Drug and Alcohol Dependence, 33 (1993) 73 -80 Elsevier Scientific Publishers Ireland Ltd. 73 Injecting drug users and HIV/AIDS: risk behaviours and risk perception Beth R. Crisp”, James G. Barberb, Michael W. RossC, Alex Wodakd, Julian Gold” and M.E. Millerf aDepartment of Social Work, La Trobe University, Bundoora, Victoria, 3083, ‘School of Social Administration, Flinders Uni- versity of South Australia, GPO Box zyxwvutsrqponmlkjihgfedcbaZYXWVUTSRQPONMLKJIHGFEDCBA 2100 Adelaide, South Australia, 5001, ‘National Centre in HIV Social Research, Universi- ty of New South Wales, 345 Crown Street, Sury Hills, New South Wales, 2010, dAAlcohol and Drug Service, St V&cents Hospital, 366 Victoria Street, Darlinghurst, New South Wales, 2010, eAlbion Street (AIDS) Centre, 150 Albion Street, Sum-y Hills, New South Wales, 2010 and fDirectorate of the Drug Offensive, 73 Miller Street, North Sydney, New South Wales, 2060 (Australia) (Accepted March 11, 1993) This paper reports on the incidence of risk taking behaviours, and the relationship between risk perception and risk behaviours in a sample of 1245 Sydney injecting drug users (IDUs). Almost all respondents reported engaging in behaviours that placed them at risk of HIV infection: 32.9% through unsafe injecting, 84.4% because of unsafe sexual behaviour and 89.2% because of either injecting or sexual behaviour. Injecting and sexual behaviour were poorly correlated. This study also found that risk perception is unrelated to injecting or sexual behaviours, previous history of sexually transmitted diseases, a range of demographic characteristics including age and gender, and the number of times tested for HIV. Social policy and prevention 1 progra& should aim to change unsafe;nj&ting &d sexual directly by changing risk perception. behaviours directly, rather than attemptingto achieve-change in- Key words: injecting drug use; AIDS; risk perception; risk behaviour Introduction Injecting drug users (IDUs) were among the earliest patients presenting with the symptoms of what has become known as AIDS (Masur et al., 1981) and now constitute the majority of HIV infected persons in Spain and Italy (Health Department of Victoria, 1991). Repeated studies have indicated that almost all IDUs report hav- ing shared needles and syringes in the past (e.g. Morlet et al., 1990; Wolk et al., 1990; Crofts and Hay, 1991). However, reporting whether IDUs have ever shared (Morlet et al., 1990) or have shared at any time in the last 5 years (Walk et Correspondence to: Beth Crisp, School of Social Administra- tion, Flinders University of South Australia, GPO Box 2100, Adelaide, South Australia, Australia 5001. 0376X716/93/$06.00 0 1993 Elsevier Scientific Publishers Printed and Published in Ireland al., 1990; Crofts and Hay, 1991) fails to account for the possibility that risk reduction measures (e.g. needle and syringe exchanges) could have resulted in some IDUs ceasing to share injecting equipment (Walk et al., 1988) and may therefore result in an overestimation of the incidence of risky injecting, currently or in the recent past. Moreover, while sharing needles and syringes is a highly effective means of transmitting HIV, the risk can be minimised by using cleaning methods known to be virucidal to HIV. Thus, a truly accurate measure of risky injecting re- quires establishing the frequency of sharing where effective cleaning methods have not been used. The presence of HIV antibodies detected in needles and syringes returned to a needle and syringe exchange has been claimed as evidence Ireland Ltd.