The micro-social risk environment for injection drug use: An event specific analysis of dyadic, situational, and network predictors of injection risk behavior

Abstract

Background This study explores the risk environment for drug use by examining injection risk behavior during specific injection episodes. By leveraging multiple observations of injection episodes of participants, the study attempts to move beyond global assessment of environmental variables to simultaneously model within (i.e., event level) as well as between (i.e., individual level) predictors of injection risk. Furthermore, gender is also explored as a potential moderator of the relationship between the association of specific partner characteristics (e.g., having an injection partner who is also a sexual partner) and injection risk behavior. Methods Data is used from the Sexual Acquisition of Transmission of HIV Cooperative Agreement Study (SATHCAP). Multilevel structural equation modeling is utilized to predict within and between variations in underlying injection risk behavior as measured using four indicators of injection risk. Results Results indicated that a number of partner level characteristics (i.e., being emotionally close with the partner, sexual partnership, being a first time partner) and one social situational (i.e., the number of non-injectors present at the injection episode) characteristic predicted event level injection risk behavior. However, the impact of partner characteristics also appears to be moderated by gender of the participants. More specifically, sharing a sexual partnership with an injection partner was more strongly associated with injection risk among females as compared to males and females indicated higher levels of risk when injecting with other females while the partner’s gender showed no significant association with risk for male injectors. Conclusion These results suggest that people who inject drug do report varying levels of risk during different injection episodes and this variation can be explained by partner and situational characteristics. Improved understanding of the social processes surrounding injection episodes is required to further refine harm reduction approaches.

Gender, Transience, Network Partnerships and Risky Sexual Practices Among Young Persons who Inject Drugs

“…Our study did not collect event-level data on specific sexual encounters, but these types of data are important for a more nuanced understanding of the contribution of individual and contextual characteristics to risk behaviors within various relational contexts. Recent work by Janulis found significant within-person variation in injection risk behavior across injection episodes, suggesting the importance of partner and contextual factors in predicting injection risk, although this variation was incompletely explained by differences in partner characteristics and situational factors measured in that study (37). More detailed characterization of the types and quality of relationships with different partners, as well as event-specific injection contexts, may help to clarify relationship and contextual influences on event-level and global individual risk behaviors.…”

Influence of social network on drug use among clients of methadone maintenance treatment centers in Kunming, China

“…Given that limited studies have been conducted on social networks among MMT clients, especially in Kunming, the capital city of Yunnan province, an area in the southwest of China where HIV/AIDS transmission is a growing concern [ 5 ], the present study characterizes MMT clients’ social network and describes its relationship with current drug use behaviors. Understanding the characteristics of social networks of MMT clients and how they affect drug use behaviors will be useful for provincial governments to tailor strategies and preventive interventions to those with HIV/AIDS [ 22 , 34 – 38 ].…”

Social network predictors of recent and sustained injection drug use cessation: findings from a longitudinal cohort study

“…laws that restrict access to clean syringes or deter individuals from carrying drug paraphernalia, lack of (or inconvenient) access to clean syringes, economic instability and neighborhood disorder) [12][13][14] and network and relationship-level factors (i.e. injecting norms: trust, emotional closeness and intimacy between injecting partners) [14][15][16][17][18][19]. Longitudinal studies of PWID suggest that there are periods of persistent drug injection, injection cessation and relapse [20,21].…”