Drug injectors using condoms at last sex, by partner type
Drug injectors frequently have sexual partners who do not inject drugs. Because of the high HIV prevalence typically found among injecting drug users, these partners are at especially high risk of infection through sex unless a condom is used. They provide a conduit by which the virus may enter the larger population of people who are sexually active but have no direct contact with drug injectors. While interventions with drug users centre on safer injecting practices, many also actively promote condom use during sex, aiming to minimise the spread of HIV from drug users to the general population. This indicator tracks changes over time in condom use by injecting drug users, by partner type.
Number reporting that they used a condom the last time they had sex with a given partner type
All those who have had sex with that type of partner in the last 12 months
Three types of partners are distinguished which can result in three potential subindicators. In a survey of injecting drug users, respondents are asked about commercial sex in the last 12 months. They are further asked whether commercial partners were paid or paying, and the timing of the most recent paying client. The indicator is the number reporting that they used a condom the last time they had sex for drugs or money, divided by all those who have sold sex in the last 12 months. In a survey of injecting drug users, respondents are also asked about sex with non-regular and regular partners in the last 12 months and about condom use at last sex with the most recent partner of each type. The indicator is the number reporting that they used a condom the last time they had sex with a given partner type, divided by all those who have had sex with that type of partner in the last 12 months. It is reported separately for each partner type.
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For reasons given in the section on sexual behaviour, a cross-sectional measure of condom use at last sex gives a rather reliable picture of overall levels of condom use. The major limitation of this measure among drug injectors is that it does not distinguish between partners who are themselves injectors and those who are not. Men and women who inject drugs are far more likely to be at risk for HIV because of their injecting behaviour than because of their sexual behaviour – unprotected sex with another injector is likely to represent only a small incremental risk of infection for them. In addition, couples who know that they are both HIV-infected are unlikely to use condoms with one another. In this case, unprotected sex does not represent any risk. It is when a drug injector has unprotected sex with someone who does not inject drugs that the risk of sexual transmission is greatest. Distinguishing between injecting and noninjecting partners may not, however, be practical. People may not know their partner’s injecting status – this is especially likely to be the case among injectors who support their habit through commercial sex. And inaccuracies in recall are more likely if people are asked to report condom use with the most recent partner who was not an injector. The indicator distinguishes between partner type for programmatic reasons. While epidemiologically the risk of a drug injector passing on HIV infection in sex is not dependent on partner type, the implications for the further spread of HIV are substantial. Low condom use with commercial partners among drug injectors who support their drug purchases by selling sex is epidemiologically more worrying than low condom use with regular partners, simply because partner turnover in commercial sex is higher. Different types of interventions may be needed to more effectively promote condom use with different partner types.