Social Circumstances of Initiation of Injection Drug Use and Early Shooting Gallery Attendance: Implication for HIV Intervention Among Adolescent and Young Adult Injection Drug Users
March 20, 2003
Studies of injection drug users (IDUs) have shown that young or recently initiated IDUs are at increased risk for HIV infection, and that young or recently initiated ("new") IDUs engage in high-risk sexual and injection practices. Rates of HBV and HCV infection have been shown to exceed 50 percent among IDUs even within the first two years of starting injection drug use. Although it has been hypothesized that young IDUs do not frequent shooting galleries (SGs) where multi-person use of injection equipment commonly occurs, the authors stated, "SGs should nevertheless be considered as high-risk settings for acquiring HIV and other blood-borne infections, because repackaging and selling of used injection equipment continues to take place in these settings."Adapted from:
Fuller and colleagues conducted a study to identify early high-risk practices and salient social circumstances associated with early SG attendance and HIV prevalence and incidence among new IDUs. They used baseline data from a prospective cohort study of 226 IDUs recruited into the Risk Evaluation and Assessment of Community Health [REACH II] study in Baltimore between July 1997 and May 1999. Eligible subjects were ages 15-30, had injected for up to five years prior to the study, and reported at least one injection in the six months before entering the study. The authors examined demographic characteristics including age, sex, race/ethnicity, education and juvenile arrest. Of the 226 subjects, 75 (33 percent) reported early SG attendance. Median age of participants was 25; 64 percent were African American; and 61 percent were female. More than half (62 percent) of the group had dropped out of high school and had not obtained a GED. One-fifth (20 percent) had been arrested as juveniles. Twenty-four participants tested seropositive for HIV antibody (11 percent).
Using multiple regression analysis, the authors found that early SG attendees were nearly three times more likely to be HIV-seropositive than subjects who had not attended SGs. Early attendees were also five times more likely to share injection equipment, over three times more likely to report a high-risk injection network soon after initiating injection, and twice as likely to be initiated by an older IDU, thus putting themselves at increased risk for HCV and HIV.
Twelve percent of the subjects identified as homosexual or bisexual. Female participants who identified themselves as lesbian or bisexual showed significantly higher early SG attendance than other female participants. Three male subjects identified themselves as gay or bisexual, and none reported early SG attendance.
"A major finding of this study was that new IDUs in Baltimore are in need of increased harm reduction strategies given their high incidence of HIV infection and lack of access to current harm reduction services," the authors wrote. They suggest that future research include quantitative and ethnographic studies of SGs "so that intervention strategies can be carefully tailored to specific neighborhoods and IDU communities ... Determining why and under what circumstances a new IDU would inject in a SG so soon after initiating injection drug use may be useful for designing programs aimed at this high-risk subgroup."
Journal of Acquired Immune Deficiency Syndromes
01.01.03; Vol. 32; No. 1: P. 86-93; Crystal M. Fuller; David Vlahov; Carl A. Latkin; Danielle C. Ompad; David D. Celentano; Steffanie A. Strathdee