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

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

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. 

MSM 

Average number of male sex partners in past 12 months 

Had condomless anal sex with a male partner in the past 12 months 

Had condomless anal sex with last male partner whose HIV status was unknown 

Had condomless anal sex with last partner living with HIV 

Used injection or non-injection drugs in the past 12 months 

Self-reported syphilis infection in the past 12 months 

 

Number 

Number 

Number 

% 

Number 

% 

Number 

% 

Number 

% 

Number 

% 

Race/Ethnicity 

 

 

 

 

 

 

 

 

 

 

 

 

White 

137 

13 

109 

80% 

15 

11% 

5% 

79 

58% 

11 

8% 

Black 

68 

45 

66% 

12% 

0% 

31 

46% 

7% 

Hispanic 

192 

11 

134 

70% 

27 

14% 

1% 

102 

53% 

14 

7% 

Other 

29 

14 

20 

69% 

10% 

0% 

17 

59% 

3% 

Total* 

427 

11 

308 

72% 

53 

12% 

2% 

230 

54% 

31 

7% 

Age group (years) 

 

 

 

 

 

 

 

 

 

 

 

 

18-24 

100 

70 

70% 

13 

13% 

1% 

58 

58% 

8% 

25-34 

196 

152 

78% 

18 

9% 

4% 

112 

57% 

17 

9% 

35-44 

63 

48 

76% 

11 

17% 

2% 

28 

44% 

5% 

45+ 

68 

22 

38 

56% 

11 

16% 

0% 

32 

47% 

4% 

Total 

427 

11 

308 

72% 

53 

12% 

2% 

230 

54% 

31 

7% 

Table 25: Sex and drug use in Dallas MSM who are not living with HIV, 2017 (weighted) 

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

 

People who Inject Drugs 

Shared needle in past 12 months 

Sharing of drug paraphernalia in past 12 months 

Exchanged money or drugs for sex in past 12 months 

Average number of sex partners in the past 12 months* 

Had condomless sex in the past 12 months 

 

Number 

Number 

% 

Number 

% 

Number 

% 

Number 

Number 

% 

Race/Ethnicity 

 

 

 

 

 

 

 

  

 

 

White 

86 

46 

53% 

51 

59% 

13 

15% 

66 

77% 

Black 

390 

81 

21% 

203 

52% 

79 

20% 

253 

65% 

Hispanic 

20 

45% 

13 

65% 

15% 

16 

80% 

Other 

13 

46% 

62% 

15% 

54% 

Total 

509 

142 

28% 

275 

54% 

97 

19% 

342 

67% 

Age group (years) 

 

 

 

 

 

 

 

  

 

 

18-24 

12 

50% 

67% 

33% 

11 

92% 

25-34 

60 

27 

45% 

32 

53% 

13% 

54 

90% 

35-44 

71 

24 

34% 

40 

56% 

14 

20% 

56 

79% 

45+ 

366 

85 

23% 

195 

53% 

71 

19% 

221 

60% 

Total 

509 

142 

28% 

275 

54% 

97 

19% 

342 

67% 

Table 26: Sex and drug use in Dallas PWID who were not living with HIV, 2015 (unweighted) 

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

 

Persons Who Engage in Heterosexual Contact 

Average number of sex partners of the opposite sex in the past 12 months 

>

Had condomless sex with a partner of the opposite sex in the past 12 months* 

>

Exchanged money or drugs for sex in past 12 months 

>

Had condomless sex with an HIV-positive partner in the past 12 months* 

 

Number 

Number 

Number 

% 

Number 

% 

Number 

% 

Race/Ethnicity 

 

 

 

 

 

 

 

 

White 

100% 

22% 

0% 

Black 

364 

331 

91% 

86 

24% 

2% 

Hispanic 

34 

32 

94% 

6% 

0% 

Other 

20 

17 

85% 

20% 

0% 

Total 

427 

389 

91% 

94 

22% 

1% 

Age group (years) 

 

 

 

 

 

 

 

 

18-24 

73 

68 

93% 

10% 

1% 

25-34 

123 

111 

90% 

29 

24% 

0% 

35-44 

89 

81 

91% 

22 

25% 

3% 

45+ 

142 

129 

91% 

36 

25% 

1% 

Total 

427 

389 

91% 

94 

22% 

1% 

Table 27: Sexual behavior in Dallas HIV-negative people at an increased risk for HIV because of their heterosexual status, Dallas, 2016 (unweighted) 

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