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Commercial Sex Work and Risk of HIV Infection Among Young Drug-Injecting Men Who Have Sex With Men in San Francisco

Bacon, Oliver MD, MPH*; Lum, Paula MD, MPH; Hahn, Judith PhD, MA; Evans, Jennifer MS*; Davidson, Peter BA; Moss, Andrew PhD§; Page-Shafer, Kimberly PhD, MPH*

Sexually Transmitted Diseases: April 2006 - Volume 33 - Issue 4 - p 228-234
doi: 10.1097/

Objective: The objective of this study was to investigate the relationship between sex work and HIV infection among young injection drug-using men who have sex with men (MSM-IDU).

Study Design: This study was a cross-sectional analysis of behavioral and serologic data collected from 227 street-recruited MSM-IDU in San Francisco, California, between January 2000 and November 2001.

Results: Sixty-eight percent of participants reported being paid by another man for sex. HIV prevalence was 12% (95% confidence interval, 8–16%); 42% of seropositive participants were unaware of their infection. HIV was independently associated with higher number of paying male partners and history of gonorrhea and inversely associated with number of female partners, education, and syringe-sharing. Consistent condom use overall was 41%, but varied significantly by type of partner.

Conclusions: Among MSM-IDU in San Francisco, sex work with men is strongly associated with HIV infection and the prevalence of condom use is low. HIV prevention among MSM-IDU must be tailored to address the excess risk associated with sex work.

A study of male injection-drug-using men who have sex with men in San Francisco found that those with a higher number of paying male partners were more likely to be HIV-positive.

From the *Center for AIDS Prevention Studies, Department of Medicine, University of California San Francisco, California; the † Positive Health Program, Department of Medicine, San Francisco General Hospital and University of California at San Francisco, California; ‡ EPI-CENTER, San Francisco General Hospital, University of California at San Francisco, California; and the § Department of Epidemiology and Biostatistics, University of California San Francisco, California

The authors acknowledge the tireless and dedicated assistance of Pam Axelson, Alya Briceno, John Day, Caycee Cullen, Sugar Edwards, Ro Giuliano, Gina Hobson, Gina Limon, Peter Morse, Kim Pierce, and Kyle Ranson. The authors also acknowledge the San Francisco Community Clinic Consortium for medical services provided through Street Outreach Services and thank all the young men and women who agreed to participate in the UFO Study.

Financial support for the UFO study was provided by the National Institute of Health/National Institute of Drug Abuse grant R01-DA-12803. Dr. Bacon was supported by NIMH grant T32 MH-19105 (Traineeships in AIDS Prevention Studies).

Oliver Bacon designed and performed the data analysis and wrote the manuscript; Paula Lum, Judith Hahn, and Andrew Moss conceived of the UFO study, acquiring the data and contributed to planning the data analysis; Jennifer Evans contributed to planning, performing, and reviewing the data analysis; Peter Davidson contributed to acquiring the data and planning the analysis; and Kimberly Page-Shafer conceived of the UFO study, acquiring the data, assisted with the data analysis and writing of the manuscript. All authors critically reviewed and contributed to the manuscript during its development.

We dedicate this paper to the memory of our colleague, Dr. Mike Pendo, who contributed so creatively to finding ways to reduce risk and prevent HIV among men in San Francisco.

The Committee on Human Subjects Research at the University of California, San Francisco reviewed and approved the study protocol.

Correspondence: Kimberly Page-Shafer, PhD, MPH, the Center for AIDS Prevention Studies, 50 Beale Street, Suite 1200, San Francisco, CA 94105. E-mail:

Received for publication April 8, 2005, and accepted September 2, 2005.

© Copyright 2006 American Sexually Transmitted Diseases Association