Designing studies to examine hepatitis C virus (HCV) transmission via the shared use of drug injection paraphernalia other than syringes is difficult because of saturation levels of HCV infection in most samples of injection drug users (IDUs). The authors measured the incidence of HCV infection in a large cohort of young IDUs from Chicago, Illinois, and determined the risk of HCV seroconversion associated with specific forms of sharing injection paraphernalia. From 1997 to 1999, serum samples obtained from 702 IDUs aged 18-30 years were screened for HCV antibodies; prevalence was 27%. Seronegative participants were tested for HCV antibodies at baseline, at 6 months, and at 12 months. During 290 person-years of follow-up, 29 participants seroconverted (incidence: 10.0/100 person-years). The adjusted relative hazard of seroconversion, controlling for demographic and drug-use covariates, was highest for sharing "cookers" (relative hazard = 4.1, 95% confidence interval: 1.4, 11.8), followed by sharing cotton filters (relative hazard = 2.4, 95% confidence interval: 1.1, 5.0). Risks associated with syringe-sharing and sharing of rinse water were elevated but not significant. After adjustment for syringe-sharing, sharing cookers remained the strongest predictor of seroconversion (relative hazard = 3.5, 95% confidence interval: 1.3, 9.9). The authors conclude that sharing of injection equipment other than syringes may be an important cause of HCV transmission between IDUs.

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Purpose-To (a) characterize human immunodeficiency virus (HIV)-related risk behaviors of homeless youth; (b) determine whether substance use is associated with risky sexual behavior in this population; and, if so, (c) explore explanations for this relationship.Methods-A purposive sample of 327 homeless youth (ages 14-21 years) in Washington, DC, were surveyed in 1995 and 1996. Survey items were adapted from items used in a national study of adult substance use and sexual behavior and measured global (lifetime) and event-specific (most recent sexual encounter) behaviors.Results-Sexual activity with many partners, "survival" sex, and substance use were common. However, needle use was rare, and consistent condom use was evident in half the sample. Nearly all correlations between global measures of substance use and risky sex were statistically significant, but only a few of the event-specific correlations were significant. Marijuana use during the most recent sexual encounter was associated with nonuse of condoms, but this relationship disappeared in the multivariate model. However, crack use during the last encounter was associated with condom use; this relationship remained significant in the multivariate model. Lack of motivation to use condoms, longer histories of sexual activity and homelessness, symptoms of drug dependency, not discussing HIV risks with partner, and being female were also associated with nonuse of condoms.Conclusions-Homeless youth do use condoms, even within the context of substance use and casual sex. Results suggest that prevention and targeted intervention efforts have had some positive effect on this population, but young homeless women are in need of targeted prevention. Finally, additional research is needed to investigate the observed relationship between crack use and condom use in this sample. KeywordsDrug use; Alcohol use; High-risk sexual behavior; HIV; AIDS; Homeless youth; Adolescents; Condom use; Event-level relationships; Gender differences Since the discovery of human immunodeficiency virus (HIV) 15 years ago, effective prevention remains the greatest hope for arresting its spread. To this end, research has focused on identifying the specific populations for targeting interventions, as well as the behavioral, situational, and cultural factors that influence sexual behaviors and may be amenable to intervention.© Society for Adolescent Medicine, 1998 Address reprint requests to: Dr. Susan L. Bailey, Department of Psychiatry, Pittsburgh Adolescent Alcohol Research Center, University of Pittsburgh, 3811 O'Hara Street, Pittsburgh, PA 15213. NIH Public AccessAuthor Manuscript J Adolesc Health. Author manuscript; available in PMC 2010 June 9. Published in final edited form as:J Adolesc Health. 1998 December ; 23(6): 378-388. NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author ManuscriptThe use of alcohol or drugs in conjunction with sex is commonly believed to lead to sexual risk taking, but empirical studies of the associations between substance use and high-r...

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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.