Community Characteristics Associated with HIV Risk among Injection Drug Users in the San Francisco Bay Area: A Multilevel Analysis

Abstract

Community characteristics have been associated with racial and ethnic health disparities for a wide range of ailments and conditions. Previous research has found that rates of AIDS cases among injection drug users (IDUs) vary by community characteristics. However, few studies have examined whether community characteristics are associated with HIV risk behaviors among IDUs. To address this gap in the literature, we examined the associations between census-tract-level community characteristics and injection-related and sex-related HIV risk behaviors among IDUs in the San Francisco Bay Area. Individual HIV risk behaviors were collected from 4,956 IDUs between 1998 and 2002. Using 2000 US census data, we constructed four census-level community measures: percent African American, percent male unemployment, percent of households that receive public assistance, and median household income. All community variables were measured continuously. Multilevel modeling was used to determine if community characteristics were associated with recent (in the last 6 months) receptive and distributive syringe sharing, multiple sex partners, and unprotected sex risk while controlling for potential individual-level confounders. In bivariate analysis, most of the census-tract-level community characteristics were significantly associated with injection-related HIV risk, while no community characteristics were associated with sex-related risk. However, results from multivariate multilevel models indicate that only percent African American in a census tract was associated with receptive [adjusted odds ratio (AOR) = 0.93; 95% confidence interval (CI) = 0.89, 0.99] and distributive syringe sharing (AOR = 0.94; 95% CI = 0.92, 0.99), net of individual-level characteristics. Accounting for individual-level factors in the multivariate model in the sex-related risk models revealed a significant inverse relationship between percent African American and propensity to engage in unprotected sex (AOR = 0.95; 95% CI = 0.92, 0.99); community-level characteristics remained unassociated with multiple sex partners. In this exploratory analysis, percent African American in a census tract was inversely associated with injection-related risk. The census-tract-level community characteristics we examined seem to exert little influence on individual risk among long-term chronic IDUs. More research is needed examining the influence of other community characteristics that were unmeasured in this paper but might be related to sex and drug risk among IDUs such as shooting galleries, crack houses, drug markets, and availability of preventive HIV services.

Association between neighbourhood socioeconomic characteristics and high-risk injection behaviour amongst injection drug users living in inner and other city areas in Montréal, Canada

“…While it is not unexpected that residing in areas with high concentrations of low income households would be associated with HRIB (Bluthenthal et al, 2007;Buchanan et al, 2003;Galea et al, 2003), we also found that higher neighbourhood educational attainment was associated with greater odds of HRIB, accounting for individual characteristics. One plausible explanation for this discordant latter finding is a possible tension between inner-city IDUs and university educated close neighbours which could adversely shape IDUs' behaviours, thus counteracting any potential advantages associated with high education concentration in a neighbourhood.…”

“…In American cities, individual injection drug use patterns were found to be associated with living in an economically disadvantaged neighbourhood and/or a low educational attainment neighbourhood (Bluthenthal et al, 2007;Buchanan et al, 2003;Fuller et al, 2005;Galea et al, 2003). Other research indicates that neighbourhood income is more strongly related to the health of low income residents than that of the more advantaged (Boardman et al, 2001;Stafford & Marmot, 2003).…”

Spatial Access to Sterile Syringes and the Odds of Injecting with an Unsterile Syringe among Injectors: A Longitudinal Multilevel Study

“…Past research has concluded that local racial/ethnic composition is related to the odds that an individual will engage in RSS. 52 We analyzed US census data to calculate the percent of district residents who were non-Hispanic White during each year of the study period.…”

A Call to Action for More Effective Preventative Care Strategies for HIV in Men Having Sex with Men (MSM): A Combined Computational Model and Qualitative Analysis

“…Many factors lead to an increasing drug use. Studies have found that prevalent drug use is related to demographic and socioeconomic strategies [11]. For instance, they showed more precise correlations between community characteristics and HIV infection among individuals with injecting drug use than their individual behaviors.…”