The longitudinal association between homelessness, injection drug use, and injection-related risk behavior among persons with a history of injection drug use in Baltimore, MD

Abstract

Background Few studies have assessed the temporal association between homelessness and injection drug use, and injection-related risk behavior. Methods Among a cohort of 1,405 current and former injection drug users in follow-up from 2005–2009, we used random intercept models to assess the temporal association between homelessness and subsequent injection drug use, and to determine whether the association between homelessness and sustained injection drug use among active injectors differed from the association between homelessness and relapse among those who stopped injecting. We also assessed the association between homelessness and subsequent injection-related risk behavior among participants who injected drugs consecutively across two visits. Homelessness was categorized by duration: none, <1 month, and ≥1 month. Results Homelessness was reported on at least one occasion by 532 (38%) participants. The relationship between homelessness and subsequent injection drug use was different for active injectors and those who stopped injecting. Among those who stopped injecting, homelessness was associated with relapse [<1 month: AOR=1.67, 95% CI (1.01, 2.74); ≥1 month: AOR=1.34 95% CI (0.77, 2.33)]. Among active injectors, homelessness was not associated with sustained injection drug use [<1 month: AOR=1.03, 95% CI (0.71, 1.49); ≥1 month: AOR=0.81 95% CI (0.56, 1.17)]. Among those injecting drugs across two consecutive visits, homelessness ≥1 month was associated with subsequent injection-related risk behavior [AOR=1.61, 95% CI (1.06, 2.45)]. Conclusion Homelessness appears to be associated with relapse and injection-related risk behavior. Strengthening policies and interventions that prevent homelessness may reduce injection drug use and injection-related risk behaviors.

Homelessness and Other Risk Factors for HIV Infection in the Current Outbreak Among Injection Drug Users in Athens, Greece

“…21–23 Lack of housing has been related to development of substance abuse problems 24 ; subsequent injection-associated risk behaviors among IDUs in consecutive visits and relapse among people who had stopped injecting 25 ; visits to shooting galleries (i.e., sites featuring the sale and congregate use of injectable drugs) 26 ; membership in 2-core networks, which are associated with elevated HIV risk 27 ; and sharing of paraphernalia. 28–30 It has been suggested that homelessness and unstable housing are also associated with risky sexual behaviors such as inconsistent condom use and multiple sexual partners, 29,31 although evidence from another study did not support such an association.…”

Injecting risk behaviours following treatment for hepatitis C virus infection among people who inject drugs: The Australian Trial in Acute Hepatitis C

“…Potential factors hypothesised to be associated with recent injecting risk behaviours during follow-up were determined a priori based on factors previously shown to be associated with injecting risk behaviours or injecting drug use cessation. These factors included age (25, 26), gender (27, 28), owned/renal accommodation (26, 29–31), level of education (32), full-time or part-time employment (29, 30, 33), OST (34), social support (30) and injecting risk behaviour at enrolment (26, 29, 35, 36). …”

Differential Risk Factors for HIV Drug and Sex Risk-Taking Among Non-treatment-seeking Hospitalized Injection Drug Users

“…Of those who declined study participation, 47 did so because they were not interested in any form of opiate replacement therapy. The most common reasons for ineligibility included a pending legal case (n = 63), benzodiazepine dependence [55], the need for pain medication [50], behavioral issues [36], medical issues [28], and alcohol abuse [27]. Of the 150 who enrolled in the study, fourteen did not complete the baseline interview and were not randomized.…”

“…Alcohol abuse among IDUs has been associated with HIV sex risk behaviors such as unprotected sex and having multiple partners [7, 14, 23, 24], although this finding has not been replicated in all studies of drug-using populations [13]. Cocaine use has been found to increase HIV sex risk behaviors [13, 23, 25], Homelessness has been found to be associated with exchanging sex for drugs or money, or having sex with another IDUs in some studies of IDUs [26, 27], although not all studies have found a relationship between homelessness and unprotected sex among IDUs [28]. This suggests that the role of homelessness and HIV risk behaviors among IDUs is not consistent across study samples.…”