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While risk behaviors related to illicit drug use are commonly studied among people who inject drugs (PWID), the role of alcohol use has received substantially less attention in this population. We explored whether drug and sexual risk behaviors as well as experiences of violence were associated with hazardous alcohol use in a cohort of PWID.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Analyses were conducted using observational data from a prospective cohort of community\u2010recruited HIV\u2010negative PWID in Vancouver, Canada. We used the U.S. National Institute on Alcohol Abuse and Alcoholism definition of hazardous alcohol use (i.e., &gt;14\u00a0drinks\/wk or &gt;4 drinks on 1 occasion for men, and &gt;7\u00a0drinks\/wk or &gt;3 drinks on 1 occasion for women). We used multivariable generalized estimating equations (GEE) to identify the factors associated with hazardous alcohol use.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Between 2006 and 2012, 1,114 HIV\u2010negative individuals were recruited, and 186 (16.7%) reported hazardous alcohol use in the previous 6\u00a0months at baseline. In multivariable GEE analyses, having multiple sex partners (adjusted odds ratio [AOR]\u00a0=\u00a01.25), history of sexually transmitted infection (AOR\u00a0=\u00a01.50), experiencing violence (AOR\u00a0=\u00a01.36), and incarceration (AOR\u00a0=\u00a01.29) were each independently associated with hazardous alcohol use. Caucasian ethnicity (AOR\u00a0=\u00a00.56), \u2265 daily heroin injection (AOR\u00a0=\u00a00.81), and engagement in addiction treatment (AOR\u00a0=\u00a00.84) were negatively associated with hazardous alcohol use (all<jats:italic>p\u00a0<\/jats:italic>&lt;<jats:italic>\u00a0<\/jats:italic>0.05).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>A considerable proportion of PWID reported hazardous alcohol use, which was independently associated with reporting sexual, but not drug\u2010related, HIV risk behaviors and experiencing recent violence. Findings suggest a need to integrate regular screening and evidence\u2010based alcohol interventions into treatment efforts for PWID.<\/jats:p><\/jats:sec>","DOI":"10.1111\/acer.13216","type":"journal-article","created":{"date-parts":[[2016,9,17]],"date-time":"2016-09-17T08:29:03Z","timestamp":1474100943000},"page":"2394-2400","source":"Crossref","is-referenced-by-count":14,"title":["Hazardous Alcohol Use Associated with Increased Sexual Risk Behaviors Among People Who Inject Drugs"],"prefix":"10.1111","volume":"40","author":[{"given":"Nadia","family":"Fairbairn","sequence":"first","affiliation":[{"name":"Urban Health Research Initiative British Columbia Centre for Excellence in HIV\/AIDS St. Paul's Hospital Vancouver BC Canada"},{"name":"Department of Medicine University of British Columbia Vancouver BC Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kanna","family":"Hayashi","sequence":"additional","affiliation":[{"name":"Urban Health Research Initiative 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