Bluthenthal Ricky N, Do D Phuong, Finch Brian, Martinez Alexis, Edlin Brian R, Kral Alex H
Health Program and Drug Policy Research Center, RAND Corporation, Santa Monica, CA 90407, USA.
J Urban Health. 2007 Sep;84(5):653-66. doi: 10.1007/s11524-007-9213-3. Epub 2007 Jul 27.
Community characteristics have been associated with racial and ethnic health disparities for a wide range of ailments and conditions. Previous research has found that rates of AIDS cases among injection drug users (IDUs) vary by community characteristics. However, few studies have examined whether community characteristics are associated with HIV risk behaviors among IDUs. To address this gap in the literature, we examined the associations between census-tract-level community characteristics and injection-related and sex-related HIV risk behaviors among IDUs in the San Francisco Bay Area. Individual HIV risk behaviors were collected from 4,956 IDUs between 1998 and 2002. Using 2000 US census data, we constructed four census-level community measures: percent African American, percent male unemployment, percent of households that receive public assistance, and median household income. All community variables were measured continuously. Multilevel modeling was used to determine if community characteristics were associated with recent (in the last 6 months) receptive and distributive syringe sharing, multiple sex partners, and unprotected sex risk while controlling for potential individual-level confounders. In bivariate analysis, most of the census-tract-level community characteristics were significantly associated with injection-related HIV risk, while no community characteristics were associated with sex-related risk. However, results from multivariate multilevel models indicate that only percent African American in a census tract was associated with receptive [adjusted odds ratio (AOR) = 0.93; 95% confidence interval (CI) = 0.89, 0.99] and distributive syringe sharing (AOR = 0.94; 95% CI = 0.92, 0.99), net of individual-level characteristics. Accounting for individual-level factors in the multivariate model in the sex-related risk models revealed a significant inverse relationship between percent African American and propensity to engage in unprotected sex (AOR = 0.95; 95% CI = 0.92, 0.99); community-level characteristics remained unassociated with multiple sex partners. In this exploratory analysis, percent African American in a census tract was inversely associated with injection-related risk. The census-tract-level community characteristics we examined seem to exert little influence on individual risk among long-term chronic IDUs. More research is needed examining the influence of other community characteristics that were unmeasured in this paper but might be related to sex and drug risk among IDUs such as shooting galleries, crack houses, drug markets, and availability of preventive HIV services.
社区特征与多种疾病和状况下的种族和族裔健康差异相关。先前的研究发现，注射吸毒者（IDU）中的艾滋病病例发生率因社区特征而异。然而，很少有研究探讨社区特征是否与注射吸毒者中的艾滋病毒风险行为相关。为了填补这一文献空白，我们研究了旧金山湾区人口普查区层面的社区特征与注射吸毒者中与注射相关和与性相关的艾滋病毒风险行为之间的关联。1998年至2002年间，从4956名注射吸毒者中收集了个人艾滋病毒风险行为数据。利用2000年美国人口普查数据，我们构建了四项人口普查层面的社区指标：非裔美国人百分比、男性失业率、接受公共援助的家庭百分比以及家庭收入中位数。所有社区变量均为连续测量。在控制潜在个体层面混杂因素的同时，使用多水平模型来确定社区特征是否与近期（过去6个月内）接受性和分发性注射器共享、多个性伴侣以及无保护性行为风险相关。在双变量分析中，大多数人口普查区层面的社区特征与注射相关的艾滋病毒风险显著相关，而没有社区特征与性相关风险相关。然而，多变量多水平模型的结果表明，在考虑个体层面特征后，只有人口普查区中的非裔美国人百分比与接受性[调整优势比（AOR）=0.93；95%置信区间（CI）=0.89，0.99]和分发性注射器共享（AOR =0.94；95%CI =0.92，0.99）相关。在与性相关风险模型的多变量模型中考虑个体层面因素后，发现非裔美国人百分比与无保护性行为倾向之间存在显著的负相关关系（AOR =0.95；95%CI =0.92，0.99）；社区层面特征与多个性伴侣仍无关联。在这项探索性分析中，人口普查区中的非裔美国人百分比与注射相关风险呈负相关。我们研究的人口普查区层面的社区特征似乎对长期慢性注射吸毒者的个体风险影响很小。需要更多研究来考察本文未测量但可能与注射吸毒者的性和毒品风险相关的其他社区特征的影响，如射击馆、快克屋、毒品市场以及预防性艾滋病毒服务的可及性。
