Background: Recent reports indicate that injection risk behavior has declined among injection drug users (IDUs) but sexual risk behavior continues. RuJu, classified as a form of body modification, is the practice of permanently inserting beads beneath the foreskin of the penis. A man who has penis beads does not comfortably use a condom while having sex. This study examined the possible association of RuJu with human immunodeficiency virus (HIV) infection among IDUs in Taiwan. Methods: Of 644 eligible male heroin users who agreed to participate in the study, 573 (89%) completed consent forms and a questionnaire between June and August 2008. Clinical characteristics (HIV, hepatitis C, and RuJu) were retrieved from their medical files. Multinomial logistic regression was performed to examine the association of RuJu and HIV seropositivity, with drug risk behavior and sexual risk behavior controlled for. Results: 206 respondents (36%) were HIV positive, 428 (75%) were HCV positive, and 232 (40%) had RuJu beads. 21% reported condom use at last sex and 34% reported multiple sexual partners during the last 6 months. 88% reported that they had injected heroin within the last 6 months, 18% shared a needle at last injection, and 26% shared rinses at last injection. Multinomial logistic regression analysis revealed that HIV-positive IDUs were more likely than HIV-negative IDUs to have HIV/AIDS knowledge, to have had RuJu and an IDU partner, and to have used a condom at last sex and shared needles and rinse water at last heroin use. Conclusion: Prevalence rates of HIV, HCV, and RuJu are high among IDUs seen at Taiwan drug detention centers. The results show that RuJu is highly associated with HIV seropositivity. Practitioners who seek to prevent HIV in male IDUs should be aware of the RuJu culture. More research on the role of RuJu in HIV infection is suggested.
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