Pubdate: Wed, 01 Jan 2003
Source: Journal Of Acquired Immune Deficiency Syndromes (PA)
Issue: Volume 32, Number 1, Pages 86-93
Copyright: 2003 Lippincott Williams & Wilkins
Contact:  http://www.jaids.com/
Details: http://www.mapinc.org/media/2670
Authors: Crystal M. Fuller, David Vlahov, Carl A. Latkin, Danielle C. 
Ompad, David D. Celentano, Steffanie A. Strathdee

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

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."

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."