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Community Characteristics Associated with HIV Risk among Injection Drug Users in the San Francisco Bay Area: A Multilevel Analysis

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Abstract

Community characteristics have been associated with racial and ethnic health disparities for a wide range of ailments and conditions. Previous research has found that rates of AIDS cases among injection drug users (IDUs) vary by community characteristics. However, few studies have examined whether community characteristics are associated with HIV risk behaviors among IDUs. To address this gap in the literature, we examined the associations between census-tract-level community characteristics and injection-related and sex-related HIV risk behaviors among IDUs in the San Francisco Bay Area. Individual HIV risk behaviors were collected from 4,956 IDUs between 1998 and 2002. Using 2000 US census data, we constructed four census-level community measures: percent African American, percent male unemployment, percent of households that receive public assistance, and median household income. All community variables were measured continuously. Multilevel modeling was used to determine if community characteristics were associated with recent (in the last 6 months) receptive and distributive syringe sharing, multiple sex partners, and unprotected sex risk while controlling for potential individual-level confounders. In bivariate analysis, most of the census-tract-level community characteristics were significantly associated with injection-related HIV risk, while no community characteristics were associated with sex-related risk. However, results from multivariate multilevel models indicate that only percent African American in a census tract was associated with receptive [adjusted odds ratio (AOR) = 0.93; 95% confidence interval (CI) = 0.89, 0.99] and distributive syringe sharing (AOR = 0.94; 95% CI = 0.92, 0.99), net of individual-level characteristics. Accounting for individual-level factors in the multivariate model in the sex-related risk models revealed a significant inverse relationship between percent African American and propensity to engage in unprotected sex (AOR = 0.95; 95% CI = 0.92, 0.99); community-level characteristics remained unassociated with multiple sex partners. In this exploratory analysis, percent African American in a census tract was inversely associated with injection-related risk. The census-tract-level community characteristics we examined seem to exert little influence on individual risk among long-term chronic IDUs. More research is needed examining the influence of other community characteristics that were unmeasured in this paper but might be related to sex and drug risk among IDUs such as shooting galleries, crack houses, drug markets, and availability of preventive HIV services.

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Notes

  1. To account for potential differences between cities (San Francisco, Richmond, and Oakland), we also ran models with city dummies at level-1. We found no substantive differences in the results and, subsequently, present results from models without city dummies.

References

  1. Boardman JD, Finch BK, Ellison CG, Williams D, Jackson J. Neighborhood disadvantage, stress, and drug use among adults. J Health Soc Behav. 2001;42(2):151–165.

    Article  PubMed  CAS  Google Scholar 

  2. Galea S, Nandai A, Vlahov D. The social epidemiology of substance abuse. Epidemiol Rev. 2004;26:36–52.

    Article  PubMed  Google Scholar 

  3. Lillie-Blanton M, Anthony JC, Schuster CR. Probing the meaning of racial/ethnic group comparisons in crack cocaine smoking. JAMA. 1993;269:993–997.

    Article  PubMed  CAS  Google Scholar 

  4. Poundstone KE, Strathdee SA, Celentano DD. The social epidemiology of human immunodeficiency virus/acquired immunodeficiency syndrome. Epidemiol Rev. 2004;26:22–35.

    Article  PubMed  CAS  Google Scholar 

  5. Bluthenthal RN, Watters JK. Multimethod research: From targeted sampling to HIV risk behaviors. In: Lambert EY, Ashery RS, Needle RH, eds. Qualitative Methods in the Prevention of Drug Abuse and HIV Research, vol 157. Rockville, MD: National Institute on Drug Abuse; 1995:212–230.

    Google Scholar 

  6. Lampinen TM, Joo E, Seweryn S, Hershow RC, Wiebel W. HIV seropositivity in community-recruited and drug treatment samples of injecting drug users. AIDS. 1992;6:123–126.

    Article  PubMed  CAS  Google Scholar 

  7. Friedman SR, Lieb S, Tempalski B, et al. HIV among injection drug users in large US metropolitan areas, 1998. J Urban Health. 2005;85:434–445.

    Google Scholar 

  8. Friedman SR, Lynch J, Perlis T, Des Jarlais DC. Economic inequality, poverty, and laws against syringe access as predictors of metropolitan area rates of drug injection and HIV infection. Paper presented at: Global Research Network on HIV Prevention in Drug-using Populations, Third Annual Meeting, Durban, South Africa, July 2000.

  9. Friedman SR, Perlis T, Des Jarlais DC. Laws prohibiting over-the-counter syringe sales to injection drug users: Relations to population density, HIV prevalence, and HIV incidence. Am J Public Health. 2001;91:791–793.

    PubMed  CAS  Google Scholar 

  10. Bluthenthal RN. Race, Poverty, and Disease: HIV/AIDS Among African American Injection Drug Users in the San Francisco Bay Area. Dissertation, Berkeley: University of California; 1998.

  11. Buchanan D, Shaw S, Teng W, Hiser P, Singer M. Neighborhood differences in patterns of syringe access, use, and discard among injection drug users: implications for HIV outreach and prevention education. J Urban Health. 2003;80(3):438–454.

    PubMed  Google Scholar 

  12. Latkin C, Williams CT, Wang J, Curry AD. Neighborhood social disorder as a determinant of drug injection behaviors: A structural equation modeling approach. Health Psychol. 2005;24(1):96–100.

    Article  PubMed  Google Scholar 

  13. Wang J, Siegal HA, Falck RS, Carlson RG. Needle transfer among injection drug users: A multilevel analysis. Am J Drug Alcohol Abuse. 1998;24(2):225–237.

    PubMed  CAS  Google Scholar 

  14. Caetano R. Alcohol-related heath disparities and treatment-related epidemiological findings among Whites, Blacks, and Hispanics in the United States. Alcohol Clin Exp Res. 2003;27(8):1337–1339.

    Article  PubMed  Google Scholar 

  15. Binswanger IA, Kral AH, Bluthenthal RN, Rybold D, Edlin BR. Abscesses and cellulitis among injection drug users in San Francisco. Clin Infect Dis. 2000;30:579–581.

    Article  PubMed  CAS  Google Scholar 

  16. Kral AH, Lorvick J, Gee L, et al. Trends in human immunodeficiency virus seroincidence among street-recruited injection drug users in San Francisco, 1987–1998. Am J Epidemiol. 2003;157(10):915–922.

    Article  PubMed  Google Scholar 

  17. Lorvick J, Kral AH, Seal K, Gee G, Edlin BR. Prevalence and duration of hepatitis C among injection drug users in San Francisco, Calif. Am J Public Health. 2001;91(1):46–47.

    PubMed  CAS  Google Scholar 

  18. Lorvick J, Thompson S, Edlin BR, Kral AH, Lifson AR, Watters JK. Incentives and accessibility: A pilot study to promote adherence to TB prophylaxis in a high-risk community. J Urban Health. 1999;76(4):461–467.

    Article  PubMed  CAS  Google Scholar 

  19. Seal K, Kral AH, Gee L, et al. Predictors of non-fatal overdose among street-recruited injection drug users in the San Francisco Bay Area, 1998–1999. Am J Public Health. 2001;91(11):1842–1846.

    PubMed  CAS  Google Scholar 

  20. Seal K, Kral AH, Lorvick J, McNees A, Gee L, Edlin BR. A randomized controlled trial of monetary incentives vs. outreach to enhance adherence to the hepatitis B vaccine series among injection drug users. Drug Alcohol Depend. 2003;71:127–131.

    Article  PubMed  Google Scholar 

  21. Watters JK, Estilo MJ, Clark GL, Lorvick J. Syringe and needle exchange as HIV/AIDS prevention for injection drug users. JAMA. 1994;271:115–120.

    Article  PubMed  CAS  Google Scholar 

  22. Watters JK, Downing M, Case P, Lorvick J, Cheng YT, Fergusson B. AIDS prevention for intravenous drug users in the community: Street-based education and risk behavior. Am J Community Psychol. 1990;18(4):587–596.

    Article  PubMed  CAS  Google Scholar 

  23. Watters JK, Biernacki P. Targeted sampling: Options for the study of hidden populations. Soc Probl. 1989;36:416–430.

    Article  Google Scholar 

  24. Ricketts ER, Sawhill IV. Defining and measuring the underclass. J Policy Anal Manage. 1988;7:321–322.

    Article  Google Scholar 

  25. Anderson JE, Chandra A, Mosher WD. HIV testing in the United States, 2002. Adv Data. 2005(363):1–32.

  26. Ebrahim SH, Anderson JE, Weidle P, Purcell DW. Race/ethnic disparities in HIV testing and knowledge about treatment for HIV/AIDS: United States, 2001. AIDS Patient Care STDS. 2004;18(1):27–33.

    Article  PubMed  Google Scholar 

  27. Miller LG, Simon PA, Miller ME, Long A, Yu EI, Asch SM. High-risk seuxal behavior in Los Angeles: Who receives testing for HIV? J Acquir Immune Defic Syndr. 1999;22(5):490–497.

    PubMed  CAS  Google Scholar 

  28. Taylor SL, Leibowitz A, Simon PA, Grusky O. ZIP code correlates of HIV-testing: A multi-level analysis in Los Angeles. AIDS Behav. 2006;10(5):579–586.

    Article  PubMed  Google Scholar 

  29. Anderson JE, Wilson R, Doll L, Jones TS, Barker P. Condom use and HIV risk behaviors among U.S. adults: Data from a national survey. Fam Plann Perspect. 1999;31(1):24–28.

    Article  PubMed  CAS  Google Scholar 

  30. Bluthenthal RN, Estilo MJ, Seeberg DM, Watters JK. HIV-1 infection and drug injectors in Oakland/Richmond, California. Paper presented at: Ninth International Conference on AIDS, Berlin, Germany, 6–11 June 1993.

  31. Kral AH, Bluthenthal RN, Booth RE, Watters JK. HIV seroprevalence among street-recruited injecting drug and crack cocaine users in 16 U.S. municipalities. Am J Public Health. 1998;88:108–113.

    PubMed  CAS  Google Scholar 

  32. Watters JK, Bluthenthal RN, Kral AH. HIV seroprevalence in injection drug users [letter]. JAMA. 1995;273:1178.

    Article  PubMed  CAS  Google Scholar 

  33. Holtgrave DR, Thomas CW, Chen H, Edlavitch S, Pinkerton SD, Fleming P. HIV prevention community planning and communities of color: Do resources track the epidemic? AIDS Public Policy J. 2000;15(2):75–81.

    PubMed  CAS  Google Scholar 

  34. CDC. Methamphetamine use and HIV risk behaviors among heterosexual men—preliminary results from five northern California counties, December 2001–November 2003. MMWR Morb Mortal Wkly Rep. 2006;55(10):273–277.

    Google Scholar 

  35. Lorvick J, Martinez A, Gee L, Kral AH. Sexual and injection risk among women who inject methamphetamine in San Francisco. J Urban Health. 2006;83(3):467–505.

    Article  Google Scholar 

  36. Molitor F, Ruiz JD, Flynn N, Mikanda JN, Sun RK, Anderson R. Methamphetamine use and sexual and injection risk behaviors among out-of-treatment injection drug users. Am J Drug Alcohol Abuse. 1999;25:475–493.

    Article  PubMed  CAS  Google Scholar 

  37. Semple SJ, Patterson TL, Grant I. The context of sexual risk behavior among heterosexual methamphetamine users. Addict Behav. 2004;29(4):807–810.

    Article  PubMed  Google Scholar 

  38. Dowling-Guyer S, Johnson ME, Fisher DG, et al. Reliability of drug users’ self-reported HIV risk behaviors and validity of self-reported recent drug use. Assessment. 1994;1:383–392.

    Google Scholar 

  39. Needle RN, Fisher DG, Weatherby N, et al. Reliability of self-reported HIV risk behaviors of drug users. Psychol Addict Behav. 1995;9:242–250.

    Article  Google Scholar 

  40. Weatherby N, Needle RH, Cesari H, et al. Validity of self-reported drug use among injection drug users recruited through street outreach. Eval Program Plann. 1994;17:347–355.

    Article  Google Scholar 

  41. Curtis R, Friedman SR, Neaigus A, Jose B, Goldstein M, Idefonso G. Street level drug market structure and HIV risk. Soc Netw. 1995;17:219–228.

    Article  Google Scholar 

  42. Friedman SR, Furst RT, Jose B, et al. Drug scene roles and HIV risk. Addiction. 1998;93:1403–1416.

    Article  PubMed  CAS  Google Scholar 

  43. Sampson RJ, Raudenbush SW. Systematic social observation of public spaces: A new look at disorder in urban neighborhoods. Am J Sociol. 1999;105(3):603–651.

    Article  Google Scholar 

  44. Burris S, Blankenship KM, Donoghoe M, et al. Addressing the “risk environment” for injection drug users: The mysterious case of the missing cop. Milbank Q. 2004;82(1):125–156.

    Article  PubMed  Google Scholar 

  45. Friedman SR, Cooper HL, Tempalski B, et al. Relationship of deterrence and law enforcement to drug-related harms among drug injectors in US metropolitan areas. AIDS. 2006;20(1):93–99.

    Article  PubMed  Google Scholar 

  46. Rhodes T, Mikhailova L, Sarange A, 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;57:39–54.

    Article  PubMed  Google Scholar 

  47. Wood E, Spittal PM, Small W, et al. Displacement of Canada’s largest public illicit drug market in response to a police crackdown. Can Med Assoc J. 2004;170(10):1551–1556.

    Article  Google Scholar 

  48. Diez Roux, AV. Investigating neighborhood and area effects on health. Am J Public Health. 2001;91(11):1783–1789.

    Article  PubMed  CAS  Google Scholar 

  49. 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):1026–1044.

    Article  PubMed  Google Scholar 

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Acknowledgments

Funding for this project was provided by the National Institute on Drug Abuse (grant #R01DA14210), the San Francisco Department of Public Health, and the Substance Abuse and Mental Health Services Administration. Support for D. Phuong Do was provided by the Kellogg Health Scholars Program.

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Authors and Affiliations

  1. Health Program and Drug Policy Research Center, RAND Corporation, Santa Monica, CA, USA

    Ricky N. Bluthenthal PhD

  2. Sociology Department and Urban Community Research Center, California State University Dominguez Hills, Carson, CA, USA

    Ricky N. Bluthenthal PhD

  3. Institute for Social Research, University of Michigan, Ann Arbor, MI, USA

    D. Phuong Do

  4. Sociology Department, San Diego State University, San Diego, CA, USA

    Brian Finch

  5. Center on AIDS, Prevention, (CAPS), University of California San Francisco, San Francisco, CA, USA

    Alexis Martinez

  6. Center for the Study of Hepatitis C, Weill Medical College of Cornell University, New York, NY, USA

    Brian R. Edlin

  7. Urban Health Program, San Francisco Regional Office, RTI International, Research Triangle Park, NC, USA

    Alex H. Kral

  8. Department of Family and Community Medicine, University of California San Francisco, San Francisco, CA, USA

    Alex H. Kral

  9. RAND Corporation, 1776 Main Street, P.O. Box 2138, Santa Monica, CA, 90407-2138, USA

    Ricky N. Bluthenthal PhD

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  1. Ricky N. Bluthenthal PhD
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Correspondence to Ricky N. Bluthenthal PhD.

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Bluthenthal, R.N., Do, D.P., Finch, B. et al. Community Characteristics Associated with HIV Risk among Injection Drug Users in the San Francisco Bay Area: A Multilevel Analysis. J Urban Health 84, 653–666 (2007). https://doi.org/10.1007/s11524-007-9213-3

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