Prevention and treatment of injection drug use remains a public health concern. We used data from the 2005 Centers for Disease Control and prevention National HIV Behavioral Surveillance system to assess substance abuse treatment utilization, risk behaviors, and recruitment processes in a respondent driven sample of suburban injectors. Twelve service utilization and injection risk variables were analyzed using latent class analysis. Three latent classes were identified: low use, low risk; low use, high risk; and high use, moderate/high risk. In multivariate analysis, annual income <$15,000 (adjusted odds ratio (aOR) = 8.19 [95 % confidence interval (CI), 3.83-17.51]) and self-reported hepatitis C virus infection (aOR = 4.32, 95 % CI (1.84-10.17)) were significantly associated with class membership. Homophily, a measure of preferential recruitment showed that injectors with recent treatment utilization appear a more cohesive group than out-of-treatment injectors. Preferentially reaching injection drug users with high risk behaviors and no recent drug treatment history via respondent driven sampling will require future research.
According to National HIV Behavioral Surveillance system data, human immunodeficiency virus (HIV) testing increased among gay, bisexual, and other men who have sex with men from 2008 to 2011 in cities funded by the Centers for Disease Control and Prevention's Expanded Testing Initiative, suggesting that focused HIV testing initiatives might have positive effects.
Purpose
Investigate whether characteristics of geographic areas are associated with condomless sex and injection-related risk behavior among racial/ethnic groups of people who inject drugs (PWID) in the United States.
Methods
PWID were recruited from 19 metropolitan statistical areas (MSAs) for 2009 National HIV Behavioral Surveillance. Administrative data described ZIP codes, counties, and MSAs where PWID lived. Multilevel models, stratified by racial/ethnic group, were used to assess relationships of place-based characteristics to condomless sex and injection-related risk behavior (sharing injection equipment).
Results
Among black PWID, living in the South (vs. Northeast) was associated with injection-related risk behavior [Adjusted Odds Ratio (AOR)=2.24, 95% Confidence Interval (CI)=1.37,4.34;p-value=0.011] and living in counties with higher percentages of unaffordable rental housing was associated with condomless sex [AOR=1.02, 95% CI=1.00,1.04; p-value=0.046]. Among white PWID, living in ZIP codes with greater access to drug treatment was negatively associated with condomless sex [AOR=0.93, 95% CI=0.88,1.00;p-value=0.038).
Discussion
Policies that increase access to affordable housing and drug treatment may make environments more conducive to safe sexual behaviors among black and white PWID. Future research designed to longitudinally explore the association between residence in the south and injection-related risk behavior might identify specific place-based features that sustain patterns of injection-related risk behavior.
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