Benny J. Kottiri

Risk networks and racial/ethnic differences in the prevalence of HIV infection among injection drug users

Studies among injection drug users (IDUs) find a higher prevalence of HIV infection among black and Puerto Rican IDUs than among white IDUs. Risk behaviors seldom explain these differences. We examine how risk networks contribute to racial/ethnic variations in HIV prevalence. Six hundred sixty-two IDUs were recruited on the street in Bushwick (New York City), interviewed, and tested for HIV. Risk behaviors and networks were analyzed to explain racial/ethnic variations in HIV. Forty percent of IDUs were infected with HIV. HIV prevalence was greater for Puerto Ricans (45%) and blacks (44%) than for whites (32%). Egocentric sexual and drug risk networks were predominantly racially/ethnically homogeneous. After multivariate adjustments for risk behaviors and risk networks, black-white differences in HIV prevalence were no longer significant. Although differences between Puerto Ricans and whites persisted, post hoc analyses suggested that network partner characteristics might explain these differences. In Bushwick, racially/ethnically discordant risk partnerships involving black IDUs may function as potential bridges of transmission between groups.

Stigmatized drug use, sexual partner concurrency, and other sex risk network and behavior characteristics of 18- to 24-year-old youth in a high-risk neighborhood.

Background Sex risks and drug use are related. This relation in youth is described. Goal To determine how stigmatized drug use is related to sexual risk behaviors and network characteristics among youth. Study Design In-person interviews were conducted with both a probability household sample (n = 363) and a targeted, street-recruited sample of cocaine, heroin, crack, or injected drug users (n - 165) comprising 18- to 24-year-olds in an inner city neighborhood. Drug use in the preceding 12 months was scaled hierarchically, lowest to highest social stigma, as none, marijuana, noninjected cocaine, noninjected heroin, crack, and injected drugs. Results Users of the more stigmatized drugs had more sex partners. They were more likely to report a history of concurrent sex partners, sex with someone who also had engaged in sex with a network member, commercial sex work, and unprotected sex. Findings showed crack use and drug injection to be associated more strongly with increased sex risk among women than among men. Conclusions Young users of the more stigmatized drugs are at much greater network and behavior risk for sexually transmitted diseases. Drug use prevention, harm reduction interventions, or both may lower this risk.

Prevalence of HIV in the US household population: the National Health and Nutrition Examination Surveys, 1988 to 2002.

Summary: To examine trends in HIV prevalence in the US household population, serum or urine samples from 2 National Health and Nutrition Examinations Surveys (NHANES) (1988-1994 and 1999-2002), were tested for HIV antibody. In the 1999 to 2002 survey, data on risk behaviors, CD4 T lymphocytes, and antiretroviral therapy (ART) were also available. In the 1988 to 1994 survey, there were 59 positive individuals of 11,203 tested. In NHANES 1999 to 2002, there were 32 positive individuals of 5926 tested. The prevalence of HIV infection among those aged 18 to 39 years in NHANES 1988 to 1994 was 0.38% (95% confidence interval [CI]: 0.22-0.68) as compared with 0.37% (95% CI: 0.17 to 0.80) in 1999 to 2002. Prevalence did not change significantly between surveys in any race and/or ethnic or gender group among 18- to 39-year-old participants. HIV prevalence was 3.58% (95% CI: 1.88 to 6.71) among non-Hispanic blacks in the 40- to 49-year-old age group in 1999 to 2002, but the age range available in NHANES 1988 to 1994 was 18 to 59 years and does not allow direct comparison of prevalence. Cocaine use and the presence of herpes simplex virus-2 antibody were the only significant risk factors for HIV infection for non-Hispanic blacks. Fifty-eight percent of infected individuals not reporting ART had CD4 T-lymphocyte counts <200 cells/mm3 compared with 18.2% on therapy and 12.5% of participants newly informed of their HIV status.

Prevalence and correlates of anal sex with men among young adult women in an inner city minority neighborhood

In a population-representative sample of 202 18-24-year-old women in a neighborhood with widespread injection of drugs and HIV, 14% reported unprotected anal sex with men in the past year. Independent significant predictors were illegal drug use, having a main partner who takes the lead in deciding what to do during sex, and less self-deception. Having ever had anal sex was associated with having ever been infected with hepatitis B.

HIV risk networks and HIV transmission among injecting drug users

Abstract The objective of this study was to demonstrate how injecting drug users’ (IDUs) HIV risk networks affect their risk for infection with HIV and influence their HIV risk behaviors. Concepts utilized in a network approach were specified. These concepts included: (1) the distinction between risk networks (the people with or among whom IDUs—or others at risk of infection with HIV—engage in HIV risk behaviors) and social influence networks (the people who shape each others behavior), (2) the extent to which risk networks and social influence networks overlap, and (3) three levels of network analysis, i.e. the dyad, personal networks, and sociometric networks. The role of IDUs’ risk networks in the transmission of HIV and their influence on promoting and preventing HIV risk behaviors were illustrated by reviewing studies of IDUs in New York City as well as other locations. Conclusions indicate that the network approach is a developing area in research on the relationship between injecting drug use and HIV risk. This approach provides a basis for deepening our understanding of this relationship, and could increase our ability to prevent the further spread of HIV among IDUs as well as their sex partners.

Consistent condom use among drug-using youth in a high HIV-risk neighbourhood.

Abstract The objectives of this study were to determine predictors of consistent condom use in heterosexual relationships of young adults who use hard drugs in a neigbourhood with widespread drug-use-connected HIV. We interviewed 196 18–24 year olds who injected drugs or used heroin, cocaine or crack in the prior year and lived in the Bushwick neighbourhood of New York City.Interviews covered sociodemographics, substance use and sexual networks. The unit of analysis is the relationship; the dependent variable measures consistent condom use over the prior 30 days in a given relationship. Consistent condom use was reported in 26% of 377 non-commercial relationships and in all of 22 commercial relationships. Using multiple logistic regression, consistent condom use in non-commercial relationships was more likely in relationships that are not ‘very close’; for men (but not women) with peers whose norms are more favourable to condom use; and for subjects who had concurrent sex partners in the last 12 months. In conclusion, we found that: (1) the lack of relationship between the peer norms of drug-using women and their condom use suggests they may have little control over condom use in their relationships—programmes should attempt to empower young women drug users and to develop ways for their peers to influence the men in their lives; (2) epidemiologically, the positive association of concurrency to consistent condom use suggests that condom use may be restricting HIV spread through the community—the presence of consistent condom use in all of the commercial sexual relationships also may restrict HIVspread; (3) prevention efforts should attempt to change peer cultures as a way to develop self-sustaining risk reduction. These changes should include changes in gender roles and power relations.

A community-based study of hepatitis B infection and immunization among young adults in a high-drug-use neighborhood in New York City

We conducted a community-based study of the prevalence and correlates of hepatitis B virus (HBV) infection and immunization among young adults in a “drug supermarket” neighborhood in New York City. Four hundred eighty-nine young adults ages 18–24 years were recruited from Bushwick, Brooklyn through multistage household probability sampling (n=332) and targeted sampling (n=157), interviewed, and tested for three hepatitis B markers (HBsAg, anti-HBc, and anti-HBs). Serological evidence of HBV infection was found in 8.0% (6.0% in the household sample and 12.1% in the targeted sample) and of hepatitis B immunization in 19.6% (22.6% in the household sample and 13.4% in the targeted sample). HBV infection was higher among young adults who either used crack or injected drugs and among those who traded sex for money or drugs. Having Medicaid was significantly associated with lower odds of infection in the household sample and higher odds of immunization in the targeted sample. Although adolescent hepatitis B immunization has been a public health priority in the United States since 1995, nearly three-quarters of young adults in this community did not have serological evidence of being either exposed or immunized. Whereas subsequent younger generations benefited from universal childhood hepatitis B immunization, this particular cohort of young adults who live in communities like Bushwick presents a unique group for prevention intervention.