI]).
The 1455 participants were 84.8 % Mono-only, 3.2 % Mono/Bi, and 12.0 % Bi+. Compared to Mono-only men, Mono/Bi and Bi+ men had greater risk of transactional sex (RR = 9.71, CI = 6.66-14.2 and RR = 5.09, CI = 2.79-9.27, respectively) and sharing syringes for injection (RR = 1.58, CI = 1.06-2.35 and RR = 1.85, CI = 1.38-2.47). Compared to Mono-only women, Mono-Bi and Bi+ women had greater risk of transactional sex (RR = 4.47, CI = 2.68-7.47 and RR = 2.63, CI = 1.81-3.81); and Bi+ women had greater risk of sharing syringes for injection (RR = 1.49, CI = 1.23-1.81), sharing syringes to mix drugs (RR = 1.44, CI = 1.23-1.69), and experiencing an overdose (RR = 1.32, CI = 1.12-1.56). Bi+ men and women both more frequently reported selling sex as a source of income (versus Mono-only, both p < 0.050) and measures of perceived stigma (all p < 0.050).
Rural PWUD who are bisexual by orientation or behavior are significantly more likely to engage in behaviors associated with infectious disease transmission and to experience stigma and drug overdose. Given the growing recognition of bisexuality as a distinct orientation that warrants individualized consideration, interventions that are specifically acknowledging and affirming to the circumstances of this group are needed.
吸毒者面临感染艾滋病毒的风险，但农村社区内与传播相关行为的频率和分布情况尚未得到充分了解。此外，虽然旨在更明确地肯定个人性取向和行为的干预措施可能更有效，但缺乏按性取向描述行为变异性的相关内容。我们试图描述农村吸毒者中疾病传播行为和过量用药风险如何因性取向和活动而有所不同。
2018年1月至2020年3月期间，对参与农村阿片类药物倡议的农村吸毒者在8个地点进行了调查。收集的数据包括：人口统计学信息；吸毒、过量用药和医疗保健经历；耻辱感；性别认同；以及性取向和性伴侣情况。参与者被分为：性取向和行为均为单一性取向（仅单一性取向）、性取向为单一性取向但行为上为双性恋（单一性取向/双性恋）、性取向为双性恋（双性恋+）。分析包括描述性总结、双变量检验（卡方检验）和逻辑回归（相对风险[RR]和95%置信区间[CI]）。
1455名参与者中，84.8%为仅单一性取向，3.2%为单一性取向/双性恋，12.0%为双性恋+。与仅单一性取向的男性相比，单一性取向/双性恋和双性恋+的男性有更高的交易性行为风险（RR分别为9.71，CI为6.66 - 14.2和RR为5.09，CI为2.79 - 9.27）以及共用注射器注射的风险（RR分别为1.58，CI为1.06 - 2.35和RR为1.85，CI为1.38 - 2.47）。与仅单一性取向的女性相比，单一性取向/双性恋和双性恋+的女性有更高的交易性行为风险（RR分别为4.47，CI为2.68 - 7.47和RR为2.63，CI为1.81 - 3.81）；双性恋+的女性有更高的共用注射器注射风险（RR为1.49，CI为1.23 - 1.81）、共用注射器混合毒品的风险（RR为1.44，CI为1.23 - 1.69）以及过量用药风险（RR为1.32，CI为1.12 - 1.56）。双性恋+的男性和女性都更频繁地报告将性交易作为收入来源（与仅单一性取向者相比，p均<0.050）以及感知耻辱感的指标（所有p<0.050）。
性取向或行为为双性恋的农村吸毒者明显更有可能从事与传染病传播相关的行为，并经历耻辱感和药物过量情况。鉴于双性恋作为一种独特的性取向越来越受到认可，需要进行专门针对并肯定该群体情况的干预措施。
