African American Users Research Articles

Racial differences in overdose events and polydrug detection in Indianapolis, Indiana

BackgroundWe examine racial disparities in drug overdose death rates by analyzing trends in fatal and nonfatal overdose outcomes in a large metropolitan area (Indianapolis, Indiana). MethodsDeath certificate and toxicology records for accidental drug overdose deaths from 2011 to 2018 were linked with emergency medical services (EMS) data. Bivariate comparisons examined differences in toxicology findings at the time of death as well as prior EMS events both overall and by indicator of non-fatal overdose. ResultsFrom 2011–2018, 2204 residents (29.4 per 100,000) died of drug overdose, 18.6% were Black (N = 410, 19.5 per 100,000) and 78.5% White (N = 1730, 35.2 per 100,000). In the year prior to death, 33.5% (N = 656) of decedents had an EMS event, 12.1% (N = 237) had an overdose event, and 9.4% (N = 185) had naloxone administered. Overdose complaint and naloxone administration were more likely to occur among White than Black patients. White decedents were more likely than Black decedents to have had naloxone administered in the year prior to death (10.1% vs. 6.8%, χ2 = 4.0, p < .05, Cramer’s V=.05). Toxicology data illustrate changing polydrug combinations, with Black decedents more likely to test positive for fentanyl-cocaine polydrug use in recent years. ConclusionsRecent racial disparities in overdose deaths are driven by a combination of fentanyl and cocaine, which disproportionally impacts African American drug users, but may be addressed through expanded harm reduction and community outreach services. Additionally, there is a need to assess the role of differing practices in overdose emergency service provision as a contributing factor to disparities.

MDMA (Ecstasy/Molly) Use Among African Americans: Patterns of Initiation

3,4-Methylenedioxymethamphetamine (MDMA; ecstasy/molly) use among African Americans has increased over the last two decades, yet there has been little examination into how African Americans initiate their use of the drug. This study aimed to fill this knowledge gap by exploring the initiation experiences of African Americans and their narrative accounts of the circumstances surrounding their MDMA onset. Audiotapes of in-depth interviews were transcribed, coded, and thematically analyzed. Analyses revealed the presence of initiation patterns that contrast somewhat with those found in other groups of MDMA users. This study adds to the limited research on African American MDMA use and sheds light on why some African Americans decide to start using the drug. The findings provide insights to prevention specialists, harm reduction workers, and treatment providers who work with African American drug users.

Motivations for Using MDMA (Ecstasy/Molly) among African Americans: Implications for Prevention and Harm-Reduction Programs

ABSTRACTDespite the growing popularity of MDMA (ecstasy/molly) among African Americans, their motives for using the drug are still largely unknown. The purpose of this study was to identify and describe the most salient motivations for using MDMA among this understudied population. In-depth interviews (n = 15) were conducted with a sample of African American young adults in Southwest Florida between August 2014 and November 2015. The primary motivations for using MDMA included: (1) altering the effects of marijuana and alcohol; (2) lasting longer sexually; (3) enhancing sexual pleasure; and (4) facilitating “freaky” sexual experiences. This is the first study to directly examine MDMA motivations specifically among African American drug users, and findings shed light on why some African Americans use MDMA. A better understanding of why African Americans use this drug should help to inform prevention and harm-reduction efforts. Study findings show the need for health messages that include the potential consequences of mixing MDMA with other drugs, and engaging in high-risk sexual behaviors after taking MDMA. These data contrast with motivations (e.g., introspection, self-enlightenment, getting into the music) commonly reported among groups of largely White MDMA users, suggesting that interventions tailored specifically for African American users are needed.

Sociodemographic and access-related correlates of health-care utilization among African American injection drug users: The BESURE study

ABSTRACTPersons who inject drugs (PWID) may have less access to, and utilization of, health-care services, and African American PWID may be less likely than other racial groups to utilize health care in the United States. The present study evaluated the prevalence of health-care utilization (HCU) among a cohort of African American PWID in Baltimore. Data were from the 2012 Baltimore National HIV Behavioral Surveillance study. Participants were adult PWID and recruited using respondent-driven sampling (RDS). They completed a comprehensive sociobehavioral survey and voluntary HIV test with trained study interviewers. Analyses included descriptive and bivariate statistics to examine the prevalence of HCU, defined as seeing a health-care provider in the past year. Poisson regression assessed correlates of HCU. Participants were 61% male; 23% self-reported HIV seropositivity. Nearly 90% reported unemployment and/or disability; HCU prevalence was 85%. Significant negative correlates of HCU included age and higher injection frequency; positive correlates included previous incarceration and moderate financial stability. Interaction analyses showed unemployed publicly insured individuals had 30% higher HCU than unemployed and uninsured individuals (χ2 = 2.52; p < .05). There is a need to improve health-care utilization among PWID. High prevalence of disability was still found, despite insurance coverage and access to care in this population. While the recent Affordable Care Act has increased health-care coverage and access, our results suggest that is only a first step to improving health outcomes among PWID; targeted intervention to integrate these individuals is still needed.

The differential role of executive dysfunction on HIV risk behaviors among African-American drug users

The differential role of executive dysfunction on HIV risk behaviors among African-American drug users

Preferences for professional versus informal care at end of life amongst African-American drug users with HIV/AIDS

With the advent of antiretroviral therapies, persons living with HIV/AIDS (PLHIVs) are living longer but with increased impairment and care needs. The purpose of this study was to assess whether a vulnerable population of PLHIVs preferred informal versus professional care when unable to care for themselves, and individual and support network factors associated with preference for informal care. The findings have potential implications for facilitating the population's informal care at end of life. Data were from the BEACON study, which examined social factors associated with health outcomes among former or current drug-using PLHIVs in Baltimore, MD. Structural equation modeling was used to identify individual and support network characteristics associated with PLHIVs' preference for informal (family or friends) compared to professional care. The structural equation model indicated preference for informal care was associated with female sex, greater informal care receipt, reporting one's main partner (i.e., boy/girlfriend or spouse) as the primary source of informal care, and a support network comprised greater numbers of female kin and persons supportive of the participant's HIV treatment adherence. Not asking for needed help to avoid owing favors was associated with preferring professional care. Findings suggest that interventions to promote informal end of life care should bolster supportive others' resources and skills for care provision and treatment adherence support, and should address perceived norms of reciprocity. Such intervention will help ensure community caregiving in a population with high needs for long-term care.

Differences in prevalence of HIV and HCV between blacks and whites based on patterns of injection and non-injection drug users in Baltimore City

s / Drug and Alcohol Dependence 140 (2014) e86–e168 e101 Differences in prevalence of HIV and HCV between blacks and whites based on patterns of injection and non-injection drug users in Baltimore City Larry Keen, W.W. Latimer Clinical and Health Psychology, University of Florida, Gainesville, FL, United States Aims: The current study examineddifferences in the prevalence of viral hepatitis C and HIV disease between Blacks and Whites adults in Baltimore City across three subtypes of drug users identified in previous research (Harrell et al., 2012): crack/nasal heroin users, heroin injectors, and polysubstance users. Methods: This study was a part of an ongoing NIDA-funded NEURO-HIV Epidemiologic study, a longitudinal study to identify neuropsychological and social-behavioral HIV risk factors among injection and non-injection drug users. Results: The subsample of 482 participants included 284 men (58.9%) and 198 women (41.1%). Approximately half of the participants self-identified as White (n=244), while the rest selfidentified as Black (n=238). There were significant differences between classes based on race (X2 (2, N=482) =97.84, p= .00) and HCV (X2 (2, N=482) =140.87, p= .00). Differences indicated that crack/nasal heroin users were predominantly Black (74.9%), while heroin injectors and polysubstance users were predominantly white (71.5% and 68.9%). Polysubstance users accounted for over half of the HCV positive diagnoses (56.5%) in Whites. Blacks HCV diagnoses were somewhat evenly spread across the groups. Though HIV did not differ significantly between groups, the Crack/Nasal Heroin contained over half (52.4%) of the 42 HIV positive diagnoses in the sample. Conclusions: Black drug users in this sample were characterized by significantly lower rates of IDU compared to whites. Since the vastmajority of the current sample is heterosexual, the findings suggest heterosexual sex as the primary mode of HIV transmission for Black drug users. In contrast,White drug usersweremore prone to HCV compared to Black drug users, which is attributable to their higher rate of IDU. The current study findings provide further support that heterosexual transmission of HIV is a primary vector of disease transmission among African American drug users who predominantly do not inject drugs and thereby may help to inform targets of disease prevention. Financial support: NIDA: RO1 DA 14498. http://dx.doi.org/10.1016/j.drugalcdep.2014.02.291 Daysimeter feasibility and acceptability in a polysubstance-using population Ashley Kennedy1, M. Rea2, M. Figueiro2, Michelle L. Jobes1, D. Epstein1, Kenzie L. Preston1 1 National Institute on Drug Abuse, Baltimore, MD, United States 2 Rensselaer Polytechnic Institute, Troy, NY, United

Differences in drug use patterns and HCV among African-American adult drug users

Differences in drug use patterns and HCV among African-American adult drug users

Coping style and service utilization among African-American female drug users

Coping style and service utilization among African-American female drug users

Neighborhood Disorder and Incarceration History Among Urban Substance Users

This research examines the relationship between neighborhood physical and social disorder and incarceration history among urban drug users. A cohort of 358 African American and White urban drug users completed a clinical interview and psychological assessment that emphasized cognitive and social-behavioral HIV risk factors. The Neighborhood Inventory for Environmental Typology was used to assess indicators of physical and social disorder. After controlling for age, gender, education, and having a place to live, multivariable analyses revealed that living in a neighborhood with moderate or high levels of disorder (odds ratio [OR] = 1.63; 95% confidence interval [CI] = [1.02, 2.59]) and drinking alcohol every day or nearly every day for 3 months or more (OR = 2.03; 95% CI [1.24, 3.31]) were associated with incarceration history. Findings suggest that select characteristics of disadvantaged communities may be important determinants of incarceration vulnerability among urban substance users. Residential improvements hold promise to enhance interventions aimed to reduce incarceration.

Exploring the Perspectives of Substance Abusing Black Men Who Have Sex With Men and Women in Addiction Treatment Programs

This study examined the perspectives of African American male injection drug users who have sex with both men and women (IDU-MSM/W) and who are involved in sex trade regarding the need for a human sexuality educational model (HSEM) for addiction professionals. Focus groups were conducted involving an exploratory sample (N = 105) of men who met the following parameters: aged 18 to 40 years, African American, engage in injection drug using behavior, have sex with male and female partners, and who frequent parks and other sex working areas in Baltimore City and surrounding areas. Data suggest that an HSEM may be useful for addiction professionals who work with substance abusing Black MSM/W. Moreover, the model should include opportunities for addiction professionals to (a) identify their personal biases about homosexuality in general (acknowledging personal biases so not to allow those personal biases to influence service); (b) understand the diversity within the Black MSM/W community (e.g., challenge assumptions that all Black MSM/W self-identify as gay); (c) understand how to, and the need for, assessing sexual trauma in Black MSM/W; and (d) understand the need to incorporate risk factors and safer sex practices that may be of concern to a subpopulation of Black MSM/W, such as "barebacking." These findings suggest the need for, and topics to include in, an HSEM that assists professionals with exploring their biases about sexuality and MSM/W and better prepares counselors to address HIV prevention and risky behavior using language that is appropriate for the Black IDU-MSM/W population.

Motivations for Sexual Risk Behavior Across Commercial and Casual Partners Among Male Urban Drug Users: Contextual Features and Clinical Correlates

The current study aimed to develop a measure for assessing the various motivations for sexual risk behavior (SRB) across commercial (involving the exchange of sex for money or drugs) and casual (nonregular) partners in a sample of inner-city, primarily African American drug users, and to examine the relationship of these motivations with a history of childhood trauma, as well as current symptoms of depression, posttraumatic stress disorder (PTSD), and borderline personality disorder (BPD). Exploratory factor analysis indicated a 5-factor solution for commercial partner type, and a 4-factor solution for casual partner type, including the motivations of sexual sensation-seeking, intimacy seeking, reassurance-seeking, emotional avoidance, and emotional expressivity. Emotional avoidance and emotional expressivity were strongly related to childhood trauma and PTSD and BPD symptoms. These results provide initial results for mechanisms underlying the relationship between SRB and a history of trauma and psychopathology.

Patterns of substance use among Hurricane Katrina evacuees in Houston, Texas

This paper focuses on changing patterns of substance use among low income, African American drug users evacuated from New Orleans, Louisiana, during Hurricane Katrina of August 2005. It examines the relationship between increases and decreases in alcohol and tobacco (AT) use and illicit drug (ID) use after Katrina and pre-disaster and within-disaster factors. Data from structured interviews with 200 Katrina evacuees currently living in Houston were collected 8-14 months after the disaster. Multivariate analysis revealed that rises in AT use were positively associated with education. Females and younger evacuees were more likely to have increased AT use. ID use increase was positively associated with resource loss and leaving the city before Katrina. Decreases in AT and ID use were found to be associated with disaster-related exposure. The paper discusses the specific consequences of disasters on disadvantaged minority substance users and the importance of developing public health disaster policies that target this population.

A Psychosocial Comparison of New Orleans and Houston Crack Smokers in the Wake of Hurricane Katrina

The purpose of this study was to compare psychological distress in a sample of African American crack cocaine users who relocated to Houston from New Orleans after Hurricane Katrina to African American drug users resident in Houston. Fifty-four African Americans from New Orleans were compared to a sample of 162 people in Houston. Data were collected between June 2002 and December 2005. There were no significant differences between the two groups on either depression or anxiety, but the New Orleans sample scored higher on the self-esteem scale and scored slightly lower on the risk-taking scale.

Decisions to participate in research: views of underserved minority drug users with or at risk for HIV

Under-representation of minority populations, particularly African Americans, in HIV/AIDS research is problematic because African Americans bear a greater disease burden from HIV/AIDS. Studies of motivations for participating in research have emphasized factors affecting individuals’ willingness to participate and barriers to participation, especially in regard to HIV vaccine research. Little is known about how underserved minority drug users perceive research and their decisions to participate. This study describes African American drug users’ perceptions of research participation and their decisions to participate based on three kinds of hypothetical HIV/AIDS-related clinical studies. In-depth, qualitative interviews were conducted with 37 underserved, African American crack cocaine users, recruited from participants already enrolled in three different behavioral HIV prevention studies. Interviews were recorded, transcribed, coded for themes and sub-themes and analyzed using directed and conventional content analysis. Participants’ decisions to take part in research often involved multiple motivations for participating. In addition, decisions to participate were characterized by four themes: a desire for information; skepticism and mistrust of research and researchers; perceptions of medical care and monitoring within a study; and participant control in decisions to participate or decline participation. Lack of adequate information and/or medical care and monitoring within a study were related to mistrust, while the provision of information was viewed by some individuals as a right and acknowledgement of the participant's contribution to the study. Participants perceived, rightly or wrongly, that medical monitoring would control some of the risks of a study. Participants also described situations of exerting control over decisions to enter or withdraw from a research study. Preliminary findings suggest that continuous communication and provision of information may enhance enrollment and adherence. Further exploration of decisions to participate in research will add to the understanding of this complex phenomenon and enhance the ability of individuals with HIV/AIDS to benefit from research.

An examination of social network characteristics of men who have sex with men who use drugs

Objectives:The purpose of this study was to compare the social network characteristics of men who have sex with men (MSM) to men who did not have sex with men (NMSM)...

Regulatory Polymorphisms in the Interleukin‐18 Promoter Are Associated with Hepatitis C Virus Clearance

The immune response is critical in determining the outcome of hepatitis C virus (HCV) infection. Interleukin (IL)-18 is a pivotal mediator of the Th1/Th2-driven immune response. Two IL-18 promoter polymorphisms (-607C/A and -137G/C) and their haplotypes were known to affect IL-18 expression. We examined the role played by these polymorphisms in determining HCV clearance or persistence. Genotyping was performed among African American injection drug users with HCV clearance (n = 91) or HCV persistence (n = 182) and among European Americans with hemophilia who were mainly infected through plasma transfusion. Among injection drug users, IL18 -607A (odds ratio [OR], 3.68 [95% confidence interval {CI},1.85-7.34]) and IL18 -137C (OR, 2.33 [95% CI, 1.24-4.36]) were significantly associated with HCV clearance. A haplotype carrying -607A and -137C (OR, 4.53 [95% CI, 1.77-11.6]) was also strongly associated with viral clearance. No association was found among those with hemophilia. These results suggest that IL18 promoter polymorphism may affect the outcome of HCV infection in certain groups.

Finding meaning: African American injection drug users’ interpretations of testing HIV-positive

In the US, African American injection drug users have increased risk for acquiring HIV and for not having long-term survival post AIDS diagnosis. This study examines the cognitive interpretations African American injection drug users make of an HIV-positive test result and the attitudinal and behavioural patterns that accompany those interpretations. Using snowball sampling techniques, street outreach was used to recruit 839 African American injection drug users and their partners for HIV testing and counselling. Subsequently, data were collected for 80 individuals who tested HIV-positive. Individuals who interpreted testing HIV-positive as a ‘wake up call’ displayed the attitudinal and behavioural patterns of ‘being blessed’, ‘living clean’ and ‘advocacy’. Those that interpreted the test result as a ‘death knell’ displayed ‘self-destructive’, ‘pleasure-seeking’ and ‘vengeance’. Those that interpreted the positive test result as ‘just one more problem’ displayed ‘resignation’ and ‘minimization’. The period following the diagnosis of HIV provides an opportunity for intervention. A positive HIV status can produce lifestyle changes that either facilitate or militate against a person's health and quality of life. HIV-prevention efforts can be improved by helping individuals living with the virus to interpret and act on their diagnosis in positive ways.

Prevalence and correlates of hepatitis A among adult drug users: The significance of incarceration and race/ethnicity

This report examines associations between hepatitis A virus (HAV) infection prevalence and a history of incarceration in jail or a correctional facility among a population of drug users in Baltimore stratified by African American and white racial/ethnic status. The study sample consisted of 509 non-injection and injection drug users recruited from inner-city neighborhoods of the Baltimore metropolitan region. The baseline prevalence of HAV infection was 36.9% ( N = 188). One-fourth (25.5%) of the sample reported no lifetime history of incarceration, 44.6% reported incarceration in a local jail in their lifetime, and 29.9% reported incarceration in a correctional facility in their lifetime. In the multivariate logistic analysis, HAV infection prevalence was higher for whites (44.3%) [adjusted odds ratio (AOR) = 2.3, 95% CI = 1.5–3.5] when compared to African Americans (30.5%) adjusting for gender, age, and education. In the analysis stratified by race/ethnicity, as anticipated, jail incarceration and correctional facility incarceration were each independently associated with elevated HAV prevalence among white drug users. African American drug users with a high school diploma had significantly lower HAV infection prevalence when compared to African American drug users who did not graduate from high school. Heightened HAV prevalence among white drug users compared to African American drug users is noteworthy given the opposite association of HAV infection prevalence and these two racial/ethnic groups in the general population. Since millions of incarcerated drug users in the US return to society each year, the results suggest that incorporating systematic HAV screening, prevention, and treatment programs within correctional systems represents a vital yet underutilized strategy to reduce HAV transmission in society as a whole.

Comorbid Substance Use and HIV Risk in Older African American Drug Users

This analysis examines substance abuse/dependence and related HIV risk behaviors among older drug users in comparison to their younger counterparts. Data related to substance use disorders and HIV related behaviors were collected from 1,079 African American drug users recruited using a street outreach method. Older users were less likely to have engaged in recent sexual activity, but those who did engage did not vary significantly in their sexual risk behaviors than did drug users aged 25 to 44. Older users were more likely to abuse cocaine and be opiate dependent than younger users were, and this abuse and dependence, along with alcohol abuse, were associated with older users' perception of their risk for HIV/AIDS. Although the years 25 to 44 are considered a critical age for HIV risk, older substance users have similar levels of risk for HIV/AIDS. However, older users may not understand how some behaviors contribute to HIV risk.