Risk factors for HIV-1 seroprevalence among drug injectors in the cocaine-using environment of Rio de Janeiro.

To determine risk factors for HIV-1 among drug injectors in Rio de Janeiro, where cocaine is the dominant drug of injection, subjects were recruited using the criteria and interview instrument of the World Health Organization's Cross-National Study of HIV infection and risk behaviour in injecting drug users. HIV antibody test results were derived both from serum tests and from self-reports of previous tests (documented evidence of self-reported seropositivity was required). The analytical sample consists of 123 subjects, recruited both at drug abuse treatment sites and at street locations. Of 27 subjects with both serological and self-reported antibody status data, 20 reported previous negative tests; of these three had positive sera and may have seroconverted. Seven subjects reporting prior positive serostatus all tested positive. For the 123 subjects, seroprevalence was 34%. Independent significant risk factors in multivariate logistic regression with backwards elimination are: years of injection greater than 5; being a male who has had sex with men in the previous 5 years; and not having taken deliberate steps to protect oneself against AIDS. These findings indicate that homosexual/bisexual male drug injectors may be a bridge group through which HIV is entering drug-injecting networks in Rio de Janeiro. Efforts by drug injectors to reduce their risk of infection seem to have protective effects. This underscores the importance of HIV prevention efforts aimed at drug injectors.