Search

Objectives. This study examined whether networks of drug-injecting and sexual relationships among drug injectors are associated with individual human immunodeficiency virus (HIV) serostatus and with behavioral likelihood of future infection. Methods. A cross-sectional survey of 767 drug injectors in New York City was performed with chain-referral and linking procedures to measure large-scale (sociometric) risk networks. Graph-theoretic algebraic techniques were used to detect 92 connected components (drug injectors linked to each other directly or through others) and a 105-member 2-core within a large connected component of 230 members. Results. Drug injectors in the 2-core of the large component were more likely than others to be infected with HIV. Seronegative 2-core members engaged in a wide range of high-risk behaviors, including engaging in risk behaviors with infected drug injectors. Conclusions. Sociometric risk networks seem to be pathways along which HIV travels in drug-injecting peer groups. The cores of large components can be centers of highrisk behaviors and can become pockets of HIV infection. Preventing HIV from reaching the cores of large components may be crucial in preventing widespread HIV epidemics. (Am J Public Health. 1997;87:1289-1296)

Drug injectors are at risk for infection with human immunodeficiency virus (HIV) and other blood-borne pathogens through the exchange of (infected) blood resulting from unhygienic injecting practices. Research attention and public discussion have focused primarily on the sharing of syringes and needles. While the focus on syringe sharing has sparked important interventions (bleach distribution, syringe exchange) it may have obscured the social relationship in which injecting equipment is used. Drug sharing plays a crucial role in the social organization of the drug using subculture. In this paper, various drug sharing practices and other distinguishable aspects of the injecting process - collectively termed Syringe-Mediated Drug Sharing (SMDS) - are described. All of these behaviors may put injecting drug users (IDUs) at risk for infection. The purpose of this paper is to stimulate scientific inquiry into SMDS behaviors and the social contexts which shape them. Descriptions are based primarily on field studies in Rotterdam and New York City. Recommendations for safer injecting training and education are proposed, as are directions for future research. Key words - injecting drug use, blood-borne pathogens, HIV risk factors, drug sharing, social factors, epidemiology, ethnography

This paper investigates whether the time period during which retrospective behavioral data are collected affects the results of studies of HIV risk factors. In particular, we address the concern that questionnaires probing behaviors in the recent past may not isolate the risk behaviors involved at the time of actual HIV infection. During 1987 and 1988, 278 street-recruited injecting drug users (IDUs) in New York City were interviewed about their sexual behaviors, medical history, drug-injection behaviors in the prior ten years, and specific needle-use behaviors during 1985-86 and thereafter. Among the 278 subjects, 52% were HIV-seropositive. In univariate analysis, serostatus was significantly related to: a) total drug-injection frequency during 1983-84 and 1985-86; b) mean monthly total drug-injection frequency during 1977 to 1987; c) cocaine injection frequencies during 1983-84 and 1985-86, and during the last thirty days; and d) injecting in shooting galleries and using previously used cookers during 1985-86. Significant predictors of seroprevalence in stepwise logistic regression were total drug and cocaine injection frequencies during 1983-84, years of injection, residence in the Bronx, not being Hispanic and history of any sexually transmitted disease. The data confirm previous reports on behavioral risk factors for HIV serostatus. Re-analysis using drug-injection frequency data for different time periods indicates that in the context of an 'older' HIV epidemic like that in New York City, analysis of risk factors may be less sensitive to time periods than had previously been feared, although it may be true that data for behaviors in 'the last thirty days' cover a sufficiently atypical period as to produce misleading results.

The resurgence of tuberculosis (TB) since 1985 and the advent of multidrug-resistant strains of TB portend potentially devastating consequences in New York City, as well as in many other parts […]

Focusing on the social environment as well as the individual should both enhance our understanding of HIV transmission and assist in the development of more effective prevention programs. Networks are an important aspect of drug injectors' social environment. We distinguish between (1) risk networks (the people among whom HIV risk behaviors occur) as vectors of disease transmission, and (2) social networks (the people among whom there are social interactions with a mutual orientation to one another) as generators and disseminators of social influence. These concepts are applied to analyses of data from interviews with drug injectors in two studies. In the first study drug injectors' risk networks converge with their social networks: 70% inject or share syringes with a spouse or sex partner, a running partner, or with friends or others whom they know. Qualitative data from interviews with injectors in the second study also show that the social relationships between drug injectors and members of their risk network are often based on long-standing and multiplex relationships, such as those based on kinship, friendship, marital and sexual ties, and economic activity. In the first study the vast majority of injectors, over 90%, have social ties with non-injectors. Injectors with more frequent social contacts with non-injectors engage in lower levels of injecting risk behavior. Risk settings may function as risk networks: injectors in this study who inject at shooting galleries are more likely than those who do not to rent used syringes, borrow used syringes and inject with strangers. Since the adoption of a network approach is relatively new, a number of issues require further attention. These include: how to utilize social networks among drug injectors to reduce risk through peer pressure; how to promote risk reduction by encouraging ties between injectors and non-injectors; and how to integrate biographical and historical change into understanding network processes. Appropriate methodologies to study drug injectors' networks should be developed, including techniques to reach hidden populations, computer software for managing and analyzing network data bases, and statistical methods for drawing inferences from data gathered through dependent sampling designs.

Aims: To describe, illustrate, and assess the reliability and construct validity of a method for assessing peer norms regarding drug use and selling. Design and participants: Face-to-face interviews of young adults (age 18-24) selected through multi-stage probability sampling in a low-income, high drug use, urban environment. Measurements: Subjects reported what proportion of their close friends actually encouraged them to use specific drugs, or would have objected to such use, currently and at age 15. Findings: Self-reports of peer norms are highly reliable, and have considerable construct validity in predicting drug behaviors. There is little encouragement of drug use, and substantial objection to use of drugs other than marijuana. While few subjects had many friends who encouraged them to sell drugs, about a third of the subjects said few if any of their friends would object to their selling drugs. Objection to drug use is more common, and encouragement of drug use less common, among women's peers than among men's peers. Conclusions: These items can be used to reliably and validly assess young adults' peer norms regarding drug use. Men and women report different peer norms. [ABSTRACT FROM AUTHOR]

The article contrasts the syringe exchange participants who continued unsafe injection behavior even after exchange program with syringe exchange participants who engaged in unsafe injection behavior prior to using an exchange program in New York City, New York State. Subjects were randomly recruited from among previously registered participants waiting in line to exchange equipment at any of the five legally authorized programs. Participants were asked about demographic characteristics and drug and sexual risk behaviors 30 days prior to their first use of the syringe exchange, as well as during the 30-day period prior to the interview while using the exchange. Among the many factors associated with continuing versus stopping unsafe injection while using the syringe exchange, there was one extremely strong predictor. Passing on used injection equipment to sexual partners, friends, and relatives was the factor most strongly associated with continuing risky injection. This suggests that there are social networks in which sharing of injection equipment within the group is seen as acceptable behavior. Several aspects of drug injection, including daily cocaine injection, not being in drug abuse treatment, and years of injecting, were associated with continuing risky injection while using the syringe exchange. The percentage of syringes obtained from the exchange was associated with stopping unsafe injections.