Columbia University Mailman School of Public Health, Department of Epidemiology, 722 W 168th St, New York, NY, 10032, USA.
Columbia University Mailman School of Public Health, Department of Epidemiology, 722 W 168th St, New York, NY, 10032, USA.
Drug Alcohol Depend. 2018 Feb 1;183:184-191. doi: 10.1016/j.drugalcdep.2017.10.025. Epub 2017 Dec 8.
Although much research has been conducted on the determinants of HIV risk behavior among people who inject drugs (PWID), the influence of the neighborhood context on high-risk injection behavior remains understudied. To address this gap in the literature, we measured associations between neighborhood socioeconomic disadvantage and high-risk injection behavior, and determined whether these associations were modified by drug-related police activity and syringe exchange program (SEP) accessibility.
Our sample was comprised of 484 pharmacy-recruited PWID in New York City. Measures of neighborhood socioeconomic disadvantage were created using data from the 2006-2010 American Community Survey. Associations with high-risk injection behavior were estimated using multivariable Poisson regression. Effect modification by drug-related police activity and SEP accessibility was assessed by entering cross-product terms into adjusted models of high-risk injection behavior.
Neighborhood socioeconomic disadvantage was associated with decreased receptive syringe sharing and unsterile syringe use. In neighborhoods with high drug-related police activity, associations between neighborhood disadvantage and unsterile syringe use were attenuated to the null. In neighborhoods with high SEP accessibility, neighborhood disadvantage was associated with decreased acquisition of syringes from an unsafe source.
PWID in disadvantaged neighborhoods reported safer injection behaviors than their counterparts in neighborhoods that were relatively better off. The contrasting patterns of effect modification by SEP accessibility and drug-related police activity support the use of harm reduction approaches over law enforcement-based strategies for the control of blood borne virus transmission among PWID in disadvantaged urban areas.
尽管已有大量研究针对影响吸毒人群（PWID）HIV 风险行为的因素展开，但社区环境对高危注射行为的影响仍有待进一步研究。为了弥补该领域文献的空白，我们对社区社会经济劣势与高危注射行为之间的相关性进行了衡量，并确定这些相关性是否受到与毒品相关的警察活动和针具交换项目（SEP）可及性的影响。
我们的样本包括来自纽约市的 484 名通过药店招募的吸毒者。利用来自 2006-2010 年美国社区调查的数据创建了社区社会经济劣势的衡量标准。使用多变量泊松回归估计与高危注射行为相关的因素。通过将交叉乘积项纳入高危注射行为的调整模型，评估与毒品相关的警察活动和 SEP 可及性对效应的修饰作用。
社区社会经济劣势与接受性共用注射器和使用不卫生注射器的行为减少有关。在与毒品相关的警察活动较多的社区中，社区劣势与不卫生注射器使用之间的关联减弱至零。在 SEP 可及性较高的社区中，社区劣势与从不安全来源获取注射器的行为减少有关。
处于劣势社区的吸毒者报告了比那些相对富裕社区的同行更安全的注射行为。SEPA 可及性和与毒品相关的警察活动的影响修饰作用的对比模式支持在处于劣势的城市地区使用减少伤害的方法来控制吸毒者的血源性病毒传播，而不是采用基于执法的策略。
