Susan L. Bailey

Childhood sexual abuse and age at initiation of injection drug use

OBJECTIVES We examined the relation between childhood sexual abuse and injection drug use initiation among young adult injection drug users. METHODS We used mixed effect linear models to compare age at first injection among 2143 young injection drug users by first sexual abuse age categories. RESULTS The participants were predominantly male (63.3%) and White (52.8%). Mean age and age at first injection were 23.7 and 19.6 years, respectively; 307 participants (14.3%) reported childhood sexual abuse. After adjustment for gender, race/ethnicity, noninjection drug use before first injection drug use, and recruitment site, childhood sexual abuse was independently associated with younger age at first injection. CONCLUSIONS Childhood sexual abuse was associated with earlier initiation of injection drug use. These data emphasize the need to integrate substance abuse prevention with postvictimization services for children and adolescents.

Adolescents' multisubstance use patterns : the role of heavy alcohol and cigarette use

OBJECTIVES Knowledge about the roles that heavy alcohol and cigarette use play in patterns of concurrent substance use among adolescents is lacking despite studies showing that adolescent substance users are typically multisubstance users and that alcohol and cigarettes are commonly used heavily by those who use illicit substances. METHODS The roles of increasing use and heavy first-time use of alcohol and cigarettes in multisubstance use patterns were examined in a cohort of 4192 secondary students who were surveyed three times over a 4-year period. RESULTS When subsequent use patterns were compared for students who increased their levels of alcohol or cigarette use and those who initiated use for the first time but at heavy frequencies, analyses indicated that the former group was more likely to initiate the subsequent use of other substances and to maintain and increase use already initiated. CONCLUSIONS These results suggest that adolescents are likely to have been involved in a history of licit substance use characterized by increasing levels of use before progressing to and maintaining the use of other substances. Increasing frequencies of alcohol and cigarette use, therefore, may be markers for more serious patterns of substance use.

HIV Prevalence, Risk Behaviors, and High-Risk Sexual and Injection Networks Among Young Women Injectors Who Have Sex With Women

Women injection drug users who have sex with women (WSW IDUs) constitute 20% to 30% of American women IDUs.1 Compared with other women IDUs, WSW IDUs have higher HIV prevalence and incidence rates and a greater likelihood of engaging in high-risk injection and sexual practices with men.1–16 Previous reports suggested that WSW IDUs may be particularly likely to engage in drug injection and sex with men who have sex with men (MSM)1,2,5,6,9,17–19 and to be subordinated and isolated within drug users’ social milieus and more generally.1,20,21 Historical and generational factors may have changed some relationships as a consequence of the HIV epidemic itself, however. Ethnographic data from New York City and Boston, Mass, suggest that many older MSM IDUs and WSW IDUs who injected drugs together may have died earlier in the epidemic, which might reduce the extent to which WSW IDUs currently engage in drug injection and sex with MSM. To further examine HIV risk among WSW IDUs, we compared social situations, injection and sexual networks, and behaviors of young WSW IDUs with those of other young women IDUs.

Injection-related risk behaviors in young urban and suburban injection drug users in Chicago (1997-1999).

Summary: We compared injection‐related risk practices between urban and suburban injection drug users (IDUs) in a large cross‐sectional sample of young IDUs. From 1997 to 1999, we recruited 700 active IDUs aged 18 to 30 years in Chicago and its suburbs. A suburban residence was reported by 38% of participants. Participants were interviewed at four urban locations and screened for HIV and hepatitis C virus antibodies. Receptive sharing of syringes and other paraphernalia by urban and suburban IDUs in the preceding 6 months was compared using univariable and multivariable models. Sharing injection paraphernalia in the total sample was high, with 50% of participants reporting receptive syringe sharing and 70% reporting sharing cotton, cookers, and/or rinse water. After adjusting for demographic characteristics, injection settings, frequency, and duration of injection as well as ease of acquiring new syringes, suburban IDUs were significantly more likely than urban IDUs to share syringes (adjusted odds ratio = 1.7; 95% confidence interval: 1.1‐2.5); however, the likelihood of sharing cotton, cookers, or rinse water was roughly equal. Despite overall higher risk profiles among suburban IDUs, HIV and hepatitis C prevalence levels were significantly lower than among urban participants. Current high levels of injection risk behaviors in suburban groups represent a potential for rapid dissemination of infection.

HIV risk practices among needle exchange users and nonusers in Chicago.

ObjectivesTo assess associations between needle exchange program (NEP) use and drug injection risk practices. MethodsBetween 1997–2000, injecting drug users (IDUs) in Chicago were recruited from NEPs and an area with no NEP, interviewed about risk practices, and counseled and tested for HIV. The risk practices of “regular NEP users” —those who obtained at least half of their needles from an NEP (n = 558) —were compared with those of IDUs who did not use an NEP (n = 175). ResultsIn multivariate analysis, regular NEP users, compared with NEP nonusers, were less likely to receptively share needles (adjusted odds ratio [AOR], 0.30; 95% CI, 0.19–0.46); lend used needles (AOR, 0.47; 95% CI, 0.31–0.71); share cookers (AOR, 0.39; 95% CI, 0.25–0.61), cottons (AOR, 0.48; 95% CI, 0.32–0.72), or water (AOR, 0.41; 95% CI, 0.27–0.63); or use a needle for >1 injection (0.15; 95% CI, 0.08–0.27). Among those who shared needles, regular NEP users were significantly more likely to do so for a smaller proportion of injections, with fewer partners and persons socially closer, and to have always bleached used needles before injecting. ConclusionsRegular NEP use is associated with less frequent and lower risk HIV injection risk practices.

The use of needle exchange by young injection drug users.

This study analyzed factors associated with utilization of needle exchange programs (NEPs) by young injection drug users (IDUs). Between 1997–1999, 700 IDUs 18–30 years of age were surveyed in Chicago. The majority of study participants (65%) had not used an NEP in the 6 months preceding baseline. Frequent NEP users were least likely to share needles (odds ratio [OR] = 0.32; 95% CI = 0.19–0.54) or other injection equipment (OR = 0.51; CI = 0.30–0.85), or to reuse their own needles (OR = 0.25, CI = 0.13–0.45), and were most likely to use condoms with steady sex partners (OR = 2.95; CI = 1.56–5.56). This study found that while frequent NEP use was associated with less risk behavior, young IDUs used NEPs infrequently or not at all.

Changes in the sharing of drug injection equipment among street-recruited injection drug users in Chicago, Illinois, 1994-1996

This study examines changes in the multi-person use of drug injection paraphernalia during the mid-1990s, a time of increasing awareness of HIV transmission modes and availability of prevention programs. Beginning in 1994, 794 street-recruited injection drug users in Chicago were interviewed and followed at 6 and 12 months postbaseline. Random-effects, pattern-mixture logistic regression models were used to determine correlates of five injection-equipment sharing practices, while accounting for repeated measurement and study attrition. At baseline, 45.7% of participants reported receptive syringe sharing in the previous 6 months. Syringe-mediated sharing was reported by 28.7% of participants and the sharing of cookers (65.1%), cotton filters (55.7%), and rinse water (46.9%) was common. During follow-up, the proportion of all sharing behaviors decreased significantly, especially receptive syringe sharing. Participation in a syringe exchange program was associated with reductions in receptive syringe sharing and syringe-mediated sharing, but not the sharing of cookers.

Prevalence and incidence of HIV among out-of-treatment injecting drug users, Chicago 1994-1996.

Objectives: To assess HIV prevalence, incidence, and associated risk factors among IDUs in Chicago. Methods: Seven hundred ninety‐four street‐recruited IDUs ranging in age from 18 to 50 years, who were not in drug treatment at study enrollment, were interviewed and tested for HIV at baseline and at two follow‐ups scheduled 6 and 12 months after baseline. Questionnaires assessed respondents’ demographic characteristics, medical and drug treatment histories, drug use, and sexual practices. Results: HIV seroprevalence at baseline was 18%. Logistic regression identified the following determinants of prevalent HIV infection: Puerto Rican ethnicity, homosexual or bisexual self‐identification, injecting for 4 or more years, and having smoked crack cocaine in the past 6 months. Follow‐up data were collected from 584 (73.6%) participants. Mean duration of follow‐up was 16.5 months, indicating that most subjects had follow‐up intervals longer than the scheduled 6 and 12 months. Seven HIV seroconversions were observed in 632 person years of risk, yielding an incidence rate of 1.1 per 100 person years of risk. Injection for 3 or less years was positively associated with HIV seroconversion. Conclusions: The findings provide evidence of a decline in HIV incidence among IDUs, though newer injectors remain at elevated risk for infection.

The multiperson use of non-syringe injection equipment and risk of hepatitis c infection in a cohort of young adult injection drug users, chicago 1997–1999

PURPOSE: The possibility that hepatitis C virus (HCV) is transmitted via the multiperson use of injection paraphernalia other than syringes has been suggested, but epidemiologic studies to examine the association are difficult to design due to saturation levels of infection in most samples of injection drug users (IDUs). This study (1) assembled a sample of young adult IDUs, among whom hepatitis C infection prevalence was still moderate, (2) measured incident HCV infection, and (3) determined the risk for seroconversion associated with specific forms of sharing injection paraphernalia.METHODS: Between 1997 and 1999, 702 IDUs, 18-30 years old, were interviewed and screened for antibodies to HCV at baseline and at 6 and 12 months post-baseline. Participants were recruited through street outreach, advertising and chain-referral from ethnically diverse neighborhoods in metropolitan Chicago. Data were analyzed using standard survival statistical methods.RESULTS: HCV prevalence was 27% at enrollment. During 296.5 person-years of observation, we observed 37 HCV seroconversions (incidence: 12.5/100 person-years). The adjusted relative hazard (RH) of seroconversion, after controlling for demographic and drug use covariates, was highest for sharing cookers (RH, 3.58; 95% CI 1.47-8.70), followed by sharing rinse water (RH, 2.16; 95% CI 1.03-4.52), and cottons (RH, 1.84; 95% CI 0.95-3.56). Risk associated with syringe sharing was marginally significant, and backloading was unassociated with hepatitis C seroconversion. Adjusting for syringe sharing, the independent effects of sharing cookers and cottons remained significant, and a final model that included each sharing practice demonstrated that sharing cookers had at the strongest association with seroconversion (RH, 3.03; 95% CI 1.05-8.72).CONCLUSIONS: This study suggests that sharing non-syringe paraphernalia may be an important cause of hepatitis C virus transmission between IDUs.