Control over Drug Acquisition, Preparation, and Injection: Implications for HIV and HCV Risk among Young Female Injection Drug Users

Karla D Wagner,Susan Dodi Hathazi,Jennifer Jackson Bloom,Bill Sanders,Stephen E Lankenau

doi:10.1155/2013/289012

Abstract

Young female injection drug users (IDUs) are at risk for HIV/HCV, and initiating the use of a new drug may confer additional and unexpected risks. While gender differences in the social context of injection drug use have been identified, it is unknown whether those differences persist during the initiation of a new drug. This mixed-methods study examined the accounts of 30 young female IDUs in Los Angeles, CA, USA from 2004 to 2006, who described the social context of initiating injection drug use and initiating ketamine injection. The analysis aimed to understand how the social context of young women's injection events contributes to HIV/HCV risk. Women's initiation into ketamine injection occurred approximately 2 years after their first injection of any drug. Over that time, women experienced changes in some aspects of the social context of drug injection, including the size and composition of the using group. A significant proportion of women described injection events characterized by a lack of control over the acquisition, preparation, and injection of drugs, as well as reliance on friends and sexual partners. Findings suggest that lack of control over drug acquisition, preparation, and injection may elevate women's risk; these phenomena should be considered as a behavioral risk factor when designing interventions.

Highlights

Though considerable declines in new HIV infections have been observed since the late 1980s, injection drug use continues to account for an estimated 12% of incident HIV infections in the United States [1]
While sometimes addressed as separate risk factors in various reports, this study examines five interrelated features of the social context of injection drug use that may have implications for increased risk of exposure to HIV and HCV among young female injection drug users (IDUs): characteristics of the using group, control over access to drugs, control over access to injection paraphernalia, control over preparation of drugs, and control over injection of drugs
We examine implications for HIV/HCV risk and identify opportunity for risk reduction and targeted HIV and HCV prevention interventions among young female IDUs

Summary

Introduction

Though considerable declines in new HIV infections have been observed since the late 1980s, injection drug use continues to account for an estimated 12% of incident HIV infections in the United States [1]. The social context of injection drug use has been shown to differ for men and women, which has been posited to explain gender differences in risk for HIV/HCV infection among IDUs [3, 4]. These social differences include the role relation of the injecting partner (women more frequently use drugs with individuals with whom they have a relationship, usually a sex partner [5]); the drug use behavior of women’s social network contacts (female IDUs’ social networks tend to have more “hard drug” users (e.g., heroin and cocaine) and IDUs than male IDUs’ networks [4]); and the greater degree to which women’s drug, sex, and friend networks overlap [3, 6]. Not feeling in control over the injection event has been associated with unsafe injection practices among women [11], and HIV infection has been shown to be almost twice as high among drug users who require help injecting [12]

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Discussion

Conclusion