1
|
Zang X, Walley AY, Chatterjee A, Kimmel SD, Morgan JR, Murphy SM, Linas BP, Nolen S, Reilly B, Urquhart C, Schackman BR, Marshall BDL. Changes to opioid overdose deaths and community naloxone access among Black, Hispanic and White people from 2016 to 2021 with the onset of the COVID-19 pandemic: An interrupted time-series analysis in Massachusetts, USA. Addiction 2023; 118:2413-2423. [PMID: 37640687 PMCID: PMC10986189 DOI: 10.1111/add.16324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 07/07/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND AND AIMS The onset of the coronavirus disease 2019 (COVID-19) pandemic was associated with a surge in opioid overdose deaths in Massachusetts, particularly affecting racial and ethnic minority communities. We aimed to compare the impact of the pandemic on opioid overdose fatalities and naloxone distribution from community-based programs across racial and ethnic groups in Massachusetts. DESIGN Interrupted time-series. SETTING AND CASES Opioid overdose deaths (OODs) among non-Hispanic White, non-Hispanic Black, Hispanic and non-Hispanic other race people in Massachusetts, USA (January 2016 to June 2021). MEASUREMENTS Rate of OODs per 100 000 people, rate of naloxone kits distributed per 100 000 people and ratio of naloxone kits per opioid overdose death as a measure of naloxone availability. We applied five imputation strategies using complete data in different periods to account for missingness of race and ethnicity for naloxone data. FINDINGS Before COVID-19 (January 2016 to February 2020), the rate of OODs declined among non-Hispanic White people [0.2% monthly reduction (95% confidence interval = 0.0-0.4%)], yet was relatively constant among all other population groups. The rate of naloxone kits increased across all groups (0.8-1.2% monthly increase) and the ratio of naloxone kits per OOD death among non-Hispanic White was 1.1% (0.8-1.4%) and among Hispanic people was 1.0% (0.2-1.8%). After the onset of the pandemic (March 2020+), non-Hispanic Black people experienced an immediate increase in the rate of OODs [63.6% (16.4-130%)], whereas rates among other groups remained similar. Trends in naloxone rescue kit distribution did not substantively change among any groups, and the ratio of naloxone kits per OOD death for non-Hispanic Black people did not compensate for the surge in OODs deaths in this group. CONCLUSIONS With the onset of the COVID-19 pandemic, there was a surge in opioid overdose deaths among non-Hispanic Black people in Massachusetts, USA with no compensatory increase in naloxone rescue kit distribution. For non-Hispanic White and Hispanic people, opioid overdose deaths remained stable and naloxone kit distribution continued to increase.
Collapse
Affiliation(s)
- Xiao Zang
- Department of Epidemiology, School of Public Health, Brown University, Providence, RI, USA
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Alexander Y Walley
- Department of Medicine, Section of General Internal Medicine, Boston Medical Center and Boston University School of Medicine, Boston, MA, USA
| | - Avik Chatterjee
- Department of Medicine, Section of General Internal Medicine, Boston Medical Center and Boston University School of Medicine, Boston, MA, USA
| | - Simeon D Kimmel
- Department of Medicine, Section of General Internal Medicine, Boston Medical Center and Boston University School of Medicine, Boston, MA, USA
- Section of Infectious Diseases, Boston Medical Center, Boston, MA, USA
| | - Jake R Morgan
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA, USA
| | - Sean M Murphy
- Department of Population Health Sciences, Weill Cornell Medical College, New York City, NY, USA
| | - Benjamin P Linas
- Section of Infectious Diseases, Boston Medical Center, Boston, MA, USA
- Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Shayla Nolen
- Department of Epidemiology, School of Public Health, Brown University, Providence, RI, USA
| | - Brittni Reilly
- Massachusetts Department of Public Health, Boston, MA, USA
| | | | - Bruce R Schackman
- Department of Population Health Sciences, Weill Cornell Medical College, New York City, NY, USA
| | - Brandon D L Marshall
- Department of Epidemiology, School of Public Health, Brown University, Providence, RI, USA
| |
Collapse
|
2
|
Boodram B, Mackesy-Amiti ME, Khanna A, Brickman B, Dahari H, Ozik J. People who inject drugs in metropolitan Chicago: A meta-analysis of data from 1997-2017 to inform interventions and computational modeling toward hepatitis C microelimination. PLoS One 2022; 17:e0248850. [PMID: 35020725 PMCID: PMC8754317 DOI: 10.1371/journal.pone.0248850] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 12/13/2021] [Indexed: 02/03/2023] Open
Abstract
Progress toward hepatitis C virus (HCV) elimination in the United States is not on track to meet targets set by the World Health Organization, as the opioid crisis continues to drive both injection drug use and increasing HCV incidence. A pragmatic approach to achieving this is using a microelimination approach of focusing on high-risk populations such as people who inject drugs (PWID). Computational models are useful in understanding the complex interplay of individual, social, and structural level factors that might alter HCV incidence, prevalence, transmission, and treatment uptake to achieve HCV microelimination. However, these models need to be informed with realistic sociodemographic, risk behavior and network estimates on PWID. We conducted a meta-analysis of research studies spanning 20 years of research and interventions with PWID in metropolitan Chicago to produce parameters for a synthetic population for realistic computational models (e.g., agent-based models). We then fit an exponential random graph model (ERGM) using the network estimates from the meta-analysis in order to develop the network component of the synthetic population.
Collapse
Affiliation(s)
- Basmattee Boodram
- Division of Community Health Sciences, School of Public Health, University of Illinois at Chicago, Chicago, Illinois, United States of America
| | - Mary Ellen Mackesy-Amiti
- Division of Community Health Sciences, School of Public Health, University of Illinois at Chicago, Chicago, Illinois, United States of America,* E-mail:
| | - Aditya Khanna
- Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, Rhode Island, United States of America
| | - Bryan Brickman
- Department of Medicine, Chicago Center for HIV Elimination, University of Chicago, Chicago, Illinois, United States of America
| | - Harel Dahari
- Division of Hepatology, Department of Medicine, Loyola University Medical Center, Maywood, Illinois, United States of America
| | - Jonathan Ozik
- Decision and Infrastructure Sciences Division, Argonne National Laboratory, Lemont, Illinois, United States of America
| |
Collapse
|
3
|
Rudolph AE, Upton E, Young AM, Havens JR. Social network predictors of recent and sustained injection drug use cessation: findings from a longitudinal cohort study. Addiction 2021; 116:856-864. [PMID: 32812273 PMCID: PMC7889767 DOI: 10.1111/add.15218] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 03/16/2020] [Accepted: 08/03/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND AIMS The US opioid crisis has led to increases in overdose fatalities and the incidence of HIV, hepatitis C and other infections. This analysis examines social network predictors of recent (self-report injection followed by non-injection) and sustained (self-report non-injection at two consecutive visits among those who previously injected) injection cessation in Appalachian Kentucky. DESIGN Data were collected through bi-annual longitudinal assessments for Social Networks among Appalachian People (SNAP; 2008-17). Using logistic regression with generalized estimating equations that clustered on individuals, we regressed non-injection status on the number of social network members who (a) did not inject and (b) recently stopped injecting and tested for interactions between each social network exposure and prior non-injection status. Social network exposures were self-reported. SETTING Rural eastern Kentucky, USA. PARTICIPANTS Participants entered the analysis only after reporting recent injection and had to have had at least two consecutive study visits (n = 326). MEASUREMENTS Interviewer-administered surveys collected individual-level socio-demographics, recent (past 6 months) drug use behaviors and the names of recent social support, sex and drug-use partners. FINDINGS After adjusting for confounders, the number of non-injecting social network members was positively associated with recent/sustained injection cessation (adjusted odds ratio = 1.27; 95% confidence interval = 1.13-1.42) and having more social network members was associated with reduced odds of recent/sustained injection cessation. The number of previously injecting social network members who had recently stopped injecting was not statistically significantly associated with injection cessation. Neither of the interactions we tested for was statistically significant, suggesting that the relationships may be similar for those who recently stopped injecting versus had not injected for at least 1 year. CONCLUSIONS For each additional network member who did not inject drugs, there was an increased odds of recent and sustained injection cessation among people with a history of injection drug use in Appalachian Kentucky.
Collapse
Affiliation(s)
- Abby E. Rudolph
- Department of Epidemiology and Biostatistics, Temple University College of Public Health, Philadelphia, PA, USA
| | - Elizabeth Upton
- Department of Mathematics and Statistics, Williams College, Williamstown, MA, USA
| | - April M. Young
- Department of Epidemiology, University of Kentucky College of Public Health, Lexington, KY, USA
- Center on Drug and Alcohol Research, Department of Behavioral Science, University of Kentucky, College of Medicine, Lexington, KY, USA
- Center for Health Equity Transformation, University of Kentucky, Lexington, KY, USA
| | - Jennifer R. Havens
- Center on Drug and Alcohol Research, Department of Behavioral Science, University of Kentucky, College of Medicine, Lexington, KY, USA
| |
Collapse
|
4
|
HCV incidence is associated with injecting partner age and HCV serostatus mixing in young adults who inject drugs in San Francisco. PLoS One 2019; 14:e0226166. [PMID: 31821365 PMCID: PMC6903751 DOI: 10.1371/journal.pone.0226166] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 11/20/2019] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND HCV incidence is increasing in the US, notably among younger people who inject drugs (PWID). In a cohort of young adult (age<30 years) PWID in San Francisco we examined whether 'injecting partner mixing' factors, i.e. age of partner and knowledge of their HCV serostatus, were associated with HCV transmission. METHODS In 448 susceptible PWID studied prospectively. All participants were asked to report characteristics and behaviors they engaged in with up to 3 injecting partners defined as "people whom you injected the most with" in the past month". These partnerships did not specify that drugs or injecting equipment was shared. HCV incidence was estimated by age of up to 3 injecting partners, categorized as: (i) all <30; (ii) mixed-age (<&≥30); and (iii) all ≥30 years and perceived knowledge of the HCV status of participants' injecting partners' HCV status. Interaction was evaluated between partnership age categories and perceived HCV status of partners. RESULTS Between 2006-2018, overall HCV incidence (/100 person years observation [pyo]) was 19.4 (95% CI: 16.4, 22.9). Incidence was highest in those with mixed-age partnerships: 28.5 (95% CI: 21.8, 37.1) and those whose partners were all <30 (23.9; 95% CI: 18.8, 30.4), and lowest if partners were ≥30 (7.5; 95% CI: 4.8, 11.8). In a multivariable analyses adjusting for age, sex (of index), injection frequency, and injection partnership 'monogamy', we found evidence for an interaction: the highest HCV incidence was seen in PWID whose partners were all <30 and who knew at least one of their partners was HCV-positive (58.9, 95% CI: 43.3, 80.0; p<0.01). CONCLUSIONS Younger injectors are more likely to acquire HCV from their similarly-aged peers, than older injecting partners. Protective seroadaptive behavior may contribute to reduce incidence. These findings can inform new HCV prevention approaches for young PWID needed to curb the HCV epidemic.
Collapse
|
5
|
Morris MD, Andrew E, Tan JY, Maher L, Hoff C, Darbes L, Page K. Injecting-related trust, cooperation, intimacy, and power as key factors influencing risk perception among drug injecting partnerships. PLoS One 2019; 14:e0217811. [PMID: 31150518 PMCID: PMC6544289 DOI: 10.1371/journal.pone.0217811] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Accepted: 05/21/2019] [Indexed: 11/18/2022] Open
Abstract
Sharing of injection drug use paraphernalia is a dyadic process linked to the transmission of HIV and hepatitis C virus (HCV). Despite this, limited research exists identifying specific dyadic interpersonal factors driving injecting partners' engagement in needle/syringe and ancillary injecting equipment sharing among young adults. Using semi-structured in-depth interview data collected between 2014 and 2015 from twenty-seven people who inject drugs (PWID), we applied an inductive approach to identify key injection drug-related interpersonal factors and developed a conceptual model integrating the findings based on interdependence theory. Interactions between injecting partners resulted in varying levels of injecting-related trust, cooperation, intimacy, and power. These factors interacted to collectively influence the type and level of risk perceived and enacted by injecting partners. The relationship between these injecting-related interpersonal factors, on the one hand, and risk perception on the other was dynamic and fluctuated between actions that protect the self (person-centered) and those that protect the partnership (partnership-centered). These findings indicate that the interpersonal context exerts substantial influence that shapes risk perception in all types of injecting partnerships. Partnership-focused prevention strategies should consider the dynamics of trust, cooperation, intimacy, and power, in characterizing dyadic risk perceptions and in understanding risky injecting practices among PWID.
Collapse
Affiliation(s)
- Meghan D. Morris
- Department of Epidemiology & Biostatistics, University of California, San Francisco, CA, United States of America
| | - Erin Andrew
- Nursing Science, University of Pennsylvania, Philadelphia, PA, United States of America
| | - Judy Y. Tan
- Center for AIDS Prevention Science, University of California, San Francisco, San Francisco, CA, United States of America
| | - Lisa Maher
- Kirby Institute, UNSW Sydney, Sydney, Australia
| | - Colleen Hoff
- Center for Research and Education on Gender and Sexuality, San Francisco State University, San Francisco, CA, United States of America
| | - Lynae Darbes
- Center for Sexuality and Health Disparities, Department of Health Behavior & Biological Sciences, School of Nursing, University of Michigan, Ann Arbor, MI, United States of America
| | - Kimberly Page
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM, United States of America
| |
Collapse
|
6
|
Morris MD, Neilands TB, Andrew E, Maher L, Page KA, Hahn JA. Development and validation of a novel scale for measuring interpersonal factors underlying injection drug using behaviours among injecting partnerships. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2017; 48:54-62. [PMID: 28804051 DOI: 10.1016/j.drugpo.2017.05.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2016] [Revised: 04/25/2017] [Accepted: 05/05/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND People who inject drugs with sexual partners or close friends have high rates of syringe/ancillary equipment sharing and HIV and hepatitis C virus (HCV) infection. Although evidence suggests that interpersonal factors underlie these higher risk profiles, there is no quantitative measure of how interpersonal factors operate within injecting relationships. We aimed to develop and validate a quantitative scale to assess levels of injecting drug-related interpersonal factors associated with risky injecting behaviours within injecting partnerships. METHODS We conducted qualitative interviews with 45 people who inject drugs (PWID) who reported having injecting partners to inform item development, and tested these items in a quantitative study of 140 PWID from San Francisco, USA, to assess internal reliability (Cronbach's alpha) and validity (convergent, and discriminant validity). RESULTS With results from the qualitative interview data, we developed the Interpersonal Dynamics in Injecting Partnerships (IDIP) scale with 54 final items for 5 subscales of injecting-related interpersonal factors. Exploratory factor analysis revealed 5 factors ("trust", "power", "risk perception", "intimacy", and "cooperation") with eigenvalues of 14.32, 6.18, 3.55, 2.46, and 2.14, explaining 57% of the variance, and indicating good internal reliability (alpha: 0.92-0.68). Strong convergent validity was observed in bivariate logistic regression models where higher levels of trust, intimacy, and cooperation within partnerships were positively associated with partners sharing needles and injecting equipment, whereas higher levels of power and risk perception were negatively associated with partners sharing needles and injecting equipment. CONCLUSIONS These findings offer strong evidence that the IDIP scale provides a psychometrically sound measure of injecting drug-related interpersonal dynamics. This measurement tool has the potential to facilitate additional investigations into the individual and collective impact of trust, intimacy, power, cooperation, and risk perception on injection drug using behaviours and engagement in HIV and HCV testing and treatment among PWID in a variety of settings.
Collapse
Affiliation(s)
- Meghan D Morris
- Department of Epidemiology & Biostatistics, University of California San Francisco (UCSF), San Francisco, CA, USA.
| | - Torsten B Neilands
- Center for AIDS Prevention Studies, Department of Medicine, UCSF, San Francisco, CA USA
| | - Erin Andrew
- Department of Epidemiology & Biostatistics, University of California San Francisco (UCSF), San Francisco, CA, USA
| | - Lisa Maher
- Kirby Institute, University of New South Wales, Sydney, Australia
| | - Kimberly A Page
- Department of Internal Medicine, University of New Mexico Health Center, Albuquerque, NM, USA
| | - Judith A Hahn
- Department of Epidemiology & Biostatistics, University of California San Francisco (UCSF), San Francisco, CA, USA; Department of Medicine, UCSF, San Francisco, CA, USA
| |
Collapse
|
7
|
Rowe C, Santos GM, Raymond HF, Coffin PO. Social mixing and correlates of injection frequency among opioid use partnerships. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2017; 41:80-88. [PMID: 28113118 DOI: 10.1016/j.drugpo.2016.11.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 11/17/2016] [Accepted: 11/18/2016] [Indexed: 12/22/2022]
Abstract
BACKGROUND As resources are deployed to address the opioid overdose epidemic in the USA, it is essential that we understand the correlates of more frequent opioid injections-which has been associated not only with HIV and HCV transmission, but also with overdose risk-to inform the development and targeting of effective intervention strategies like overdose prevention and naloxone distribution programs. However, no studies have explored how characteristics of opioid use partnerships may be associated within injection frequency with opioid partnerships. METHODS Using baseline data from a trial of a behavioural intervention to reduce overdose among opioid users in San Francisco, CA, we calculated assortativity among opioid use partnerships by race, gender, participant-reported HIV- and HCV-status, and opioids used using Newman's assortativity coefficient (NC). Multivariable generalized estimating equations linear regression was used to examine associations between individual- and partnership-level characteristics and injection frequency within opioid use partnerships. RESULTS Opioid use partnerships (n=134) reported by study participants (n=55) were assortative by race (NC=0.42, 95%CI=0.33-0.50) and participant-reported HCV-status (NC=0.42, 95%CI=0.31-0.52). In multivariable analyses, there were more monthly injections among sexual/romantic partnerships (β=114.4, 95%CI=60.2-168.7, p<0.001), racially concordant partnerships reported by white study participants (β=71.4, 95%CI=0.3-142.5, p=0.049), racially discordant partnerships reported by African American study participants (β=105.7, 95%CI=1.0-210.5, p=0.048), and partnerships in which either member had witnessed the other experience an overdose (β=81.8, 95%CI=38.9-124.6, p<0.001). CONCLUSION Social segregation by race and HCV-status should potentially be considered in efforts to reach networks of opioid users. Due to higher injection frequency and greater likelihood of witnessing their partners experience an overdose, individuals in sexual/romantic opioid use partnerships, white individuals in racially homogenous partnerships, and African American individuals in heterogeneous partnerships may warrant focused attention as part of peer- and network-based overdose prevention efforts, as well as broader HIV/HCV prevention strategies. Developing and targeting overdose prevention education programs that provide information on risk factors and ways to identify overdose, as well as effective responses, including naloxone use and rescue breathing, for more frequently injecting networks may help reduce opioid morbidity and mortality in these most at risk groups.
Collapse
Affiliation(s)
- Christopher Rowe
- San Francisco Department of Public Health, 25 Van Ness Avenue, Suite 500, San Francisco, CA 94102, USA.
| | - Glenn-Milo Santos
- San Francisco Department of Public Health, 25 Van Ness Avenue, Suite 500, San Francisco, CA 94102, USA; University of California, San Francisco, 500 Parnassus Avenue, San Francisco, CA 94143, USA
| | - Henry F Raymond
- San Francisco Department of Public Health, 25 Van Ness Avenue, Suite 500, San Francisco, CA 94102, USA; University of California, San Francisco, 500 Parnassus Avenue, San Francisco, CA 94143, USA
| | - Phillip O Coffin
- San Francisco Department of Public Health, 25 Van Ness Avenue, Suite 500, San Francisco, CA 94102, USA; University of California, San Francisco, 500 Parnassus Avenue, San Francisco, CA 94143, USA
| |
Collapse
|
8
|
McNair LD, Prather CM. African American Women and AIDS: Factors Influencing Risk and Reaction to HIV Disease. JOURNAL OF BLACK PSYCHOLOGY 2016. [DOI: 10.1177/0095798403261414] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
African American women represent the fastest growing group of individuals infected with HIV in the United States. Social and contextual influences on HIV risk vulnerability in this group are discussed, with particular emphasis on risk behaviors related to heterosexual contact and injection drug use. Social factors associated with the sex-ratio imbalance and low rates of condom use in the African American community are addressed, as are contextual influences related to environmental stress and psychosocial issues. We describe interventions that directly address both social and contextual influences on African American women’s risk behaviors. Finally, mental health and psychological concerns are presented as a framework for better understanding women’s reactions to HIV/AIDS and for developing comprehensive programs and services that better meet their needs.
Collapse
|
9
|
Janulis P. The micro-social risk environment for injection drug use: An event specific analysis of dyadic, situational, and network predictors of injection risk behavior. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2016; 27:56-64. [PMID: 26530884 PMCID: PMC4715965 DOI: 10.1016/j.drugpo.2015.09.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Revised: 09/07/2015] [Accepted: 09/15/2015] [Indexed: 11/18/2022]
Abstract
BACKGROUND This study explores the risk environment for drug use by examining injection risk behavior during specific injection episodes. By leveraging multiple observations of injection episodes of participants, the study attempts to move beyond global assessment of environmental variables to simultaneously model within (i.e., event level) as well as between (i.e., individual level) predictors of injection risk. Furthermore, gender is also explored as a potential moderator of the relationship between the association of specific partner characteristics (e.g., having an injection partner who is also a sexual partner) and injection risk behavior. METHODS Data is used from the Sexual Acquisition of Transmission of HIV Cooperative Agreement Study (SATHCAP). Multilevel structural equation modeling is utilized to predict within and between variations in underlying injection risk behavior as measured using four indicators of injection risk. RESULTS Results indicated that a number of partner level characteristics (i.e., being emotionally close with the partner, sexual partnership, being a first time partner) and one social situational (i.e., the number of non-injectors present at the injection episode) characteristic predicted event level injection risk behavior. However, the impact of partner characteristics also appears to be moderated by gender of the participants. More specifically, sharing a sexual partnership with an injection partner was more strongly associated with injection risk among females as compared to males and females indicated higher levels of risk when injecting with other females while the partner's gender showed no significant association with risk for male injectors. CONCLUSION These results suggest that people who inject drug do report varying levels of risk during different injection episodes and this variation can be explained by partner and situational characteristics. Improved understanding of the social processes surrounding injection episodes is required to further refine harm reduction approaches.
Collapse
Affiliation(s)
- Patrick Janulis
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, 625 North Michigan Avenue, Suite 2700, Chicago, IL 60611, United States.
| |
Collapse
|
10
|
Transitions in latent classes of sexual risk behavior among young injection drug users following HIV prevention intervention. AIDS Behav 2014; 18:464-72. [PMID: 23975477 PMCID: PMC3932146 DOI: 10.1007/s10461-013-0601-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
We analyzed data from a large randomized HIV/HCV prevention intervention trial with young injection drug users (IDUs). Using categorical latent variable analysis, we identified distinct classes of sexual behavior for men and women. We conducted a latent transition analysis to test the effect of the intervention on transitions from higher to lower risk classes. Men who were in a high-risk class at baseline who received the intervention were 86 % more likely to be in a low-risk class at follow-up compared to those in the control group (p = 0.025). High-risk intervention participants were significantly more likely to transition to the class characterized by unprotected sex with a main partner only, while low-risk intervention participants were significantly less likely to transition to that class. No intervention effect was detected on the sexual risk behavior of women, or of men who at baseline were having unprotected sex with a main partner only.
Collapse
|
11
|
Simmons J, Rajan S, McMahon JM. Retrospective accounts of injection initiation in intimate partnerships. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2012; 23:303-11. [PMID: 22398215 DOI: 10.1016/j.drugpo.2012.01.009] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2011] [Revised: 11/24/2011] [Accepted: 01/24/2012] [Indexed: 11/29/2022]
Abstract
BACKGROUND The influence of family members, peers and sexual partners on initiation to injection drug use is well established. Furthermore, research on gender differences in injection initiation has recognized the increased vulnerability of women, in particular, to injection-related health risks, and the gendered nature of the injection initiation experience. Yet more research is needed on the interpersonal and structural dynamics that shape injection initiation within intimate partnerships. METHODS This paper draws on narrative data from semi-structured ethnographic interviews with 25, relatively stable, drug-using couples from two New York City neighbourhoods. The study was conducted between 2007 and 2009. Our analyses focus on retrospective accounts of injection initiation from IDUs who were initiated to injection (or initiated their partners) in current or former intimate partnerships. In particular we analyse narratives of injection initiation events where both partners participated as initiates or initiators. RESULTS Transition to injection within intimate partnerships was common, especially for women, and occurred in specific contexts. Structural and interpersonal dynamics, including the ubiquity of drugs in poor communities and the gendered nature of drug acquisition and use strategies, as well as the problem of increased drug tolerance, situational impediments to drug access, and the perceived cost-benefit of injecting, all influenced the process of initiation to injection drug use within couples. The data also suggest that, even when risks associated with injection initiation were understood, both pragmatic and emotional considerations within relationships tended to offset concerns about potential dangers. CONCLUSION The findings suggest the need for a broad range of interventions (including couples-focussed interventions) to minimize rates of injection initiation within intimate partnerships.
Collapse
Affiliation(s)
- Janie Simmons
- National Development and Research Institutes, New York, NY, USA.
| | | | | |
Collapse
|
12
|
Dias PT, Hahn JA, Delwart E, Edlin B, Martin J, Lum P, Evans J, Kral A, Deeks S, Busch MP, Page K. Temporal changes in HCV genotype distribution in three different high risk populations in San Francisco, California. BMC Infect Dis 2011; 11:208. [PMID: 21810243 PMCID: PMC3199778 DOI: 10.1186/1471-2334-11-208] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2011] [Accepted: 08/02/2011] [Indexed: 12/19/2022] Open
Abstract
Background Hepatitis C virus (HCV) genotype (GT) has become an important measure in the diagnosis and monitoring of HCV infection treatment. In the United States (U.S.) HCV GT 1 is reported as the most common infecting GT among chronically infected patients. In Europe, however, recent studies have suggested that the epidemiology of HCV GTs is changing. Methods We assessed HCV GT distribution in 460 patients from three HCV-infected high risk populations in San Francisco, and examined patterns by birth cohort to assess temporal trends. Multiple logistic regression was used to assess factors independently associated with GT 1 infection compared to other GTs (2, 3, and 4). Results Overall, GT 1 was predominant (72.4%), however younger injection drug users (IDU) had a lower proportion of GT 1 infections (54.7%) compared to older IDU and HIV-infected patients (80.5% and 76.6%, respectively). Analysis by birth cohort showed increasing proportions of non-GT 1 infections associated with year of birth: birth before 1970 was independently associated with higher adjusted odds of GT 1: AOR 2.03 (95% CI: 1.23, 3.34). African-Americans as compared to whites also had higher adjusted odds of GT 1 infection (AOR: 3.37; 95% CI: 1.89, 5.99). Conclusions Although, HCV GT 1 remains the most prevalent GT, especially among older groups, changes in GT distribution could have significant implications for how HCV might be controlled on a population level and treated on an individual level.
Collapse
Affiliation(s)
- Paulo Telles Dias
- Núcleo de Estudos e Pesquisas em Atenção ao Uso de Drogas (NEPAD)-Universidade do Estado do Rio de Janeiro (State University of Rio de Janeiro), 20940-200 Rio de Janeiro, RJ, Brasil
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
13
|
Kerr T, Fairbairn N, Hayashi K, Suwannawong P, Kaplan K, Zhang R, Wood E. Difficulty accessing syringes and syringe borrowing among injection drug users in Bangkok, Thailand. Drug Alcohol Rev 2010; 29:157-61. [PMID: 20447223 DOI: 10.1111/j.1465-3362.2009.00093.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
INTRODUCTION AND AIMS Thailand's longstanding HIV epidemic among injection drug users (IDU) has been attributed, in part, to the Thai government's unwillingness to implement evidence-based HIV prevention interventions. This study was undertaken to examine risk factors for syringe borrowing among a community-recruited sample of Thai IDU. DESIGN AND METHODS We examined the prevalence of syringe borrowing among 238 IDU participating in the Mit Sampan Community Research Project, Bangkok. Multivariate logistic regression was used to identify independent predictors of syringe borrowing in the past 6 months. RESULTS A total of 238 IDU participated in this study; 66 (26.2%) were female, and the median age was 36.5 years. In total, 72 (30.3%) participants reported borrowing a used syringe in the past 6 months, with 47 (65.3%) of these individuals reporting multiple borrowing events. In multivariate analyses, syringe borrowing was positively associated with difficulty accessing syringes [adjusted odds ratio (AOR) = 2.46; 95% confidence interval (CI): 1.08-5.60] and injecting with other people on a frequent basis (AOR = 3.17; 95% CI: 1.73-5.83). Primary reasons offered for experiencing difficulty accessing syringes included being too far from syringe outlets (34.1%), pharmacies being closed (13.6%) and being refused syringes at pharmacies (9.1%). DISCUSSION AND CONCLUSIONS We observed an alarmingly high rate of syringe borrowing among a community-recruited sample of Thai IDU. Various lines of evidence indicate that poor access to sterile syringes is driving the high rate of syringe borrowing observed in this study. Immediate action should be taken to increase access to sterile syringes among Thai IDU.
Collapse
Affiliation(s)
- Thomas Kerr
- Urban Health Research Initiative, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC, Canada.
| | | | | | | | | | | | | |
Collapse
|
14
|
Frye V, Koblin B, Chin J, Beard J, Blaney S, Halkitis P, Vlahov D, Galea S. Neighborhood-level correlates of consistent condom use among men who have sex with men: a multi-level analysis. AIDS Behav 2010; 14:974-85. [PMID: 18712593 DOI: 10.1007/s10461-008-9438-5] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2008] [Accepted: 07/16/2008] [Indexed: 11/30/2022]
Abstract
There is growing evidence that the neighborhood environment influences sexual behavior and related outcomes, but little work has focused specifically on men who have sex with men (MSM). Using interview data from a probability sample of 385 young MSM living in New York City, recruited at public venues in 1999 and 2000 as part of the Young Men's Survey-New York City, and data on neighborhood characteristics obtained from the U.S. Census 2000, we conducted multi-level analyses of the associations between neighborhood-level characteristics and consistent condom use during anal intercourse, while controlling for individual-level sociodemographic and other factors. After adjusting for individual-level factors, neighborhood-level gay presence remained significantly and positively associated with consistent condom use during anal intercourse. This finding suggests that neighborhoods with a significant gay presence may have norms that act to discourage high risk sexual activity.
Collapse
Affiliation(s)
- Victoria Frye
- Urban Public Health Program, Hunter College, City University of New York, New York, USA.
| | | | | | | | | | | | | | | |
Collapse
|
15
|
Hahn JA, Evans JL, Davidson PJ, Lum PJ, Page K. Hepatitis C virus risk behaviors within the partnerships of young injecting drug users. Addiction 2010; 105:1254-64. [PMID: 20491725 PMCID: PMC2907461 DOI: 10.1111/j.1360-0443.2010.02949.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
AIMS Young injection drug users (IDU) are at high risk for hepatitis C virus (HCV). We sought to determine whether perceiving one's injecting partner to be HCV positive was associated with decreased odds of engaging in receptive needle/syringe sharing (RNS) or ancillary equipment sharing (AES) with that partner. DESIGN Cross sectional study. SETTING 2003 to 2007 in San Francisco. PARTICIPANTS 212 young (under age 30) IDU who were HCV antibody negative reported on 492 injecting partnerships. MEASUREMENTS Self-reported RNS and AES within injecting partnerships. FINDINGS RNS and AES (in the absence of RNS) occurred in 23% and 64% of injecting partnerships in the prior month. The odds of engaging in RNS were significantly lower for relationships in which the participant reported that his/her partner was HCV positive (odds ratio [OR] 0.49; 95% confidence interval [CI] 0.25-0.95). This association was attenuated when adjusted for reusing one's own needle/syringe (adjusted OR 0.57; 95% CI 0.28-1.15). The odds of engaging in AES were lower for participants who did not know the HCV status of their partner, only among non-sexual partnerships (OR 0.47; 95% CI 0.29-0.76). CONCLUSIONS Because perceiving one's partner to be HCV positive was associated with decreased RNS, increased HCV testing and partner disclosure may be warranted. AES was common and was decreased only among non-sexual partnerships in which the HCV status of the partner was not known. This suggests that interventions to reduce AES in young IDU must be widespread.
Collapse
Affiliation(s)
- Judith A. Hahn
- Department of Medicine, University of California, San Francisco, San Francisco, CA 94143, USA.
| | - Jennifer L. Evans
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA 94143
| | - Peter J. Davidson
- School of Medicine, Division of Global Public Health, University of California, San Diego
| | - Paula J. Lum
- Department of Medicine, University of California, San Francisco, San Francisco, CA 94143, USA.
| | - Kimberly Page
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA 94143
| |
Collapse
|
16
|
WILKINS LOUISE, BISSELL PAUL, MEIER PETRAS. Risky injecting practices associated with snowballing: A qualitative study. Drug Alcohol Rev 2010; 29:256-62. [DOI: 10.1111/j.1465-3362.2009.00142.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
|
17
|
Beckerleg S. How ‘Cool’ is heroin injection at the Kenya coast. DRUGS-EDUCATION PREVENTION AND POLICY 2009. [DOI: 10.1080/0968763031000140192] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
18
|
Havens JR, Stoops WW, Leukefeld CG, Garrity TF, Carlson RG, Falck R, Wang J, Booth BM. Prescription opiate misuse among rural stimulant users in a multistate community-based study. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2009; 35:18-23. [PMID: 19152201 DOI: 10.1080/00952990802326298] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES The purpose of the current analysis was to examine the factors associated with prescription opiate misuse among stimulant users from rural counties in Arkansas, Kentucky, and Ohio (N = 714). METHODS Multiple logistic regression was utilized to determine the independent correlates of recent (prior 6 months) prescription opiate misuse. RESULTS More than half of participants (53.2%) reported prescription opiate misuse in the previous 6 months. Other drug use (heroin, cocaine, methamphetamine, and marijuana) and anxiety (Adjusted Odds Ratio: 2.04, 95% Confidence Interval: 1.60, 2.59) were independently associated with prescription opiate misuse. Chronic pain and other health indicators were not associated with prescription opiate misuse after adjustment for covariates. CONCLUSIONS Results indicate that illicit drug involvement and psychiatric symptoms may be driving the high rates of prescription opiate misuse among rural stimulant users. These findings have implications for the provision of treatment in resource-deprived rural areas.
Collapse
Affiliation(s)
- Jennifer R Havens
- Center on Drug and Alcohol Research, Department of Behavioral Science, University of Kentucky College of Medicine, Lexington, Kentucky, USA.
| | | | | | | | | | | | | | | |
Collapse
|
19
|
What you think you know can hurt you: perceptual biases about HIV risk in intimate relationships. AIDS Behav 2009; 13:246-57. [PMID: 18080101 DOI: 10.1007/s10461-007-9341-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2007] [Accepted: 11/26/2007] [Indexed: 10/22/2022]
Abstract
The use of heuristic biases and the false consensus effect can lead individuals to misperceive risk of HIV infection. The current paper presents the results of two studies which sought to examine whether individuals, (a) weigh risk relevant information accurately in their assessments of HIV risk, and (b) are susceptible to the false consensus effect in their assessments of actual intimate partner risk behaviors. The results of the first study support the hypothesis that individuals do not use objective risk information based on probability statistics in their assessments of HIV risk. In addition, the results of the second study find that female partners exhibit the false consensus effect regarding sexual risk behaviors, whereas male partners did not. Discussion centers on the role of perceptual biases in HIV risk behaviors among individuals in intimate relationships.
Collapse
|
20
|
De P, Cox J, Boivin JF, Platt RW, Jolly AM. The importance of social networks in their association to drug equipment sharing among injection drug users: a review. Addiction 2007; 102:1730-9. [PMID: 17935581 DOI: 10.1111/j.1360-0443.2007.01936.x] [Citation(s) in RCA: 137] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIM To examine the scientific evidence regarding the association between characteristics of social networks of injection drug users (IDUs) and the sharing of drug injection equipment. METHODS A search was performed on MEDLINE, EMBASE, BIOSIS, Current Contents, PsycINFO databases and other sources to identify published studies on social networks of IDUs. Papers were selected based on their examination of social network factors in relation to the sharing of syringes and drug preparation equipment (e.g. containers, filters, water). Additional relevant papers were found from the reference list of identified articles. RESULTS Network correlates of drug equipment sharing are multi-factorial and include structural factors (network size, density, position, turnover), compositional factors (network member characteristics, role and quality of relationships with members) and behavioural factors (injecting norms, patterns of drug use, severity of drug addiction). Factors appear to be related differentially to equipment sharing. CONCLUSIONS Social network characteristics are associated with drug injection risk behaviours and should be considered alongside personal risk behaviours in prevention programmes. Recommendations for future research into the social networks of IDUs are proposed.
Collapse
Affiliation(s)
- Prithwish De
- Department of Epidemiology and Biostatistics, McGill University, Montreal, Canada.
| | | | | | | | | |
Collapse
|
21
|
Kapadia F, Latka MH, Hudson SM, Golub ET, Campbell JV, Bailey S, Frye V, Garfein RS. Correlates of consistent condom use with main partners by partnership patterns among young adult male injection drug users from five US cities. Drug Alcohol Depend 2007; 91 Suppl 1:S56-63. [PMID: 17329041 DOI: 10.1016/j.drugalcdep.2007.01.004] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2006] [Revised: 01/10/2007] [Accepted: 01/11/2007] [Indexed: 11/23/2022]
Abstract
This paper examined correlates of consistent condom use with a main partner among heterosexual male injection drug users (IDUs). Using data from a multi-site sample of young IDUs, we identified 1770 sexually active men of whom 24% (429/1770) reported an exclusive main female sex partner and 49% (862/1770) reported both main and casual female sex partners. Consistent condom use with a main partner was low among men with an exclusive main partner and those with multiple partners (12% and 17%, respectively). In multivariate analysis, consistent condom use with a main partner across partnership patterns was directly associated with anticipating a positive response to requests for condom use and by partner support of condom use; consistent condom use was inversely associated with a main partner's pregnancy desires. Among men with an exclusive main partner, consistent condom use was also inversely associated with needle sharing with a main partner. Among men with multiple partners, consistent condom use with a main partner was inversely associated with injecting with a used needle and intimate partner violence. The low prevalence of consistent condom use with main female partners among heterosexually active male IDUs indicates an increased risk for HIV transmission between men and their primary sex partners. Interventions for heterosexual males that are geared toward increasing condom use in primary relationships are warranted.
Collapse
Affiliation(s)
- F Kapadia
- Center for Urban Epidemiologic Studies, New York Academy of Medicine, New York, NY 10029, USA.
| | | | | | | | | | | | | | | |
Collapse
|
22
|
Golub ET, Strathdee SA, Bailey SL, Hagan H, Latka MH, Hudson SM, Garfein RS. Distributive syringe sharing among young adult injection drug users in five U.S. cities. Drug Alcohol Depend 2007; 91 Suppl 1:S30-8. [PMID: 17398039 DOI: 10.1016/j.drugalcdep.2007.02.013] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2006] [Revised: 02/20/2007] [Accepted: 02/20/2007] [Indexed: 11/17/2022]
Abstract
Blood-borne pathogens such as human immunodeficiency virus (HIV) and hepatitis C virus (HCV) are transmitted most commonly among injection drug users (IDUs) through the sharing of needles and syringes. Distributive syringe sharing (DSS) (i.e., passing on a used needle/syringe to another IDU) poses the potential risk of transmitting HIV and viral hepatitis to others. We studied the prevalence and correlates of DSS among IDUs enrolled in a randomized behavioral intervention trial designed to reduce behaviors associated with HIV and HCV transmission in five U.S. cities. Among 3129 IDUs ages 15-30 years who completed the baseline visit, 1432 (45.8%) engaged in DSS during the 3 months prior to baseline. Significant correlates of DSS were perception that peer norms condone needle sharing, frequent injection, not obtaining most syringes from needle exchange programs or pharmacies, injecting most frequently in shooting galleries and with sex partners, low perceived risk of HIV from sharing syringes, increased anxiety, low self-esteem, and having unprotected sex. Restricting to only those IDUs who reported not injecting with previously used syringes, similar independent correlates of DSS were found. These findings suggest that interventions to reduce ongoing transmission of blood-borne infections should focus on altering peer norms among networks of young IDUs.
Collapse
Affiliation(s)
- Elizabeth T Golub
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe St., room E-7137, Baltimore, MD 21117, USA.
| | | | | | | | | | | | | |
Collapse
|
23
|
Bailey SL, Ouellet LJ, Mackesy-Amiti ME, Golub ET, Hagan H, Hudson SM, Latka MH, Gao W, Garfein RS. Perceived risk, peer influences, and injection partner type predict receptive syringe sharing among young adult injection drug users in five U.S. cities. Drug Alcohol Depend 2007; 91 Suppl 1:S18-29. [PMID: 17434267 DOI: 10.1016/j.drugalcdep.2007.02.014] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2006] [Revised: 02/14/2007] [Accepted: 02/14/2007] [Indexed: 11/18/2022]
Abstract
OBJECTIVES This study examined risk factors for receptive syringe sharing (RSS) during illicit drug injection by persons 15-30 years old in five U.S. cities. METHODS Participants were recruited through street outreach and respondent-driven referrals in Baltimore, Chicago, Los Angeles, New York, and Seattle between May 2002 and January 2004. Surveys of drug use, sexual behaviors, and correlates were administered through audio computer-assisted self-interviews at baseline and, for the subset of participants who enrolled in an HIV/HCV prevention intervention trial, at 3-months and 6-months post-baseline. The proportions of injections involving RSS at baseline and at follow-up were used as outcomes in multivariate models that adjusted for intervention effects. RESULTS At baseline, 54% of 3128 participants reported RSS in the past 3 months. RSS decreased to 21% at 6-months post-baseline for the combined trial arms. Participants were more likely to report RSS if they perceived that their peers were not against RSS and if they injected with sex partners. Lower levels of perceived risk of infection with HIV (baseline, p<.001) or HCV (follow-up, p<.001) through RSS were also significant predictors of greater RSS. CONCLUSIONS Perceived risks, peer influences, and type of injection partner were robust predictors of RSS. Perceived risks and peer influences are particularly amenable to intervention efforts that may prevent RSS in this age group.
Collapse
Affiliation(s)
- Susan L Bailey
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, IL, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
24
|
Shaw SY, Shah L, Jolly AM, Wylie JL. Determinants of injection drug user (IDU) syringe sharing: the relationship between availability of syringes and risk network member characteristics in Winnipeg, Canada. Addiction 2007; 102:1626-35. [PMID: 17854339 DOI: 10.1111/j.1360-0443.2007.01940.x] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIMS Despite the establishment of syringe exchange programmes, syringe-sharing behaviour remains common among some injection drug users (IDU). Previous studies have identified several individual- and social network-level variables associated with syringe sharing. We examine the extent to which each of these variables is related independently to this behaviour within a diverse study population. DESIGN, SETTING AND PARTICIPANTS A cross-sectional survey of 435 IDU conducted between December 2003 and September 2004 in Winnipeg, Canada. MEASUREMENTS Individual and social-network variables were obtained from a survey instrument administered through a personal interview. Syringe sharing was defined as receptive syringe sharing in the last 6 months. Logistic regression analysis with generalized estimating equations was used to determine simultaneously the role of individual-level and risk network member-level variables on the odds of syringe sharing. FINDINGS Individuals' relationship to a risk network member (sex partner, OR: 15.3 95% CI: 7.6-30.8; family member, OR: 3.4 95% CI: 1.3-9.0) and difficulty of access to syringes (OR: 3.6 95% CI: 1.3-9.9) were predictive of syringe sharing. Dyads who 'often' pooled resources to obtain drugs were at 4.9 times (95% CI: 2.1-11.6) the odds of syringe sharing, while those who 'sometimes' pooled resources were at 2.8 times (95% CI: 1.1-6.7) the odds, compared to those who 'never' pooled resources together. CONCLUSIONS Syringe sharing in this population depended on both the availability of clean syringes and social network relationships. Adopting interventions that take into account relationships and behaviours that shape social norms present in networks/dyads would be a necessary prevention strategy alongside the provision of clean syringes.
Collapse
Affiliation(s)
- Souradet Y Shaw
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | | | | |
Collapse
|
25
|
Backmund M. [Illegal drug users and risk factors for HIV and HCV infection]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2007; 50:471-5. [PMID: 17377722 DOI: 10.1007/s00103-007-0189-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Since the beginning of the HIV-epidemic, injection drug users (IDUs) have had a high risk of acquiring an infection with HIV. Chronic hepatitis C (HCV) is the most common infectious disease among IDUs. About 4 to 6 % of IDUs are HIV positive and more than 60 % are HCV positive. 90 % of HIV-positive IDUs are both HIV positive and HCV positive. Substitution treatment is the most effective prevention of HIV and HCV infection. Both HIV infection and chronic hepatitis C can be treated most successfully during substitution treatment.
Collapse
Affiliation(s)
- M Backmund
- Bereich Suchtmedizin, Klinikum Schwabing, München, BRD.
| |
Collapse
|
26
|
Fischer B, Rehm J, Patra J, Kalousek K, Haydon E, Tyndall M, El-Guebaly N. Crack across Canada: Comparing crack users and crack non-users in a Canadian multi-city cohort of illicit opioid users. Addiction 2006; 101:1760-70. [PMID: 17156175 DOI: 10.1111/j.1360-0443.2006.01614.x] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
AIMS To examine possible differences between crack users and crack non-users across Canada. DESIGN Cohort study of illicit opioid and other drug users in five cities across Canada. SETTING Vancouver, Edmonton, Toronto, Montreal and Quebec City, Canada. PARTICIPANTS Regular illicit opioid and other street drug users not in treatment at time of assessment. MEASUREMENTS Participants (n = 677) were assessed at baseline (2002) by way of an interviewer-administered questionnaire, a psychiatric diagnostic instrument (Composite International Diagnostic Interview), and salivary antibody tests for infectious disease. FINDINGS Approximately half the sample had used crack in the past 30 days, although prevalence rates differed strongly between study sites. When examined by discriminant analysis, crack users in the study population were more likely to have: no permanent housing, have illegal and sex work income, indicate physical health problems and hepatitis C virus (HCV) antibodies, use walk-in clinics, use heroin and to have been arrested and in detention (in past year). They were less likely to report depressive symptoms, and use Dilaudid (hydromorphone) and alcohol. CONCLUSION These results illustrate crack users' pronounced social marginalization (as expressed by homelessness and high involvement in illegal activities) as well as extensive health problems compared to non-crack users in the Canadian context. The development of targeted interventions-addressing the dynamics of social marginalization-of this population is urgently needed.
Collapse
Affiliation(s)
- Benedikt Fischer
- Centre for Addiction and Mental Health/Univrersity of Toronto, Toronto, Ontario, Canada.
| | | | | | | | | | | | | |
Collapse
|
27
|
Frye V, Latka MH, Koblin B, Halkitis PN, Putnam S, Galea S, Vlahov D. The urban environment and sexual risk behavior among men who have sex with men. J Urban Health 2006; 83:308-24. [PMID: 16736379 PMCID: PMC2527165 DOI: 10.1007/s11524-006-9033-x] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Increasingly, studies show that characteristics of the urban environment influence a wide variety of health behaviors and disease outcomes, yet few studies have focused on the sexual risk behaviors of men who have sex with men (MSM). This focus is important as many gay men reside in or move to urban areas, and sexual risk behaviors and associated outcomes have increased among some urban MSM in recent years. As interventions aimed at changing individual-level risk behaviors have shown mainly short-term effects, consideration of broader environmental influences is needed. Previous efforts to assess the influence of environmental characteristics on sexual behaviors and related health outcomes among the general population have generally applied three theories as explanatory models: physical disorder, social disorganization and social norms theories. In these models, the intervening mechanisms specified to link environmental characteristics to individual-level outcomes include stress, collective efficacy, and social influence processes, respectively. Whether these models can be empirically supported in generating inferences about the sexual behavior of urban MSM is underdeveloped. Conceptualizing sexual risk among MSM to include social and physical environmental characteristics provides a basis for generating novel and holistic disease prevention and health promotion interventions.
Collapse
Affiliation(s)
- Victoria Frye
- Center for Urban Epidemiologic Studies, New York Academy of Medicine, 1216 Fifth Avenue, New York, NY, 10029, USA.
| | | | | | | | | | | | | |
Collapse
|
28
|
Backmund M, Meyer K, Henkel C, Reimer J, Wächtler M, Schütz CG. Risk Factors and predictors of human immunodeficiency virus infection among injection drug users. Eur Addict Res 2005; 11:138-44. [PMID: 15990431 DOI: 10.1159/000085549] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND/AIM Injection drug users (IDUs) have a high risk of acquiring an infection with the human immunodeficiency virus (HIV). To improve counseling and prevention, a better understanding of risk factors and predictors for an infection must be gained. This retrospective study has the aim to determine the risk factors for acquisition of HIV infection other than sharing of needles/syringes. METHODS The study population consisted of all patients admitted to the detoxification unit between 1991 and 1996 who met ICD-10 criteria for opioid dependency, who reported to share needles, and who agreed to have an antibody test. Possible risk factors were assessed by interview. Cross tables based on bivariate logistic regression were constructed to estimate the relative odds. Multiple logistic regression modeling procedures were used to adjust possible confounding factors. RESULTS A total of 1,049 out of 1,656 patients admitted were included into the study. 4.8% of the patients were HIV-1 seropositive. The prevalence was higher among older patients and among patients living with a significant other substance drug user with substance dependency, after a longer duration of drug use, and after coinfection with hepatitis B virus and/or hepatitis C virus (HCV). Using multiple logistic regression analyses and including all individually significant risk factors, we found only coinfection with HCV to remain significant. 92% of the HIV-infected patients were also HCV infected. In the group younger than 23 years of age, a total of 53.5% of the IDUs were still seronegative for HIV, hepatitis A and B virus, and HCV. CONCLUSIONS Despite the high rate of HCV coinfection (92%) in HIV-infected patients, we found more than 50% of IDUs younger than 23 years to be neither infected with HCV nor with HIV. Early prevention strategies against infectious diseases should especially focus on young IDUs.
Collapse
Affiliation(s)
- Markus Backmund
- Addiction Medicine, Clinic 3, General Hospital Munich Schwabing, Munich, Germany.
| | | | | | | | | | | |
Collapse
|
29
|
Nikolova R, Carignan M, Moscovitz N, Demers L. The psychogeriatric and risk behavior assessment scale (PARBAS): a new measure for use with older adults living in the community. Arch Gerontol Geriatr 2004; 39:187-200. [PMID: 15249155 DOI: 10.1016/j.archger.2004.03.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2003] [Revised: 03/02/2004] [Accepted: 03/18/2004] [Indexed: 10/26/2022]
Abstract
In the context of decreased access to inpatient mental health care, the assessment of risk behavior in older adults living in the community is a growing concern. The purpose of the study was to develop a risk behavior screening tool to help community practitioners plan early intervention for frail older adults with severe mental illness (SMI) referred to community health and social service centers. The initial instrument development involved discussion-based work among practitioners and researchers. It was followed by a content validation phase (involving nine experts), preliminary testing of inter-rater reliability (27 subjects, 12 pairs of raters), and item analysis procedures combining previous data. The psychogeriatric and risk behavior assessment scale (PARBAS) includes 34 items organized in 10 sections of risk behavior: (i) self neglect; (ii) non-compliance; (iii) substance abuse; (iv) risk toward oneself and others; (v) aggressive behavior; (vi) emotional distress; (vii) suicidal behavior; (viii) personal security; (ix) risk of victimization by others and (x) financial security. It can provide professionals with essential information about their clients' risky behaviors, thereby contributing to timely and appropriate preventive interventions. Future research is needed to establish its psychometric properties.
Collapse
Affiliation(s)
- Rossitza Nikolova
- Institute of Social Gerontology of Quebec/CLSC René Cassin, 5800, bvd. Cavendish, suite 600, Côte St-Luc, Que., H4W 2T5, Canada
| | | | | | | |
Collapse
|