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

• Type of Material: Article
• Authors: Sabriya Linton, Emory University; Hannah Cooper, Emory University; Mary Kelley, Emory University; Conny C. Karnes, Emory University; Zev Ross, ZevRoss SpatialAnalysis; Mary E. Wolfe, Emory University; Yen-Tyng Chen, Emory University; Samuel R. Friedman, National Development and Research Institutes; Don Des Jarlais, Mount Sinai Beth Israel; Salaam Semaan, Centers for Disease Control and Prevention; Barbara Tempalski, National Development and Research Institutes; Catlainn Sionean, Centers for Disease Control and Prevention; Elizabeth DiNenno, Centers for Disease Control and Prevention; Cyprian Wejnert, Centers for Disease Control and Prevention; Gabriella Paz-Bailey, Emory University
• Language: English
• Date: 2016-09
• Publisher: Elsevier Masson
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2016 Elsevier Inc.
• Final Published Version (URL): http://dx.doi.org/10.1016/j.annepidem.2016.07.012
• Title of Journal or Parent Work: Annals of Epidemiology
• ISSN: 1047-2797
• Volume: 26
• Issue: 9
• Start Page: 619
• End Page: 630.e2
• Grant/Funding Information: This research was supported by two grants from the National Institutes of Health: “Place Characteristics & Disparities in HIV in IDUS: A Multilevel Analysis of NHBS” (DA035101; Cooper, PI) and the Emory Center for AIDS Research (P30 AI050409; Curran, PI).; It was also supported by the Centers and Disease Control and Prevention, and the National HIV Behavioral Surveillance System Study Group: Atlanta, GA: Jennifer Taussig, Shacara Johnson, Jeff Todd; Baltimore, MD: Colin Flynn, Danielle German; Boston, MA: Debbie Isenberg, Maura Driscoll, Elizabeth Hurwitz; Chicago, IL: Nikhil Prachand, Nanette Benbow; Dallas, TX: Sharon Melville, Richard Yeager, Jim Dyer, Alicia Novoa; Denver, CO: Mark Thrun, Alia Al-Tayyib; Detroit, MI: Emily Higgins, Eve Mokotoff, Vivian Griffin; Houston, TX: Aaron Sayegh, Jan Risser, Hafeez Rehman; Los Angeles, CA: Trista Bingham, Ekow Kwa Sey; Miami, FL: Lisa Metsch, David Forrest, Dano Beck, Gabriel Cardenas; Nassau-Suffolk, NY: Chris Nemeth, Lou Smith, Carol-Ann Watson; New Orleans, LA: William T. Robinson, DeAnn Gruber, Narquis Barak; New York City, NY: Alan Neaigus, Samuel Jenness, Travis Wendel, Camila Gelpi-Acosta, Holly Hagan; Newark, NJ: Henry Godette, Barbara Bolden, Sally D’Errico; Philadelphia, PA: Kathleen A. Brady, Althea Kirkland, Mark Shpaner; San Diego, CA: Vanessa Miguelino-Keasling, Al Velasco; San Francisco, CA: H. Fisher Raymond; San Juan, PR: Sandra Miranda De León, Yadira Rolón-Colón; Seattle, WA: Maria Courogen, Hanne Thiede, Richard Burt; St Louis, MO: Michael Herbert, Yelena Friedberg, Dale Wrigley, Jacob Fisher; Washington, DC: Marie Sansone, Tiffany West-Ojo, Manya Magnus, Irene Kuo; Behavioral Surveillance Team
• Keywords: NEW-YORK-CITY; Life Sciences & Biomedicine; SURVEILLANCE SYSTEM; US METROPOLITAN-AREAS; C VIRUS-INFECTIONS; STERILE SYRINGES; Science & Technology; Drug treatment; PWID; Housing; HCV; LONGITUDINAL ANALYSIS; Injection drug use; RACIAL RESIDENTIAL SEGREGATION; HIV; SAN-FRANCISCO; SEXUAL RISK; Condom use; Public, Environmental & Occupational Health; SYRINGE EXCHANGE PROGRAMS
• Research Categories: Biology, Virology; Health Sciences, Public Health; Health Sciences, Epidemiology

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.