Sex, drugs, and syringe exchange in New York City: women's experiences.

The sex and drug human immunodeficiency virus (HIV) risk factors of drug-injecting women participating in New York City syringe exchange programs were studied and racial/ethnic differences examined. African-American women reported injecting least frequently and had lower rates of injecting with borrowed or used syringes. Women attending syringe exchange reported high levels of sexual risk behavior, and syringe exchange provides an opportunity for a sexual risk reduction intervention. Women were more likely to "always" use condoms with causal partners than with primary partners. About 60% of the women engaging in commercial sex work reported "always" using condoms. Three independent predictors for consistent condom use with primary partners were: knowing one's HIV status, any risky injection during the past 30 days, and being African-American, compared with white or Latina. The profile of African-American women attending syringe exchange in New York City suggests a higher level of stabilization than is found in the other groups of women. White women appear to be more socially isolated and to engage in higher risk behaviors. Although women attending New York City syringe exchange programs have significantly reduced risky drug injection, consistent with other studies, sexual risk behavior has remained at a high level. Syringe exchange and drug treatment programs have a great opportunity to target drug-injecting women for sexual risk reduction interventions.