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Ann Epidemiol. 2016 Sep;26(9):619-630.e2. doi: 10.1016/j.annepidem.2016.07.012. Epub 2016 Aug 8.

Associations of place characteristics with HIV and HCV risk behaviors among racial/ethnic groups of people who inject drugs in the United States.

Author information

1
Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA. Electronic address: sabriya.linton@emory.edu.
2
Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA.
3
ZevRoss Spatial Analysis, Ithaca, NY.
4
Institute for Infectious Disease Research, National Development and Research Institutes, New York, NY.
5
Baron Edmond de Rothschild Chemical Dependency Institute, Mount Sinai Beth Israel, New York, NY.
6
Centers for Disease Control and Prevention, Atlanta, GA.

Abstract

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 for 2009 National HIV Behavioral Surveillance. Administrative data described ZIP codes, counties, and metropolitan statistical areas where PWID lived. Multilevel models, stratified by racial/ethnic groups, 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] = 1.21-4.17; P = .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 = .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 = .038).

CONCLUSIONS:

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.

KEYWORDS:

Condom use; Drug treatment; HCV; HIV; Housing; Injection drug use; PWID

PMID:
27576908
PMCID:
PMC5110217
DOI:
10.1016/j.annepidem.2016.07.012
[Indexed for MEDLINE]
Free PMC Article

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