Abstract
The “HIV risk environment” has been characterized as a dynamic interplay between structural and network factors. However, most HIV prevention research has not examined the independent and combined impact of network and structural factors. We aimed to identify individual, network, and neighborhood correlates of exchange sex (≥1 exchange sex partner, past 90 days) among female non-injection drug users (NIDUs). We used baseline data from 417 NIDUs enrolled in a randomized HIV prevention trial in Baltimore (2005–2007). Surveys ascertained demographic variables, drug/sex risk behaviors, neighborhood perceptions, and social/sexual network characteristics. Correlates of exchange sex were identified with descriptive statistics and log-binomial regression. Our findings suggest that sex and drug relationships among female NIDUs are interlinked and may be difficult to modify without altering social norms. Strengthening ties that provide social support but not drug support and reducing ties that provide both drug and social support may facilitate reductions in individual-level HIV-risk behaviors.
Resumen
El “ambiente de riesgo para VIH” se ha caracterizado como una interacción dinámica entre los factores estructurales y de redes sociales. Sin embargo, la mayoría de las investigaciones en la prevención del VIH no han examinado el impacto independiente y combinado de los factores estructurales y de las redes sociales. El objetivo fue identificar la correlación entre los factores individuales, de las redes sociales, y del vecindario con el intercambio de relaciones sexuales (≥1 pareja de intercambio sexual en los últimos 90 días) entre las mujeres que usan drogas no inyectables (UDNIs). Se utilizaron los datos de 417 mujeres UDNIs incluidas en un estudio aleatorio de prevención del VIH en Baltimore (2005–2007). Los cuestionarios incluyeron variables demográficas, de conductas de riesgo (sexual y drogas), percepciones del vecindario, y características de las redes sociales y sexuales. Estadísticas descriptivas y de regresión log-binomial se utilizaron para identificar las correlaciones con las relaciones sexuales de intercambio. Los resultados sugieren que las relaciones sexuales y de drogas entre las mujeres UDNIs están vinculadas y pueden ser difíciles de modificar sin alterar las normas sociales. El fortalecimiento de los vínculos con los que se brinda apoyo social pero no apoyo para drogas y la reducción de los vínculos con los que brindan ambos tipos de apoyo pueden facilitar la reducción de comportamientos de riesgo para VIH.
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References
Link BG, Phelan J. Social conditions as fundamental causes of disease. J Health Soc Behav. 1995;35:80–94.
Chakrapani V, Newman PA, Shunmugam M, Dubrow R. Social-structural contexts of needle and syringe sharing behaviours of HIV-positive injecting drug users in Manipur, India: a mixed methods investigation. Harm Reduct J. 2011;8(1):9.
Grund JPC, Stern LS, Kaplan CD, Adriaans NFP, Drucker E. Drug-use contexts and HIV-consequences—the effect of drug policy on patterns of everyday drug-use in Rotterdam and the Bronx. Br J Addict. 1992;87(3):381–92.
Hien NT, Giang LT, Binh PN, Wolffers I. The social context of HIV risk behaviour by drug injectors in Ho Chi Minh City, Vietnam. AIDS Care-Psychol Socio-Med Aspects AIDS/HIV. 2000;12(4):483–95.
Rhodes T. Risk environments and drug harms: a social science for harm reduction approach. Int J Drug Policy. 2009;20(3):193–201.
Rhodes T, Mikhailova L, Sarang A, Lowndes CM, Rylkov A, Khutorskoy M, et al. Situational factors influencing drug injecting, risk reduction and syringe exchange in Togliatti City, Russian Federation: a qualitative study of micro risk environment. Soc Sci Med. 2003;57(1):39–54.
Singer M, Jia Z, Schensul JJ, Weeks M, Page JB. AIDS and the IV drug user: the local context in prevention efforts. Med Anthropol. 1992;14(2–4):285–306.
Rhodes T, Singer M, Bourgois P, Friedman SR, Strathdee SA. The social structural production of HIV risk among injecting drug users. Soc Sci Med. 2005;61(5):1026–44.
Albarracin D, Tannenbaum MB, Glasman LR, Rothman AJ. Modeling structural, dyadic, and individual factors: the inclusion and exclusion model of HIV related behavior. AIDS Behav. 2010;14:239–49.
Campsmith M, Rhodes P, Hall H, Green T. HIV prevalence estimates—United States, 2006. MMWR Morb Mortal Wkly Rep. 2008;57(39):1073–6.
Denning P, DiNenno E. Communities in crisis: is there a generalized HIV epidemic in impoverished urban areas of the United States? XVIII international AIDS conference, 2010.
Friedman SR, Lieb S, Tempalski B, Cooper H, Keem M, Friedman R, et al. HIV among injection drug users in large US metropolitan areas, 1998. J Urban Health. 2005;82(3):434–45.
Friedman SR, Des Jarlais DC. Economic inequality, poverty, and laws against syringe access as predictors of metropolitan area rates of drug injection and of HIV. 2000;2000. p. abstract no. WePpE1428.
Hixson BA, Omer SB, del Rio C, Frew PM. Spatial clustering of HIV prevalence in Atlanta, Georgia and population characteristics associated with case concentrations. J Urban Health. 2011;88(1):129–41.
Latkin CA, Mandell W, Knowlton AR, Doherty MC, Vlahov D, Suh T, et al. Gender differences in injection-related behaviors among injection drug users in Baltimore, Maryland. AIDS Educ Prev Off Publ Int Soc AIDS Educ. 1998;10(3):257.
Booth R, Kwiatkowski C, Chitwood D. Sex related HIV risk behaviors: differential risks among injection drug users, crack smokers, and injection drug users who smoke crack. Drug Alcohol Depend. 2000;58(3):219–26.
Edlin BR, Irwin KL, Faruque S, McCoy CB, Word C, Serrano Y, et al. Intersecting epidemics–crack cocaine use and HIV infection among inner-city young adults. Multicenter Crack Cocaine and HIV Infection Study Team. N Engl J Med. 1994;331(21):1422–7.
Brown QL, Cavanaugh CE, Penniman TV, Latimer WW. The impact of homelessness on recent sex trade among pregnant women in drug treatment. J Subst Use. 2011;00:1–7.
Pilowsky DJ, Hoover D, Hadden B, Fuller C, Ompad DC, Andrews HF, et al. Impact of social network characteristics on high-risk sexual behaviors among non-injection drug users. Subst Use Misuse. 2007;42(11):1629–49.
Neblett RC, Davey-Rothwell M, Chander G, Latkin CA. Social network characteristics and HIV sexual risk behavior among urban African American women. J Urban Health. 2011;88(1):54–65.
El-Bassel N, Schilling RF, Irwin KL, Faruque S, Gilbert L, Von Bargen J, et al. Sex trading and psychological distress among women recruited from the streets of Harlem. Am J Public Health. 1997;87(1):66–70.
Goodman LA, Fallot RD. HIV risk-behavior in poor urban women with serious mental disorders: association with childhood physical and sexual abuse. Am J Orthopsychiatry. 1998;68(1):73–83.
Meade CS, Fitzmaurice GM, Sanchez AK, Griffin ML, McDonald LJ, Weiss RD. The relationship of manic episodes and drug abuse to sexual risk behavior in patients with co-occurring bipolar and substance use disorders: a 15-month prospective analysis. AIDS Behav. 2008;15(8):1829–33.
Vaddiparti K, Bogetto J, Callahan C, Abdallah AB, Spitznagel EL, Cottler LB. The effects of childhood trauma on sex trading in substance using women. Arch Sex Behav. 2006;35(4):451–9.
Galea S, Ahern J, Rudenstine S, Wallace Z, Vlahov D. Urban built environment and depression: a multilevel analysis. J Epidemiol Community Health. 2005;59(10):822–7.
Galea S, Vlahov D. Social determinants and the health of drug users: socioeconomic status, homelessness, and incarceration. Public Health Rep. 2002;117(Suppl 1):S135.
Schulz A, Krieger J, Galea S. Addressing social determinants of health: community-based participatory approaches to research and practice. Health Educ Behav. 2002;29(3):287.
Ford JM, Beveridge AA. “Bad” neighborhoods, fast food, “sleazy” businesses, and drug dealers: Relations between the location of licit and illicit businesses in the urban environment. J Drug Issues. 2004;34(1):51–76.
Ford JM, Beveridge AA. Varieties of substance use and visible drug problems: individual and neighborhood factors. J Drug Issues. 2006;36(2):377–91.
Kelling GL, Coles CM. Fixing broken windows: restoring order and reducing crime in our communities. New York, NY: Simon & Schuster, Inc; 1996.
Wilson W. When work disappears: the world of the new urban poor. 1st ed. New York: Alfred A. Knopf, Inc; 1996.
Latkin CA, Curry AD. Stressful neighborhoods and depression: a prospective study of the impact of neighborhood disorder. J Health Soc Behav. 2003;44(1):34–44.
Zule WA, Morgan-Lopez AA, Lam WKK, Wechsberg WM, Luseno WK, Young SK. Perceived neighborhood safety and depressive symptoms among African American crack users. Subst Use Misuse. 2008;43(3–4):445–68.
Latkin CA, Curry AD, Hua W, Davey MA. Direct and indirect associations of neighborhood disorder with drug use and high-risk sexual partners. Am J Prev Med. 2007;32(6 Suppl):S234–41.
Hembree C, Galea S, Ahern J, Tracy M, Piper TM, Miller J, et al. The urbant built environment and overdose mortality in New York City neighborhoods. Health Place. 2005;11(2):147–56.
Wallace D, Wallace R. A plague on your houses- how New York was burned down and national public health crumbled. New York: Verso; 1998.
Yonas MA, O’Campo P, Burke JG, Gielen AC. Neighborhood-level factors and youth violence: giving voice to the perceptions of prominent neighborhood individuals. Health Educ Behav. 2007;34(4):669–85.
Jones DL, Irwin KL, Inciardi J, Bowser B, Schilling R, Word C, et al. The high-risk sexual practices of crack-smoking sex workers recruited from the streets of three American cities. Sex Transm Dis. 1998;25(4):187.
Sterk CE, Elifson KW, Theall KP. Individual action and community context—the health intervention project. Am J Prev Med. 2007;32(6):S177–81.
Liljeros F, Edling CR, Amaral LAN. Sexual networks: implications for the transmission of sexually transmitted infections. Microbes Infect. 2003;5(2):189–96.
Wasserman S, Katherine F, eds. Social network analysis: methods and applications (structural analysis in social sciences). Cambridge: Cambridge University Press; 1994.
Latkin C, Mandell W, Vlahov D, Knowlton A, Oziemkowska M, Celentano D. Personal network characteristics as antecedents to needle-sharing and shooting gallery attendance. Soc Netw. 1995;17(3–4):219–28.
Valente TW. Network models of the diffusion of innovations. Comput Math Org Theory. 1996;2(2):163–4.
Davey-Rothwell MA, Latkin CA. Gender differences in social network influence among injection drug users: perceived norms and needle sharing. J Urban Health-Bull N Y Acad Med. 2007;84(5):691–703.
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(11):1730–9.
Latkin CA, Davey MA, Hua W. Social context of needle selling in Baltimore, Maryland. Subst Use Misuse. 2006;41(6–7):901–13.
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(10):1626–35.
Unger JB, Kipke MD, De Rosa CJ, Hyde J, Ritt-Olson A, Montgomery S. Needle-sharing among young IV drug users and their social network members: the influence of the injection partner’s characteristics on HIV risk behavior. Addict Behav. 2006;31(9):1607–18.
Tobin KE, Davey-Rothwell M, Latkin CA. Social-level correlates of shooting gallery attendance: a focus on networks and norms. AIDS Behav. 2010;14(5):1142–8.
Latkin CA, Hua W, Tobin K. Social network correlates of self-reported non-fatal overdose. Drug Alcohol Depend. 2004;73(1):61–7.
Latkin CA, Mandell W, Vlahov D. The relationship between risk networks’ patterns of crack cocaine and alcohol consumption and HIV-related sexual behaviors among adult injection drug users: a prospective study. Drug Alcohol Depend. 1996;42(3):175–81.
Davey-Rothwell MA, Tobin K, Yang C, Sun CJ, Latkin CA. Results of a randomized controlled trial of a peer mentor HIV/STI prevention intervention for women over an 18 month follow-up. AIDS Behav. 2011;15(8):1654–63.
German D, Latkin CA. Social stability and hiv risk behavior: evaluating the role of accumulated vulnerability. AIDS Behav. 2012;16(1):168–78.
Grieb SM, Davey-Rothwell M, Latkin CA. Social and sexual network characteristics and concurrent sexual partnerships among urban African American high-risk women with main sex partners. AIDS Behav. 2011.
Perkins DD, Taylor RB. Ecological assessments of community disorder: their relationship to fear of crime and theoretical implications. Am J Community Psychol. 1996;24(1):63–107.
Elwood WN, Williams ML, Bell DC, Richard AJ. Powerlessness and HIV prevention among people who trade sex for drugs (‘strawberries’). AIDS care. 1997;9(3):273–84.
Davey-Rothwell MA, Latimore A, Hulbert A, Latkin CA. Sexual networks and housing stability. J Urban Health. 2011;88(4):759–66.
Havassy BE, Wasserman DA, Hall SM. Social relationships and abstinence from cocaine in an American treatment sample. Addiction. 1995;90(5):699–710.
Latkin CA, Knowlton AR, Hoover D, Mandell W. Drug network characteristics as a predictor of cessation of drug use among adult injection drug users: a prospective study. Am J Drug Alcohol Abuse. 1999;25(3):463–73.
Karney BR, Hops H, Redding CA, Reis HT, Rothman AJ, Simpson JA. A framework for incorporating dyads in models of HIV-prevention. AIDS Behav. 2010;14:189–203.
Bauer HM, Gibson P, Hernandez M, Kent C, Klausner J, Bolan G. Intimate partner violence and high-risk sexual behaviors among female patients with sexually transmitted diseases. Sex Transm Dis. 2002;29(7):411.
Ulibarri MD, Strathdee SA, Lozada R, Magis-Rodriguez C, Amaro H, O’Campo P, et al. Intimate partner violence among female sex workers in two Mexico–US Border cities: partner characteristics and HIV risk behaviors as correlates of abuse. Psychol Trauma Theory Res Practice Policy. 2010;2(4):318.
El-Bassel N, Witte SS, Wada T, Gilbert L, Wallace J. Correlates of partner violence among female street-based sex workers: substance abuse, history of childhood abuse, and HIV risks. AIDS Patient Care STDs. 2001;15(1):41–51.
Wu E, El-Bassel N, Witte SS, Gilbert L, Chang M. Intimate partner violence and HIV risk among urban minority women in primary health care settings. AIDS Behav. 2003;7(3):291–301.
Pavao J, Alvarez J, Baumrind N, Induni M, Kimerling R. Intimate partner violence and housing instability. Am J Prev Med. 2007;32(2):143–6.
Curry A, Latkin C, Davey-Rothwell M. Pathways to depression: the impact of neighborhood violent crime on inner-city residents in Baltimore, Maryland, USA. Soc Sci Med. 2008;67(1):23–30.
Furr-Holden CDM, Smart MJ, Pokorni JL, Ialongo NS, Leaf PJ, Holder HD, et al. The NIfETy method for environmental assessment of neighborhood-level indicators of violence, alcohol, and other drug exposure. Prev Sci. 2008;9(4):245–55.
Macalino GE, Celentano DD, Latkin C, Strathdee SA, Vlahov D. Risk behaviors by audio computer-assisted self-interviews among HIV-seropositive and HIV-seronegative injection drug users. AIDS Educ Prev. 2002;14(5):367–78.
Sherman SG, German D, Cheng Y, Marks M, Bailey-Kloche M. The evaluation of the JEWEL project: an innovative economic enhancement and HIV prevention intervention study targeting drug using women involved in prostitution. AIDS Care-Psychol Socio-Med Aspects AIDS/HIV. 2006;18(1):1–11.
Latkin C, Weeks MR, Glasman L, Galletly C, Albarracin D. A dynamic social systems model for considering structural factors in HIV prevention and detection. AIDS Behav. 2010;14:222–38.
Dickson-Gomez JB, Cromley E, Convey M, Hilario H. How much choice is there in housing choice vouchers? Neighborhood risk and free market rental housing accessibility for active drug users in Hartford, Connecticut. Subst Abuse Treat Prev Policy. 2009;4(5).
Riley ED, Moss AR, Clark RA, Monk SL, Bangsberg DR. Cash benefits are associated with lower risk behavior among the homeless and marginally housed in San Francisco. J Urban Health. 2005;82(1):142–50.
Acknowledgments
This work was funded by the National Institute on Mental Health (Grant number R01 MH66810). Further support for this work was provided by the National Institute on Mental Health (Grant number R25 MH080644) and the National Institute on Drug Abuse (Grant numbers T32 DA023356, T32DA007292, and R01 DA028766).
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Rudolph, A.E., Linton, S., Dyer, T.P. et al. Individual, Network, and Neighborhood Correlates of Exchange Sex Among Female Non-Injection Drug Users in Baltimore, MD (2005–2007). AIDS Behav 17, 598–611 (2013). https://doi.org/10.1007/s10461-012-0305-z
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DOI: https://doi.org/10.1007/s10461-012-0305-z