Iskandar et al. BMC Public Health 2010, 10:472 http://www.biomedcentral.com/1471-2458/10/472 Table 3 Risk behavior among former (fIDUs) and current injecting drug users (cIDUs) in the last 30 days Risk Behavior fIDUs cIDUs (N = 92) (N = 118) Blood-blood transfer, n (%) Suck or lick a filter which had been used by another person Inject a drug prepared with water which had been used by another person Been injected by another person who had already injected or assisted in someone else’s injection Receive an accidental needle-stick/prick from another person’s used needle/syringe Re-use a needle/syringe taken out of a shared disposal/sharps container Sexual risk behavior, n (%) Engage in unprotected vaginal sex with another person Engage in unprotected vaginal sex with another person during menstruation Engage in unprotected anal sex with another person Tattoo or piercing, n (%) Tattooed by someone who was not a professional tattooist Been pierced by someone who was not a professional piercer Use another person’s toothbrush 13% 4% 0% 0% 3% 0% 42% 35% 11% 7% 52% 4% 10% 3% 76% 14% 41% 20% 15% 9% 56% 47% 20% 8% 53% 15% 14% 14% Page 5 of 7 X2 82,73 5,81 45,30 21,13 7,56 8,26 3,57 2,98 2,90 0,10 0,02 6,56 0,96 7,45 P <0,01 0,02 <0,01 <0,01 <0,01 <0,01 0,06 0,08 0,09 0,76 0,90 <0,01 0,327 <0,01 Sexual risk behavior of some form was reported by 56% of cIDUs and 42% of fIDUs (X2 = 3,57; P = 0,06). The most common sexual risk behavior for cIDUs and fIDUs was unprotected vaginal sex (47% respectively 35%, NS); reported unprotected anal sex was much lower (8% respectively 7%, NS). No statistical significant differences were found between former and current IDUs regarding oral and manual sex (data not shown). Excessive alcohol use was more common in IDUs enga- ging in risky sexual behavior, both among cIDUs (51% vs 33%; X2 = 3,86; P = 0,06) and fIDUs (46% vs 11%; X2 = 14,14; P < 0.01). Other risk behavior such as tat- tooing and piercing, which confer a much lower risk of HIV transmission compared to needle-sharing, was reported by half of all respondents (52% of fIDUs and 53% of cIDUs). Discussion This cross-sectional study from Indonesia shows a high prevalence of HIV-infection among relatively young and well-educated former and current IDUs. Current IDUs obviously had much higher risks of viral transmission related to injecting drugs, but also former IDUs had risks related to blood to blood transmission. Impor- tantly, both groups engaged in substantial risks related to sexual transmission of HIV. Almost half of respon- dents in our study were former IDUs, showing that this group may contribute significantly to HIV transmission. Injecting drug use is the main factor driving the HIV- epidemic in Indonesia. In a large cohort of HIV patients in our setting, two thirds had a history of IDU [19]. In line with this finding, the prevalence of HIV-infection among fIDUs and cIDUs in this study was high (66% respectively 60%), similar or slightly higher compared with previous local and national data [4]. The prevalence of AIDS was higher among fIDUs; concern about their general health or the development of AIDS may cause them to move from injecting drugs [6]. Injecting with needles or syringe from other people (15%) or from shared disposal/sharps containers without bleaching (9%) was reported by a substantial proportion of IDUs, although lower compared to previous research in Indonesia (24% - 80%) [5,20]. The high rate of needle stick injuries is no surprise given the fact 40% of IDUs fail to discard used needles safely [21]. Risk related to injecting drugs was especially high in cIDUs, but fIDUs are experience certain things (e.g. needle sticks or shar- ing of injecting equipment) which may have a low risk of HIV-transmission, but which may pose a significiant risk of transmitting HCV. This is important, as the pre- valence of HCV is very high among IDUs in this setting; among 633 HIV patients with a history of IDU 87.7% were HCV-infected [19]. Both among current and former IDUs, sexual risk behavior may contribute significantly to HIV transmis- sion. Sexual risk behavior was equally high in both groups, which is in contrast with previous studies reporting associations between injecting drug use and unsafe sex [22,23]. Condom use among IDUs has found to be inconsistent and especially low with sex workers and other risk groups for HIV transmission [20]. As IDUs often have multiple sex partners, including sex workers, HIV transmission may easily spread to people outside the IDU community. Heroin was the most frequently used drug among IDUs in this sample but many reported use of cannabis, benzo- diazepines and alcohol as well, in line with reports from China, Thailand, Ukraine, Lithuania, and Poland [24].