High-Risk Behaviors Associated with Transition from Illicit Non-Injection to Injection Drug Use Among Adolescent and Young Adult Drug Users: A Case-Control Study

The goal of this study was to elucidate characteristics of individuals likely to transition into injection drug use and to identify characteristics of a group at high risk for blood-borne infection so that interventions might be targeted to them.

An age-matched case-control analysis was performed from a cohort study in Baltimore, 1997-1999, of street-recruited non-injection and injection drug users (IDUs), ages 15 to 30. Cases were IDUs injecting less than or equal to two years. Controls were age-matched persons who used non-injection heroin, cocaine or crack.

At baseline, all were interviewed about prior year-by-year behaviors; analysis using conditional logistic regression was based on information for the year prior to injection onset for the case and the same calendar time for the controls as well as recent behaviors for both groups.

Of 270 participants, most were African American (78 percent), female (61 percent), and HIV seroprevalence was 7 percent at baseline. IDUs were significantly more likely than controls to be non-African-American (adjusted odds ratio (AOR) = 0.09) and report high school dropout (AOR = 2.32), early sex-trading (AOR = 2.72), and recent violence victimization (AOR = 9.28).

The authors concluded that new injectors are at high-risk for HIV and hepatitis, yet are difficult to reach for prevention efforts. The data suggest categories that could be used to target non-injectors who are likely to transition into injection use.

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