Asunto(s)
Terapia Conductista/métodos , Terapia Conductista/tendencias , Consumidores de Drogas/psicología , Consumidores de Drogas/estadística & datos numéricos , Reducción del Daño , Abuso de Sustancias por Vía Intravenosa/prevención & control , Abuso de Sustancias por Vía Intravenosa/psicología , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Predicción , Humanos , Masculino , Persona de Mediana Edad , Factores de Riesgo , Estados UnidosRESUMEN
BACKGROUND: Unhoused people who use drugs in the United States are at risk for a variety of negative health outcomes. As the crisis of houselessness continues to impact major urban areas, a wave of punitive policies has been enacted to remove visible unhoused people from public spaces. There is reason to believe that harsh policies of encampment displacement will have negative immediate and downstream impacts on this community. METHODS: Participant observation was conducted weekly or bi-weekly at unhoused encampments in Los Angeles County, USA over the course of two years (2021, 2022). Data were generated through the lens of ontological security theory via in-field jottings and comprehensive field notes. Formal, semi-structured qualitative interviews were conducted with 30 unhoused people who use drugs recruited primarily through peer-referral sampling at these same venues. Data were coded and analyzed thematically using the Template Analysis approach. Field notes were used to triangulate and further contextualize thematic analysis of interview data. RESULTS: Encampment sweeps impacted nearly all participants and occurred multiple times at every visited field site. They were observed to occur both with and without the presence of police, but always resulted in the loss of the personal property of encampment residents. Sweeps occurred across seasons, hazardous weather, and without offers of alternative shelter. Participants described sweeps as impacting all aspects of their ontological security, including dismantling material and social constancy, disrupting routines of daily life and resource management, increasing feelings of surveillance, and potentially creating negative identity formation. CONCLUSIONS: In both ethnographic observation and participant interviews, encampment sweeps were noted to be physically, psychologically, and socially destructive. Sweeps left participants feeling anger, loss, and hopelessness while further driving the societal marginalization of unhoused people who use drugs. Sweeps should be discontinued as they harm the capacity of unhoused people to improve their well-being.
Asunto(s)
Vivienda , Personas con Mala Vivienda , Humanos , Estados Unidos , Investigación Cualitativa , Antropología Cultural , PoliciaRESUMEN
BACKGROUND: Comprehensive preventive services are recommended for injection drug users (IDU), including screening tests, vaccinations, risk reduction counseling, and sterile syringes. Syringe exchange programs (SEP) may facilitate receipt of preventive services by IDUs, but whether SEP clients receive recommended preventive care is not known. We examined use of recommended preventive services by clients of 23 SEPs throughout California. METHODS: Five hundred and sixty SEP clients were recruited from 23 SEPs throughout California between March and September 2003. Receipt of 10 recommended preventive services and source of care (SEP versus non-SEP providers) was ascertained from client interviews. RESULTS: On average, SEP clients received only 13% of recommended preventive services and 49% of clients received none of the recommended services. Of services that were received, 76% were received from SEPs. In multivariate analysis, use of drug treatment and more frequent SEP visits were associated with receipt of recommended preventive services by clients. CONCLUSIONS: SEPs are often the only source of preventive care for their IDU clients. Still, SEP clients fail to receive most recommended preventive services. Interventions to increase use of preventive services and improve the quality of preventive care received by IDUs, such as increased access to drug treatment and SEPs, are needed.
Asunto(s)
Necesidades y Demandas de Servicios de Salud/organización & administración , Tamizaje Masivo , Programas de Intercambio de Agujas/organización & administración , Servicios Preventivos de Salud/organización & administración , Calidad de la Atención de Salud , Abuso de Sustancias por Vía Intravenosa/complicaciones , California , Consejo , Infecciones por VIH/diagnóstico , Infecciones por VIH/prevención & control , Infecciones por VIH/transmisión , Humanos , Compartición de Agujas/efectos adversos , Asunción de Riesgos , JeringasRESUMEN
OBJECTIVE: To determine whether syringe exchange program use is associated with cessation of syringe sharing among high-risk injection drug users. DESIGN AND METHODS: Between 1992 and 1996, street-recruited injection drug users were interviewed and received HIV testing and counseling semi-annually, as part of a dynamic cohort study. We examined a cohort of 340 high-risk injection drug users for whom two observations, 6-months apart, were available and who reported syringe sharing at the first interview. Multivariate logistic regression analysis was performed to determine the relationship between syringe exchange program use and cessation of syringe sharing, while controlling for confounding factors. RESULTS: At follow-up interview, 60% (204 of 340) reported quitting syringe sharing. High-risk injection drug users who began using the syringe exchange program were more likely to quit sharing syringes [adjusted odds ratio (AOR), 2.68; 95% confidence interval (CI), 1.35-5.33], as were those who continued using the syringe exchange program (AOR,1.98; 95% CI, 1.05-3.75) in comparison with non-syringe exchange program users, while controlling for confounding factors. CONCLUSIONS: The initiation and continuation of syringe exchange program use among high-risk injection drug users is independently associated with cessation of syringe sharing. Syringe exchange program use can be an important component in reducing the spread of blood-borne infectious diseases among high-risk injection drug users.
Asunto(s)
Infecciones por VIH/prevención & control , Compartición de Agujas/efectos adversos , Programas de Intercambio de Agujas , Evaluación de Programas y Proyectos de Salud/estadística & datos numéricos , Abuso de Sustancias por Vía Intravenosa/virología , Adulto , Estudios de Cohortes , Femenino , Infecciones por VIH/epidemiología , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Factores de Riesgo , Abuso de Sustancias por Vía Intravenosa/epidemiología , Encuestas y CuestionariosRESUMEN
AIMS: To assess risk factors associated with injection drug users (IDUs) who give injections to or receive injections from other IDUs. DESIGN AND SETTING: IDUs were recruited into a cross-sectional study using targeted sampling methods in Oakland, Richmond, and San Francisco, California from August 1996 to January 1997. "Street docs" are IDUs who reported having given injections to other IDUs in the past month. "Injection recipients" are IDUs who reported having received injections from other people in the past month. PARTICIPANTS: Of 1166 IDUs interviewed, 283 (24%) reported being injection recipients and 427 (37%) reported being street docs. MEASUREMENTS: Socio-demographic characteristics and injection-related risk behaviors. FINDINGS: Injection recipients and street docs were significantly more likely (p < 0.001) than other IDUs to report sharing syringes (33% of injection recipients, 21% of street docs and 7% of others), cookers (71% of injection recipients, 55% of street docs and 24% of others), rinse water (44% of injection recipients, 35% of street docs and 13% of others), and filters (60% of injection recipients, 47% of street docs and 20% of others). In a logistic regression model, injection recipients (adjusted odds ratio (AOR) = 4.29) and street docs (AOR = 1.91) were more likely than other IDUs to report having shared syringes. CONCLUSIONS: Giving and receiving injections is common among IDUs in the San Francisco Bay area. Qualitative and epidemiological studies are needed to understand better the infectious disease risks associated with giving and receiving injections. Interventions need to address these issues and provide practical solutions.
Asunto(s)
Compartición de Agujas , Abuso de Sustancias por Vía Intravenosa/complicaciones , Adulto , California/epidemiología , Estudios Transversales , Femenino , Humanos , Masculino , Análisis de Regresión , Factores de RiesgoRESUMEN
To determine if frequent needle-exchange program (NEP) use is associated with lower readiness to change drug use, NEP clients in Providence, RI were interviewed regarding their drug use, HIV risk, health, and past use of drug treatment services in 1997-1998. Readiness to change drug use was assessed using a nine-step decision ladder. Based on this assessment, 14.3% of the sample were classified as precontemplators (24/168), 29.2% were in the contemplation stage (49/168), and 56.5% were in the determination or ready to change stage (95/168). We found that mean number of NEP visits was 25.5 among precontemplators, 28.7 among contemplators, and 22.5 among those in the determination stage. In multivariate analysis, an inverse relationship between having ever been in alcohol treatment and higher readiness to change drug use was the only significant association. In this exploratory study, we found that more frequent NEP participation did not impact readiness to change drug use among intravenous drug users. Given the high proportion of NEP clients ready to change drug use, improving linkages between NEPs and substance abuse treatment appears warranted.
Asunto(s)
Infecciones por VIH/prevención & control , Programas de Intercambio de Agujas , Abuso de Sustancias por Vía Intravenosa/psicología , Adulto , Alcoholismo/epidemiología , Alcoholismo/terapia , Femenino , Infecciones por VIH/epidemiología , Infecciones por VIH/psicología , Humanos , Análisis de los Mínimos Cuadrados , Masculino , Persona de Mediana Edad , Análisis Multivariante , Programas de Intercambio de Agujas/estadística & datos numéricos , Abuso de Sustancias por Vía Intravenosa/epidemiología , Abuso de Sustancias por Vía Intravenosa/terapiaRESUMEN
Needle sharing has long been recognized as a primary route of HIV infection. However, recent research has shown that HIV antibody is also detectable in injection supplies other than needles. In this study we tested frequency of attendance at a Providence, Rhode Island, needle exchange program (NEP) as a correlate of injection risk indicators including not just sharing needles but also sharing cookers, sharing cotton filters, cleaning the skin before injecting, and using bleach as a needle disinfectant. Results showed that drug users who attended the NEP less frequently were more likely to report needle sharing, less likely to report always cleaning their skin, and more likely to report sharing cookers. The Providence NEP is one at which alcohol swabs and cookers are distributed along with clean needles. Our results suggest that NEPs represent a valuable and underexploited opportunity to promote risk reduction efforts beyond the avoidance of needle sharing. NEPs should be distributing risk reduction supplies in addition to clean needles and should adopt strategies (e.g., outreach and more days/hours of operation) to encourage frequent attendance.
Asunto(s)
Infecciones por VIH/prevención & control , Programas de Intercambio de Agujas/métodos , Adulto , Femenino , Infecciones por VIH/epidemiología , Infecciones por VIH/etiología , Humanos , Inyecciones Intravenosas/efectos adversos , Masculino , Análisis Multivariante , Compartición de Agujas/efectos adversos , Compartición de Agujas/psicología , Programas de Intercambio de Agujas/estadística & datos numéricos , Evaluación de Programas y Proyectos de Salud/estadística & datos numéricos , Análisis de Regresión , Rhode Island/epidemiología , Trastornos Relacionados con Sustancias/complicacionesRESUMEN
Drug paraphernalia and prescription laws make syringe exchange programs (SEPs) illegal in most states in the U.S. Nonetheless, SEPs have been started in 25 states and the District of Columbia as of September 1995. In some states like California and New Jersey, SEPs have operated despite police arrest of volunteers and clients. We examine the impact of police action and threat on SEPs by comparing an underground syringe exchange site (SES) in West Oakland to a tolerated SES in the Fillmore neighborhood of San Francisco. The following data sources are utilized: demographic and service utilization data from Alameda County Exchange (ACE) in West Oakland and Prevention Point Needle and Syringe Exchange (PPNSE) in the Fillmore, San Francisco; demographic and syringe exchange utilization information collected from street-recruited samples of injection drug users (IDUs) in West Oakland and the Fillmore; and participant observation of SES in these two communities. We found that police action and the threat of police action in West Oakland decreased utilization of SEP by IDUs, limited the number and diversity of volunteers at SES, and inhibited the operation and expansion of SEP.
Asunto(s)
Síndrome de Inmunodeficiencia Adquirida/prevención & control , Programas de Intercambio de Agujas/legislación & jurisprudencia , Policia , Crimen , Femenino , Humanos , Masculino , San Francisco , Abuso de Sustancias por Vía IntravenosaAsunto(s)
Infecciones por VIH/prevención & control , Programas de Intercambio de Agujas/organización & administración , Abuso de Sustancias por Vía Intravenosa , Connecticut , Infecciones por VIH/transmisión , Humanos , Programas Controlados de Atención en Salud , Programas de Intercambio de Agujas/legislación & jurisprudencia , Política , Política Pública , Medio Social , Estados UnidosRESUMEN
The federal ban on funding for syringe exchange programs (SEPs) has greatly hampered attempts to prevent the spread of HIV among injection drug users in the United States. State laws prohibiting the possession and/or distribution of syringes have made SEPs illegal. These factors have lent a unique social movement quality to harm reduction efforts in the United States. Using a social movement perspective, this paper explores dynamics of the implementation and defense of the syringe exchange program in Oakland, California. The advantages and disadvantages of the social movement aspects of harm reduction are discussed.
Asunto(s)
Infecciones por VIH/etiología , Infecciones por VIH/prevención & control , Programas de Intercambio de Agujas/organización & administración , Política , Prevención Primaria/organización & administración , Abuso de Sustancias por Vía Intravenosa/complicaciones , Servicios Urbanos de Salud/organización & administración , California , Humanos , Desarrollo de Programa , Justicia SocialRESUMEN
With the many recent improvements in the medical management of HIV, the benefits of early detection of the virus have increased. People found to be HIV-positive can be offered immediate referrals for medical care and a comprehensive continuum of services. However, it is estimated that, among the 650,000 to 900,000 seropositive persons in the United States, about one third are unaware of their serostatus. Many of those who are tested for HIV do not return for their results. Among those less likely to return for results are young people and black Americans. Many factors at the individual, system and societal levels negatively impact whether individuals at risk for HIV seek HIV testing in the first place, whether they return for their results, and whether they get appropriate care after they are found to be HIV-positive. Some solutions are offered to improve the identification of new HIV infections. These include social marketing campaigns to encourage individuals to be tested for HIV. Also, more use of the rapid HIV test, which will substantially increase the number of people obtaining their HIV results, is recommended. New computer technologies, such as telemedicine, also have the potential to improve linkages to care for newly diagnosed individuals. In addition, it is essential that HIV care continue to be readily available through the Ryan White Care Act.
Asunto(s)
Seropositividad para VIH/diagnóstico , VIH/inmunología , Accesibilidad a los Servicios de Salud , Adolescente , Adulto , Confidencialidad/psicología , Femenino , Seropositividad para VIH/tratamiento farmacológico , Seropositividad para VIH/psicología , Humanos , Masculino , Factores de TiempoRESUMEN
OBJECTIVE: To determine factors associated with syringe and injection supply sharing among injection drug users (IDUs) in a community with an illegal underground syringe exchange program (SEP). METHODS: From 1992 to 1995, semiannual cross-sectional samples of IDUs were recruited in Oakland, California. To account for multiple observations from the same individual, we used general estimating equations with logit transformations to determine factors associated with sharing syringes and other injection supplies. RESULTS: 1304 IDUs were interviewed; 684 (53%) returned for more than one interview. 2830 interviews were available for analysis. SEP use increased and syringe and supply sharing declined from 1992 to 1995 among study participants. In multivariate analysis, SEP users were less likely to share syringes than non-SEP users (adjusted odds ratio [AOR] = 0.57; 95% confidence interval [CI] = 0.46-0.72). SEP use was not significantly associated with the sharing of injection supplies (AOR = 0.85; 95% CI = 0.68-1.07). Syringe sharing and injection supply sharing were significantly less likely to occur among African American and HIV-positive IDUs. CONCLUSIONS: These data suggest that illegal SEPs can be effective HIV prevention programs. Lower rates of syringe-based risk behaviors among African American and HIV-positive IDUs are encouraging.
Asunto(s)
Compartición de Agujas/estadística & datos numéricos , Programas de Intercambio de Agujas/estadística & datos numéricos , Asunción de Riesgos , Abuso de Sustancias por Vía Intravenosa/psicología , Jeringas , California/epidemiología , Estudios Transversales , Femenino , Infecciones por VIH/epidemiología , Infecciones por VIH/etiología , Infecciones por VIH/prevención & control , Humanos , Entrevistas como Asunto , Masculino , Análisis Multivariante , Compartición de Agujas/efectos adversos , Programas de Intercambio de Agujas/legislación & jurisprudencia , Abuso de Sustancias por Vía Intravenosa/complicaciones , Jeringas/efectos adversos , Jeringas/normasRESUMEN
OBJECTIVES: This study deter- mined human immunodeficiency virus (HIV) seroprevalence and factors associated with HIV infection among street-recruited injection drug users and crack cocaine smokers. METHODS: An analysis was performed on HIV serologies and risk behaviors of 6402 injection drug users and 3383 crack smokers in 16 US municipalities in 1992 and 1993. RESULTS: HIV seroprevalence was 12.7% among injection drug users and 7.5% among crack smokers. Most high-seroprevalence municipalities (>25%) were located along the eastern seaboard of the United States. In high-seroprevalence municipalities, but not in others, HIV seroprevalence was higher for injection drug users than for crack smokers. Among injection drug users, cocaine injection, use of speedballs (cocaine or amphetamines with heroin), and sexual risk behaviors were independently associated with HIV infection. Among crack smokers, sexual risk behaviors were associated with HIV infection. CONCLUSIONS: Injection drug users and crack smokers are at high risk for HIV infection.
Asunto(s)
Trastornos Relacionados con Cocaína/complicaciones , Cocaína Crack , Seroprevalencia de VIH , Abuso de Sustancias por Vía Intravenosa/complicaciones , Adulto , Trastornos Relacionados con Cocaína/sangre , Trastornos Relacionados con Cocaína/psicología , Femenino , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Asunción de Riesgos , Conducta Sexual , Abuso de Sustancias por Vía Intravenosa/sangre , Abuso de Sustancias por Vía Intravenosa/psicología , Estados Unidos/epidemiologíaRESUMEN
The objective of this study was to analyze HIV-related risks of women injection drug users (IDU) and crack cocaine users (CCU) who have sex with women (WSW). IDU and CCU women (N = 3856) were recruited from street settings in 19 U.S. cities between 1992 and 1994. For this study, we analyze data on 231 women who reported female sex partners in the 30 days before interview. In the 30 days before interview, 53% of IDUs had shared syringes, and 66% had shared injection supplies. Only 11 women (6%) always used barrier protection while giving oral sex to women and 5 (3%) while receiving oral sex from women in the 30 days before interview. Fifty percent had sex with men as well as women in the previous 30 days. Thirty percent of women who reported sex with men had used condoms for penile-vaginal sex, and 26% for penile-anal sex. In logistic regression analysis modeling sex with men in the previous 30 days, sex work was predictive, "lesbian" self-identification was protective, and the interaction between these two terms was predictive, while controlling for race and age. Differences in risk perception were significant between women who reported varying sexual risks, but not significant between women who reported varying injection-related risks. There is a high prevalence of risky sex and drug behaviors among drug-using WSWs. There is a need for epidemiological studies specifically geared toward studying risk behaviors among WSWs. Risk reduction activities need to focus on injection-related risks, as well as sex-related risks, among WSWs.
Asunto(s)
Cocaína Crack , Infecciones por VIH/epidemiología , Homosexualidad Femenina/estadística & datos numéricos , Abuso de Sustancias por Vía Intravenosa/epidemiología , Trastornos Relacionados con Sustancias/epidemiología , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Factores de Riesgo , Conducta Sexual , Estados Unidos/epidemiologíaRESUMEN
The prevalence of and risk factors for abscesses and cellulitis were investigated among a community sample of injection drug users (IDUs). Participants were interviewed, and those with symptoms were examined. Of 169 IDUs, 54 (32%) had abscesses (n=35), cellulitis (n=5), or both (n=14); 27% had lanced their own abscesses; and 16% had self-treated with antibiotics they purchased on the street. IDUs who skin-popped (injected subcutaneously or intramuscularly) were more likely to have an abscess or cellulitis than those who had injected only intravenously (odds ratio, 4.9; 95% confidence interval, 2.2-11). The likelihood of abscesses and cellulitis increased with frequency of skin-popping and decreased with increasing duration of injection drug use. Abscesses are extremely prevalent among IDUs in San Francisco. Skin-popping is a major risk factor, and self-treatment is common.
Asunto(s)
Absceso/epidemiología , Celulitis (Flemón)/epidemiología , Abuso de Sustancias por Vía Intravenosa/complicaciones , Absceso/etiología , Adulto , Celulitis (Flemón)/etiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Factores de Riesgo , San Francisco/epidemiologíaRESUMEN
OBJECTIVES: To determine trends in HIV infection and risk behaviors among street-recruited self-identified gay and bisexual male injection drug users (IDUs) in San Francisco. METHODS: Trends in HIV infection and risk behaviors were calculated for gay/bisexual ( n = 1594 interviews) IDUs in 26 semiannual cross sections from 1988 to 2000. RESULTS: HIV seroprevalence among gay/bisexual IDUs decreased from the range of 35% to 45% in 1988/1989 to 25% in 1996 and then began to increase, reaching 42% in 2000. In contrast, HIV prevalence among heterosexual male IDUs remained stable during the study period. For gay/bisexual IDUs, injection and sex-related HIV risk behaviors declined modestly throughout the study period. As of the last cross section (July 2000), however, over a third of respondents reported recent syringe sharing or unprotected anal sex. CONCLUSIONS: Gay/bisexual men who inject drugs continue to be at elevated risk for HIV, suggesting that interventions such as amphetamine drug treatment and sexual risk reduction programs targeted at this population are needed.
Asunto(s)
Infecciones por VIH/epidemiología , VIH/inmunología , Abuso de Sustancias por Vía Intravenosa/virología , VIH/clasificación , Infecciones por VIH/etiología , Infecciones por VIH/virología , Heterosexualidad , Homosexualidad Masculina , Humanos , Masculino , Asunción de Riesgos , San Francisco/epidemiología , Estudios Seroepidemiológicos , Abuso de Sustancias por Vía Intravenosa/complicacionesRESUMEN
BACKGROUND: Many new HIV-1 infections in the USA occur in injection drug users (IDUs). HIV-1seroconversion of IDUs is mainly associated with injection-related risk factors. Harm- reduction programmes concentrate on injection-risk behaviour. We aimed to establish whether injection or sexual risk factors, or both, were associated with HIV-1antibody seroconversion of street-recruited IDUs in San Francisco, from 1986 to 1998. METHODS: IDUs were enrolled every 6 months from four community sites. We did a nested case-control study comparing 58 respondents who seroconverted between visits with 1134 controls who remained seronegative. Controls were matched with cases by sex and date. Adjusted odds ratios and 95% CI were calculated for men and women by use of conditional logistic regression. FINDINGS: Men who had sex with men were 8.8 times as likely to seroconvert (95% CI 3.7-20.5) as heterosexual men. Women who reported having traded sex for money in the past year were 5.1 times as likely as others to seroconvert (95% CI 1.9-13.7). Women younger than 40 years were more likely to seroconvert than those 40 years or older (2.8 [1.05-7.6]), and women who reported having a steady sex-partner who injected drugs were less likely to seroconvert than other women (0.32 [0.11-0.92]). INTERPRETATION: HIV-1 seroconversion of street-recruited IDUs in San Francisco is strongly associated with sexual behaviour. HIV-1risk might be reduced by incorporation of innovative sexual-risk-reduction strategies into harm-reduction programmes.
Asunto(s)
Infecciones por VIH/transmisión , Seropositividad para VIH , VIH-1 , Conducta Sexual , Abuso de Sustancias por Vía Intravenosa , Adulto , Estudios de Casos y Controles , Femenino , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Factores de Riesgo , San FranciscoRESUMEN
OBJECTIVES: This study sought to determine prevalence of and risk factors for nonfatal recent overdose among street-recruited injection heroin users. METHODS: From August 1998 through July 1999, 1427 heroin injectors were recruited from 6 inner-city neighborhoods in the San Francisco Bay Area, Calif, and interviewed. Factors hypothesized to be associated with recent overdose were analyzed with logistic regression. RESULTS: Of the 1427 participants, 684 (48%) had had an overdose, 466 (33%) had experienced 2 or more overdose events, and 182 (13%) had had a recent overdose. In multiple logistic regression, being younger (adjusted odds ratio [OR] for each year of increasing age = 0.95; 95% confidence interval [CI] = 0.94, 0.97), having been arrested 3 or more times in the past year (adjusted OR = 2.50; 95% CI = 1.61, 3.87), drinking 4 or more alcoholic drinks per day (adjusted OR = 2.05; 95% CI = 1.37, 3.05), and having participated in methadone detoxification during the past year (adjusted OR = 1.47; 95% CI = 1.03, 2.09) were independently associated with recent overdose. Being homeless; identifying as gay, lesbian, bisexual, or transgender; having spent 5 or more years in prison or jail; and having engaged in sex work also were associated with recent overdose. CONCLUSIONS: Targeted interventions that decrease risk for overdose are urgently needed.
Asunto(s)
Sobredosis de Droga/epidemiología , Heroína/efectos adversos , Abuso de Sustancias por Vía Intravenosa/complicaciones , Adulto , Femenino , Conductas Relacionadas con la Salud , Educación en Salud , Heroína/administración & dosificación , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Prevalencia , Factores de Riesgo , San Francisco/epidemiología , Abuso de Sustancias por Vía Intravenosa/epidemiología , Salud UrbanaRESUMEN
This study examines drug acquisition and multiperson use of paraphernalia, drugs, and needles/syringes. Ethnographers observed 54 injection episodes in which IDUs were linked by HIV risk behaviors, and developed a typology of higher-risk, lower-risk, and nonsharing-risk networks. Multiperson use of injection paraphernalia or drug solution occurred in most injection events (94%). Serial use of syringes/needles occurred infrequently (14%) relative to "backloading" (37%) and reuse of paraphernalia (cookers 84%, cotton 77%, water 77%). Higher-risk injection networks were characterized by larger size and pooling of resources for drugs. Prevention messages must include avoiding reuse of injection paraphernalia and transfer of drug solution.