Risk environments and drug harms: A social science for harm reduction approach

Rhodes, Tim

doi:10.1016/j.drugpo.2008.10.003

Cited by 769 publications

(748 citation statements)

References 99 publications

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“…8,[28][29][30] The risk environment is defined as "…the space-whether social or physical-in which a variety of factors exogenous to the individual interact to affect the chances of HIV transmission." 8(p.1027) There are different types of factors (i.e., physical, social, economic, and policy) which operate on different levels (i.e., micro and macro).…”

Section: Seps and The Risk Environment: A Conceptual Modelmentioning

confidence: 99%

“…8(p.1027) There are different types of factors (i.e., physical, social, economic, and policy) which operate on different levels (i.e., micro and macro). 30 In areas where SEPs are legal, spatial access to syringes flowing from SEPs has been conceptualized as a protective micro-level policy factor. 30 This model posits that risk environments are produced by the interplay of many factors operating both within and across levels.…”

Section: Seps and The Risk Environment: A Conceptual Modelmentioning

confidence: 99%

“…30 In areas where SEPs are legal, spatial access to syringes flowing from SEPs has been conceptualized as a protective micro-level policy factor. 30 This model posits that risk environments are produced by the interplay of many factors operating both within and across levels. 8,[28][29][30] As discussed above, the impact of SEPs on injection practices may vary according to whether injectors personally go to SEP sites.…”

Section: Seps and The Risk Environment: A Conceptual Modelmentioning

confidence: 99%

“…30 This model posits that risk environments are produced by the interplay of many factors operating both within and across levels. 8,[28][29][30] As discussed above, the impact of SEPs on injection practices may vary according to whether injectors personally go to SEP sites. 19 Evidence suggests that at least three other factors may also interact with spatial access to syringes to shape injection practices:…”

Section: Seps and The Risk Environment: A Conceptual Modelmentioning

confidence: 99%

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

et al. 2012

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Despite the 2010 repeal of the ban on spending federal monies to fund syringe exchange programs (SEPs) in the USA, these interventions-and specifically SEP site locations-remain controversial. To further inform discussions about the location of SEP sites, this longitudinal multilevel study investigates the relationship between spatial access to sterile syringes distributed by SEPs in New York City (NYC) United Hospital Fund (UHF) districts and injecting with an unsterile syringe among injectors over time (1995)(1996)(1997)(1998)(1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006). Annual measures of spatial access to syringes in each UHF district (N = 42) were created using data on SEP site locations and site-specific syringe distribution data. Individual-level data on unsterile injecting among injectors (N = 4,067) living in these districts, and on individual-level covariates, were drawn from the Risk Factors study, an ongoing cross-sectional study of NYC drug users. We used multilevel models to explore the relationship of district-level access to syringes to the odds of injecting with an unsterile syringe in 975% of injection events in the past 6 months, and to test whether this relationship varied by district-level arrest rates (per 1,000 residents) for drug and drug paraphernalia possession. The relationship between district-level access to syringes and the odds of injecting with an unsterile syringe depended on district-level arrest rates. In districts with low baseline arrest rates, better syringe access was associated with a decline in the odds of frequently injecting with an unsterile syringe (AOR, 0.95). In districts with no baseline syringe access, higher arrest rates were associated with increased odds of frequently injecting with an unsterile syringe (AOR, 1.02) When both interventions were present, arrest rates eroded the protective effects of spatial access to syringes. Spatial access to syringes in small geographic areas appears to reduce the odds of injecting with an unsterile syringe among local injectors, and arrest rates elevate these odds. Policies and practices that curtail syringe flow in geographic areas (e.g., restrictions on SEP locations or syringe distribution) or that make it difficult for injectors to use the sterile syringes they have acquired may damage local injectors' efforts to reduce HIV transmission and other injection-related harms.

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Section: Seps and The Risk Environment: A Conceptual Modelmentioning

confidence: 99%

Section: Seps and The Risk Environment: A Conceptual Modelmentioning

confidence: 99%

Section: Seps and The Risk Environment: A Conceptual Modelmentioning

confidence: 99%

Section: Seps and The Risk Environment: A Conceptual Modelmentioning

confidence: 99%

See 2 more Smart Citations

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

et al. 2012

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“…36,37 The "risk environment" of drug users includes the complex interaction between micro (e.g., violence and drug use) and macro (e.g., neighborhood drug activity, drug use and distribution laws, and local law enforcement policies) environmental levels 38 which can lead to both violent victimization and high-risk sexual partnerships in drug users. Drug users may be more likely to be victims of violence due to participation in the illegal drug economy or in other illegal activities in order to buy drugs or get money to buy drugs.…”

Section: Discussionmentioning

confidence: 99%

Physical Victimization and High-Risk Sexual Partners among Illicit Drug-Using Heterosexual Men in New York City

et al. 2014

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Physical victimization has been linked to high-risk sexual partnerships in women. Although illicit drug-using heterosexual men are at high-risk of physical victimization, the association between violence and high-risk partners in heterosexual men has received little attention in the published literature. We examined the association between experience of severe physical victimization and acquisition of a high-risk sexual partner (i.e., a partner who injected drugs or participated in transactional sex) 1 year later among illicit drug-using men in New York City (2006-2009) using secondary cross-sectional data. Injection and non-injection drug-using men (n=280) provided a retrospectively recalled history of risk behavior and violence for each year over the past 4 years. Our primary outcome was acquisition of a high-risk sexual partner in any year following the baseline year. Our primary exposure was severe physical victimization (i.e., threatened with a knife or gun, beaten up, shot, or stabbed) in the prior year. Frequency of cocaine, heroin, and crack use and sexual victimization were also assessed. Log-binomial logistic regression with generalized estimating equation (GEE) methods was used to account for repeated measures for up to four time points. After adjustment for important covariates, participants that experienced physical victimization were significantly more likely to have acquired a high-risk sexual partner 1 year later (relative risk (RR), 3.73; 95 % confidence interval (CI), 1.55-8.97). Our study challenges gender-based stereotypes surrounding physical victimization and provides support for multidisciplinary programs that address both violence and HIV risk among illicit drugusing heterosexual men. KEYWORDS Physical victimization, Sexual risk behavior, Illicit drug users, Male victimsInjection drug users (IDUs) and non-injection drug users (non-IDUs) are at increased risk of being victims of physical violence compared to the general population. 1,2 In a substance abuse treatment sample, 61 % of men and 65 % of women reported being the victim of physical partner violence, and 75 % of men and 45 % of women reported physical victimization from a person other than an intimate partner in the past 12 months. 3 The HIV risk behaviors of an individual's sexual partners, in addition to condom use, have significant epidemiological implications for the Turner, Rivera, and Lewis are with the

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Applying Principles of Mindlessness‐Mindfulness Theory and Drug‐Injecting Behavior

Treloar¹

2014

The Wiley Blackwell Handbook of Mindfulness

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Risk environments and drug harms: A social science for harm reduction approach

Cited by 769 publications

References 99 publications

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

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

Physical Victimization and High-Risk Sexual Partners among Illicit Drug-Using Heterosexual Men in New York City

Applying Principles of Mindlessness‐Mindfulness Theory and Drug‐Injecting Behavior

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