The dynamics of injection drug users’ personal networks and HIV risk behaviors. Addiction (Abingdon, England), 101(7), 1003-1013

Johns Hopkins University, Baltimore, Maryland, United States
Addiction (Impact Factor: 4.74). 08/2006; 101(7):1003-13. DOI: 10.1111/j.1360-0443.2006.01431.x
Source: PubMed


While studies of the social networks of injection drug users (IDUs) have provided insight into how the structures of interpersonal relationships among IDUs affect HIV risk behaviors, the majority of these studies have been cross-sectional. The present study examined the dynamics of IDUs' social networks and HIV risk behaviors over time.
Using data from a longitudinal HIV-intervention study conducted in Baltimore, MD, this study assessed changes in the composition of the personal networks of 409 IDUs. We used a multi-nomial logistic regression analysis to assess the association between changes in network composition and simultaneous changes in levels of injection HIV risk behaviors. Using the regression parameters generated by the multi-nomial model, we estimated the predicted probability of being in each of four HIV risk behavior change groups.
Compared to the base case, individuals who reported an entirely new set of drug-using network contacts at follow-up were more than three times as likely to be in the increasing risk group. In contrast, reporting all new non-drug-using contacts at follow-up increased the likelihood of being in the stable low-risk group by almost 50% and decreased the probability of being in the consistently high-risk group by more than 70%.
The findings from this study show that, over and above IDUs' baseline characteristics, changes in their personal networks are associated with changes in individuals' risky injection behaviors. They also suggest that interventions aimed at reducing HIV risk among IDUs might benefit from increasing IDUs' social contacts with individuals who are not drug users.

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    • "People inject with others for various reasons and while some injection partnerships only endure for short periods, others become more established. The heterogeneity in injection partnership type and related drug using contexts has previously been discussed (Costenbader et al., 2006; Gyarmathy et al., 2010; Lakon et al., 2006). "
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    ABSTRACT: Background: Studies have shown intimate injection partners engage in higher rates of syringe and injecting equipment sharing. We examined the drug use context and development of injection drug use behaviors within intimate injection partnerships. Methods: In-depth interviews (n=18) were conducted with both members of nine injecting partnerships in Sydney, Australia. Content analysis identified key domains related to the reasons for injecting with a primary injection partner and development of drug injection patterns. Main findings: Most partnerships (n=5) were also sexual; three were blood-relatives and one a friend dyad. The main drug injected was heroin (66%) with high rates of recent sharing behaviors (88%) reported within dyads. Injecting within a primary injection partnership provided perceived protection against overdose events, helped reduce stress, increased control over when, where, and how drugs were used, and promoted the development of an injecting pattern where responsibilities could be shared. Unique to injecting within primary injection partnerships was the social connection and companionship resulted in a feeling of fulfillment while also blinding one from recognizing risky behavior. Conclusions: Findings illuminated the tension between protection and risks within primary injection partnerships. Primary injection partnerships provide a potential platform to expand risk reduction strategies.
    Full-text · Article · Sep 2015 · Drug and alcohol dependence
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    • "Geographic factors can directly and indirectly affect HIV/HCV risk by altering a person's injection network. For example, residential transience (German et al., 2007; Roy et al., 2011) may impact HIV/HCV risk through increased network turnover (Costenbader et al., 2006; Hoffmann et al., 1997) by disrupting social ties, and increased frequency of injecting in semi-public places (e.g., shooting galleries) that present more opportunities for engagement in high-risk practices and with high-risk partners due to lack of safe injection spaces (German et al., 2007). In addition, structural geographic factors such as the distance and settings (e.g. "
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    ABSTRACT: Little is known about young persons who inject drugs (PWID), who are increasingly from suburban communities and predominantly non-Hispanic white. We conducted a cross-sectional personal network (egocentric) and geographic study of young PWID and their drug-using, sexual, and support network members in 2012-13 in metropolitan Chicago, Illinois, U.S. We enrolled 164 young (median age=26), mostly male (65%), non-Hispanic white PWID (71%), with a self-reported HCV prevalence of 13%. Many (59%) reported multiple residences (i.e., were transient) in the past year, 45% of whom reported living in both urban and suburban places (i.e., were cross-over transients). In multivariable analyses that adjusted for participant and network member characteristics, (1) large injection networks were more common among homeless participants; and (2) syringe sharing was (a) highest among cross-over transients compared to suburban (OR=4.19 95% CI 1.69-10.35) and urban only residents (OR=2.91 95% CI 1.06-8.03), (b) higher among HCV-unknown compared HCV-negative participants (OR=4.62 95% CI 1.69-10.35), (c) more likely with network members who were cross-over transients compared to urban (OR=4.94, 95% CI 2.17-11.23) and (d) less likely with network members with HCV-unknown compared to HCV-negative status (OR=0.4 95% CI 0.19-0.84). We identified homelessness as a significant risk factor for large networks and cross-over transience as a significant risk factor for syringe sharing. Further research is needed to understand the role of geographic factors promoting higher risk among these crossover transient PWID. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
    Full-text · Article · Jul 2015 · Drug and alcohol dependence
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    • "However, it could be that in the chronic presence of stressors such as PTSD or exchange sex, individuals are not able to develop the capacity to reduce their frequency of sharing as they get older. It may also be that individuals with these stressors have less stable or more frequently changing social networks, something which has also been associated with more risky drug using behavior [24,25]. Factors specific to the social networks or life stressors of injection drug users may in part explain the conflicting results of previous studies regarding age and injection equipment sharing. "
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    ABSTRACT: Hepatitis C infection (HCV) among individuals aged 15-24 years has increased in Massachusetts, likely due to injection drug use. The prevalence of injection equipment sharing (sharing) and its association with age was examined in a cohort of out-of-treatment Massachusetts substance users. This analysis included baseline data from a behavioral intervention with substance users. Younger and older (<25 versus >=25 years) injection drug users were compared on demographic characteristics, substance use practices, including factors present during the most recent sharing event ("event-level factors"), and HCV testing history. Sharing was reported by 41% of the 484 individuals who reported injection drug use in the past 30 days. Prevalence of sharing varied by age (50% <25 years old versus 38% >=25 years, p = 0.02). In a multivariable logistic regression model younger versus older individuals had twice the odds of sharing (95% CI = 1.26, 3.19). During their most recent sharing event, fewer younger individuals than older had their own drugs available (50% versus 75%, p < 0.001); other injection event-level factors did not vary by age. In the presence of PTSD, history of exchanging sex for money, or not being US born, prevalence of sharing by older users was higher and was similar to that of younger users, such that there was no association between age and sharing. In this cohort of injection drug users, younger age was associated with higher prevalence of sharing, but only in the absence of certain stressors. Harm reduction efforts might benefit from intervening on mental health and other stressors in addition to substance use. Study findings suggest a particular need to address the dangers of sharing with young individuals initiating injection drug use.
    Full-text · Article · Dec 2013 · Addiction science & clinical practice
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