Williams Leslie D, Mackesy-Amiti Mary Ellen, Latkin Carl, Boodram Basmattee
Division of Community Health Sciences, University of Illinois at Chicago School of Public Health, Chicago, IL, United States.
Division of Community Health Sciences, University of Illinois at Chicago School of Public Health, Chicago, IL, United States.
Drug Alcohol Depend. 2021 Apr 1;221:108626. doi: 10.1016/j.drugalcdep.2021.108626. Epub 2021 Feb 17.
Identifying risk for hepatitis C (HCV) infection is important for understanding recent increases in HCV incidence among young people who inject drugs (PWID) in suburban and rural areas; and for refining the targeting of effective HCV preventive interventions. Much of the extant research has focused on individual health behaviors (e.g., risky drug injection behaviors) as predictors of HCV infection. The present study examines two social factors (substance use-related stigma and injection-related social norms), and the interaction between these factors, as predictors of HCV infection.
Baseline data were used from an ongoing longitudinal study of young PWID (N = 279; mean age = 30.4 years) from the Chicago suburbs and their injection risk network members. Adjusted logistic regression models were used to examine relationships among substance use-related stigma, safer injection norms, and HCV infection.
Despite a marginal bivariate association between less safe injection norms and HCV infection (OR = 0.74; 95 % CI[0.39, 1.02]; p = .071), a significant stigma X norms interaction (AOR = 0.68; 95 % CI[0.51, 0.90]) suggested that at high levels of stigma, probability of HCV infection was high regardless of injection norms.
Findings suggest that social factors - specifically, substance use-related stigma and injection norms - are important predictors of HCV infection risk. The interaction found between these social factors suggests that intervening only to change injection norms or behaviors is likely insufficient to reduce risk for HCV infection in high-stigma settings or among high-stigma populations. Future research should develop and evaluate stigma-reduction interventions in combination with safer-injection interventions in order to maximize HCV risk reduction.
识别丙型肝炎（HCV）感染风险对于理解郊区和农村地区注射毒品的年轻人（PWID）中HCV发病率近期的上升情况很重要；也有助于优化有效的HCV预防干预措施的目标人群。现有的大部分研究都集中在将个体健康行为（如危险的药物注射行为）作为HCV感染的预测因素。本研究考察了两个社会因素（与物质使用相关的耻辱感和与注射相关的社会规范）以及这些因素之间的相互作用，作为HCV感染的预测因素。
使用了一项正在进行的对芝加哥郊区年轻PWID（N = 279；平均年龄 = 30.4岁）及其注射风险网络成员的纵向研究的基线数据。采用调整后的逻辑回归模型来检验与物质使用相关的耻辱感、更安全的注射规范和HCV感染之间的关系。
尽管不太安全的注射规范与HCV感染之间存在微弱的双变量关联（OR = 0.74；95%CI[0.39, 1.02]；p = 0.071），但耻辱感X规范的显著相互作用（AOR = 0.68；95%CI[0.51, 0.90]）表明，在高耻辱感水平下，无论注射规范如何，HCV感染的概率都很高。
研究结果表明，社会因素——特别是与物质使用相关的耻辱感和注射规范——是HCV感染风险的重要预测因素。这些社会因素之间的相互作用表明，仅通过干预来改变注射规范或行为可能不足以降低高耻辱感环境或高耻辱感人群中HCV感染的风险。未来的研究应该开发和评估减少耻辱感的干预措施，并与更安全的注射干预措施相结合，以最大程度地降低HCV风险。
