The social structural production of HIV risk among injecting drug users

Rhodes, Tim; Singer, Merrill; Bourgois, Philippe; Friedman, Samuel R.; Strathdee, Steffanie A.

doi:10.1016/j.socscimed.2004.12.024

Cited by 822 publications

(744 citation statements)

References 136 publications

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“…10,15,54 Thus, the development of interventions that impact the risk environment of drug-involved women and increase economic opportunity and independence are needed. 55 Race/ethnicity was not significantly associated with differences in unprotected sex. Prior research has found mixed results for the relationship between HIV risk and race/ethnicity.…”

Section: Discussionmentioning

confidence: 89%

Relationship Power and Sexual Risk among Women in Community-Based Substance Abuse Treatment

et al. 2009

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Relationship power has been highlighted as a major factor influencing women's safer sex practices. Little research, however, has specifically examined relationship power in drug-involved women, a population with increased risk for HIV transmission. Using baseline data from a National Institute on Drug Abuse Clinical Trials Network multisite trial of a women's HIV prevention intervention in communitybased drug treatment programs, this paper examined the association between sexual relationship power and unprotected vaginal or anal sex. The Sexual Relationship Power Scale, a measure of relationship control and decision-making dominance, was used to assess the association between power and unprotected sex in relationships with primary male partners. It was hypothesized that increased relationship power would be associated with decreased unprotected sexual occasions, after controlling for relevant empirical and theoretical covariates. Findings show a more complex picture of the association between power and sexual risk in this population, with a main effect in the hypothesized direction for decision-making dominance but not for relationship control. Possible explanations for these findings are discussed, and future research directions for examining power constructs and developing interventions targeting relationship power among drug-involved women are suggested.

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Section: Discussionmentioning

confidence: 89%

Relationship Power and Sexual Risk among Women in Community-Based Substance Abuse Treatment

et al. 2009

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“…In order to do so, more subjective elements of youth's residential situation will have to be considered and evaluated, namely youth's perception of their security, privacy, and autonomy. 16,25,61,62 As well, study findings stress the importance to longitudinally examine individual's housing trajectory and its link to engagement in risk behaviors in order to better understand the pathways of association between these two health determinants. Finally, the results underscore the need for health care providers and social service agencies to offer these vulnerable youth more integrated services addressing simultaneously their various health issues (drug use and mental health) and social problems (housing, security, schooling, and employment).…”

Section: Discussionmentioning

confidence: 98%

“…15 More recently, in relation to HIV, the concept of "risk environment" was put forward as being "the space, whether social or physical, in which a variety of factors exogenous to the individual interact to increase vulnerability to HIV." 16 Many studies of vulnerable individuals such as injection drug users and the homeless have shown that these factors have a significant influence on their health since they shape daily risk taking. 17,18 In this perspective, housing has been identified as a major determinant that could both directly and indirectly fashion an individual's physical and mental health through his or her involvement in high-risk behaviors.…”

Section: Introductionmentioning

confidence: 99%

Residential Trajectory and HIV High-Risk Behaviors among Montréal Street Youth—A Reciprocal Relationship

et al. 2011

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Evidence has linked residential instability and engagement in high-risk behaviors. This paper longitudinally examines the relationship between changes in residential stability and changes in HIV risk behaviors among Montréal street youth (SY). Between April 2006 and May 2007, 419 SY (18-25 years old) were recruited in a cohort study. SY (using Montréal street youth agencies services) were eligible if they had had at least one 24-hour episode of homelessness in the previous 30 days. Baseline and follow-up interviews, carried out every 3 months, included completion of a questionnaire (based on Life History Calendar Technique) assessing daily sleeping arrangements since the last interview, and monthly sexual and drug use behaviors. Using mixed-effects logistic regression method, we examined the association between various risk behaviors and residential stability, reached when a youth resided in any of the following settings for a whole month: own place; friends'/partner's/parent's place; any types of housing service (excluding emergency shelters). Analyses were carried out controlling for gender, age, education level, lifetime duration of homelessness, childhood sexual trauma, and lifetime mental health disorders. This calls for more integrated services combining both individual and structural-level interventions to improve the health of street youth.

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“…The DTES in Vancouver is one of the most economically disadvantaged neighbourhoods in Canada, and as such has the lowest per capita income of any urban region in the country (Statistics Canada, 1996). Homelessness, a common feature of this and many other impoverished neighbourhoods, has been recognized as a major determinant of poor health among IDU, including an elevated risk of HIV infection (Fisher et al, 1995;Rhodes et al, 2005;Zolopa et al, 1994). The observed association between homelessness and violence may be attributed to a variety of factors.…”

Section: Discussionmentioning

confidence: 99%

“…Risk environment theory posits that the physical, social, economic, and policy environments in which drug use takes place structures and shapes the production and re-production of HIV risk (Rhodes, 2002). Given that this theory has been used effectively to conceptualize the multifactorial influences that produce HIV risk among IDU (Rhodes et al, 2005), a similar approach may be useful for describing the "risk environment" factors that structure susceptibility to physical violence among this population.…”

Section: Introductionmentioning

confidence: 99%

Physical violence among a prospective cohort of injection drug users: A gender-focused approach

Marshall

Fairbairn

et al. 2008

Drug and Alcohol Dependence

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Although dramatically heightened rates of violence have been observed among injection drug users (IDU), little is known about the gender differences associated with violence among this population. Employing a risk environment framework, we performed an analysis of the factors associated with experiencing violence among participants enrolled in a prospective cohort study of IDU during the years 1996-2005 using generalized estimating equations (GEE). Among 1114 individuals, 291 (66%) of females and 470 (70%) of males reported experiencing violence during the study period. In multivariate analyses, mental illness, frequent alcohol use, frequent crack use, homelessness, Downtown Eastside residency, and requiring help injecting were positively associated with experiencing violence for both sexes (all p < 0.05). For females, binge drug use (AOR = 1.30) and drug dealing (AOR = 1.42) were positively associated with violence, while younger age (AOR = 1.02), frequent heroin injection (AOR = 1.24), and incarceration (AOR = 1.50) were significant for males. Women were more likely to be attacked by acquaintances, partners, and sex trade clients, while men were more likely to experience violence from strangers and the police. These findings indicate that susceptibility to violence among IDU is structured by environmental factors such as homelessness and drug-related factors such as frequent alcohol use and involvement in drug economies. Furthermore, important gender differences with respect to the predictors and characteristics of violent attacks do exist. These findings indicate an urgent need for the development of comprehensive programs and structural interventions that take a gender-focused approach to violence among IDU.

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The social structural production of HIV risk among injecting drug users

Cited by 822 publications

References 136 publications

Relationship Power and Sexual Risk among Women in Community-Based Substance Abuse Treatment

Relationship Power and Sexual Risk among Women in Community-Based Substance Abuse Treatment

Residential Trajectory and HIV High-Risk Behaviors among Montréal Street Youth—A Reciprocal Relationship

Physical violence among a prospective cohort of injection drug users: A gender-focused approach

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