Background PWID engaged in unconventional sexual behaviour run the greater risk of becoming HIV infected due to multiple sexual and injecting risks. We sought to test the sexual health indicators (SHI) developed by UNAIDS/WHO and understand the impact of attitude on risk behaviour of PWID.

Method RDS was used in a cross sectional survey to recruit 500 PWID in August-October 2012 in Barnaul, Russia. One of the composite SHIs defined as “Conformity with traditional social norms concerning gender and sexuality among men and women 15+” included a question “Homosexuality is normal diversity of sexuality”. Respondents should either “Agree” or “Disagree” with the above statement. RDSAT was used to calculated point estimates.

Results Response rate was 94.2%. More than a half of all participants reported incarceration history (60.3%, 95% CI 55.2, 65.4) and coverage by prevention programmes (64.2%, 95% CI 58.3, 69.7). Majority (90.7%, 95% CI 85.4, 90.4) disagreed with statement: 96.0% (95% CI 91.4.98.7) of men and 79.4%(95% CI 67.5.90.20) of women. Young female PWID (< 30 years) had highest proportion of negative attitude (94.4%, 95% CI 89.1, 99.1) among all age groups. Positive attitude among PWID who reported no incarceration was 13.9% (95% CI 7.5, 21.9) and who had been incarcerated 2.9% (95% CI 0.8, 5.1). 82.6% (95% CI 72.1, 92.7) of women at 30–39 had negative attitude. 66.3% (95% CI 51.4, 77.7) of female PWID who disagreed did not use condom at last sexual contact while those who agreed - 17.5% (95% CI 5.8, 31.4). In comparison with women 2.9% (95% CI0.1, 8.1) of men PWID who agreed did not use condom.

Conclusions History of incarceration correlates with negative attitude towards non-traditional sexual orientation as well as condom use by PWID. Further research is necessary to understand social determents and behavioural factors and develop adequate interventions.