Sex and Substance Use in People at Increased Risk for HIV in Texas - Epi Profile Section 10

The National HIV Behavioral Surveillance Survey (NHBS) project conducts interviews in Dallas with MSM, PWID, and heterosexually active people who are not living with HIV. The data collection is completed in rotating, annual cycles of the three groups. Since the interviews are conducted in Dallas, the results may not reflect other areas of the state. 

MSM

In 2017, 427 MSM who were not living with HIV were interviewed (Table 25). Of this group, 72% had condomless anal sex with a male partner, 54% used injection or non-injection drugs, and 12% had condomless anal sex with a male partner whose HIV status was unknown within the past 12 months. Only 2% reported having condomless anal sex with a partner living with HIV in the past 12 months.  Seven percent reported having syphilis in the past 12 months.

In Texas, young Black MSM experience the highest rates of new HIV diagnoses (see Section 4: New Diagnoses in MSM). However, NHBS data indicates that White MSM and Hispanic MSM in Dallas are more likely to report having condomless anal sex: 80% of White MSM and 70% of Hispanic MSM had condomless anal sex compared to 66% of Black MSM. Furthermore, 5% of White MSM had condomless anal sex with a partner living with HIV compared to 0% of Black MSM and 1% of Hispanic MSM. 

In general, risk behavior among MSM decreased with age. A lower proportion of respondents 45 years of age or older had condomless anal sex (56%), had condomless anal sex with a male partner whose HIV status was unknown (16%) or had condomless anal sex with a partner living with HIV (0%) compared to those in the younger age groups. 

PWID

Interviews with people who inject drugs (PWID) in Dallas were conducted in 2015 (Table 26). Over 70% of PWID recruited for this survey were over the age of 45 and 77% were Black.

Respondents reported that in the last 12 months they had shared needles (28%) or other injection equipment (54%), exchanged money or drugs for sex (19%) or had condomless sex (67%). 

White PWID more frequently reported sharing needles compared to Hispanic (45%) and Black participants (21%). In addition, 65% of Hispanic participants shared drug paraphernalia compared to 59% of White and 52% of Black participants. Slightly more Black participants (20%) exchanged money or drugs for sex compared to all other race/ethnic groups (15% for each). 

In general, risk behavior among PWID decreased with age. A lower proportion of respondents 45 years of age or older shared needles (23%) or drug paraphernalia (53%) compared to their 18 to 24-year-old counterparts (50% and 67%). Fewer older respondents exchanged money or drugs for sex (19%) compared to those 18 to 24-years-old (33%). Finally, fewer older respondents had condomless sex (60%) compared to those 18 to 24-years-old (92%). 

Persons who Acquired HIV through Heterosexual Contact

Ninety-one percent of heterosexual study participants in Dallas reported having condomless sex with a partner of the opposite sex. Twenty-two percent exchanged money or drugs for sex in the past 12 months. Only 1% reported having condomless sex with a person living with HIV within the last 12 months. 

Age appears unrelated to patterns in condomless sex, as it was reported by 93% of those 18-24 years of age and by 91% of those 45 years of age or older. Furthermore, older respondents were more likely to report exchanging sex for money or drugs. More information on this wave of the project can be found in Table 27. 

* One participant whose race/ethnicity was missing was included in the total. 

* This analysis excluded female PWID who reported sex exclusively with other females. 

* This item is referring to condomless sex with either a main or casual partner.