‘It’s not what you know but who you know’: Role of social capital in predicting risky injection drug use behavior in a sample of people who inject drugs in Baltimore City

Abstract

Background Injection drug use is the third highest risk factor for HIV transmission. Injection drug users, marginalized population, continue to be at threat for several health problems, including HIV, Hepatitis B & C and drug overdose. The area of social capital and risk behaviors is understudied. The current study aims to prospectively assess the relationship between social capital and the risk behaviors associated with injection drug use. Methods The sample of the present study is a subset of 130 drug users who reported injection drug use (IDU) at both baseline and first follow-up wave for assessing the relationship between social capital and needle sharing in the city of Baltimore, MD. Factor analysis, structural equation modeling and multivariate logistic regression were conducted to explore these relationships. Results A single-factor model fit well with factor loadings ranging from .20 to .95. Social capital is shown to be significantly and inversely associated (p<.05) with 35% decreased odds of the risk of sharing needles with every unit increase in social capital (AOR: 0.65, 95% CI: 0.06, 0.84). Conclusion The result from this study can be used to inform and fill gaps in the field of harm reduction. The interplay between social support, social participation and norms of trust, reciprocity generated from the index’s social network and its relationship with behavior of needle sharing demonstrates that these leverage points should be emphasized in future harm reduction interventions.

Needle acquisition patterns, network risk and social capital among rural PWID in Puerto Rico

“…These findings support those of Kumar et al [ 11 ] and provide further evidence of complex dynamics in the social capital among PWID. We note that paying for a syringe from a seller or receiving one free from the same source, as well as finding one found on the street, are the only syringe sources that do not require an additional, non-financial resource—payment does not require relationships implied by other categories such as friends, relatives, or even consistent “running partners” (i.e., consistent co-users) or access to locations beyond those necessary to obtain drugs.…”

“…In the absence of a full range of choices, what may appear like modifiable behaviors may not be nearly so malleable. Rather than reading the results of this analysis as a reflection on individual choices, decisions, or behaviors [ 56 , 57 ]—an interpretation that would be possible only where everyone has equal access to all possible sources—we instead consider these results as a reflection of the social capital of rural PWID as it is expressed in their injection behaviors, including syringe acquisition [ 11 , 29 ].…”

“…Social connections have been implicated as an important source of social capital among PWID [ 58 – 61 ], including recent research that has drawn attention to what has been referred to (unfortunately) as “negative” social capital—patterns of connection that draw individuals into more high-risk situations [ 12 ]. In the latter case, risk-reducing connections such as those providing social support are balanced by other relationships with less salubrious outcomes [ 11 ]. In rural Puerto Rico, this relationship between having a high number of risk partners and lacking the means to obtain sufficient injection equipment seems to hold.…”

“…Under such conditions, syringe access sources do not necessarily reflect choices by drug users, at least in any strict sense. Rather, information on syringe access also (and perhaps only) points to ways in which access to sterile injection equipment may be decided by larger structural factors, such as syringe availability and the presence or absence of individual social capital [ 11 ]. In this sense, a focus on syringe sources may best be understood as a study of the extent to which the structural issues that govern users lives potentially limit their opportunities to engage in safe injection practices, putting the larger community of drug users (and the community in which those users are embedded) at risk of infection [ 12 ].…”

Social Networks of Substance-Using Populations: Key Issues and Promising New Approaches for HIV

“…Despite extensive research on the networks of substance-using populations, our understanding of how risk epidemiology, viral characteristics, and social determinants intersect with networks to shape HIV transmission continues to develop. New research supports the importance of network size [21], structure [22], bridging (i.e., ties connecting different groups) [23], clustering (i.e., nodes grouping together) [24], multiplexity (i.e., ties with multiple social connections, such as a sexual and drug use connection) [25][26][27], and social support and capital [28][29][30] for HIV risk behavior, transmission, viral suppression, HIV disclosure, and ART initiation. This work entails an expanded focus on populations that have historically received less attention, including research on the networks of non-injecting drug users [31,32], substance users in suburban and rural areas [22,31,[33][34][35][36], and the role of networks in newly emerging HIV outbreaks, both domestically [37][38][39] and globally [3,[40][41][42][43].…”