Skip to main content

Advertisement

SpringerLink
Log in

Differing HIV Risks and Prevention Needs among Men and Women Injection Drug Users (IDU) in the District of Columbia

  • Published:
Journal of Urban Health Aims and scope Submit manuscript

Abstract

Washington, DC has among the highest HIV/AIDS rates in the US. Gender differences among injection drug users (IDUs) may be associated with adoption of prevention opportunities including needle exchange programs, HIV testing, psychosocial support, and prevention programming. National HIV Behavioral Surveillance data on current IDUs aged ≥18 were collected from 8/09 to 11/09 via respondent-driven sampling in Washington, DC. HIV status was assessed using oral OraQuick with Western Blot confirmation. Weighted estimates were derived using RDSAT. Stata was used to characterize the sample and differences between male and female IDU, using uni-, bi-, and multivariable methods. Factors associated with HIV risk differed between men and women. Men were more likely than women to have had a history of incarceration (86.6 % vs. 66.8 %, p < 0.01). Women were more likely than men to have depressive symptoms (73.9 % vs. 47.4 %, p < 0.01), to have been physically or emotionally abused (66.1 % vs. 16.1 %, p < 0.0001), to report childhood sexual abuse (42.7 % vs. 4.7 %, p < 0.0001), and pressured or forced to have sex (62.8 % vs. 4.0 %, p < 0.0001); each of these differences was significant in the multivariable analysis. Despite a decreasing HIV/AIDS epidemic among IDU, there remain significant gender differences with women experiencing multiple threats to psychosocial health, which may in turn affect HIV testing, access, care, and drug use. Diverging needs by gender are critical to consider when implementing HIV prevention strategies.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

References

  1. DC Department of Health HIV/AIDS, Hepatitis, STD, and TB Administration. District of Columbia HIV/AIDS, Hepatitis, STD, and TB Epidemiology 2009 Annual Report Update, 2010.

  2. Vlahov D, Des Jarlais DC, Goosby E, et al. The role of epidemiology in needle exchange programs. Am J Public Health. 2000; 90(9): 1390–2.

    Article  PubMed  Google Scholar 

  3. Holtzman D, Barry V, Ouellet LJ, et al. The influence of needle exchange programs on injection risk behaviors and infection with hepatitis C virus among young injection drug users in select cities in the United States, 1994–2004. Prev Med. 2009; 49(1): 68–73.

    Article  PubMed  Google Scholar 

  4. Vlahov D, Des Jarlais DC, Goosby E, et al. Needle exchange programs for the prevention of human immunodeficiency virus infection: epidemiology and policy. Am J Epidemiol. 2001; 154(12 Suppl): S70–7.

    Article  PubMed  CAS  Google Scholar 

  5. Vlahov D, Junge B, Brookmeyer R, et al. Reductions in high-risk drug use behaviors among participants in the Baltimore needle exchange program. J Acquir Immune Defic Syndr Hum Retrovirol. 1997; 16(5): 400–6.

    Article  PubMed  CAS  Google Scholar 

  6. Absalon J, Fuller CM, Ompad DC, et al. Gender differences in sexual behaviors, sexual partnerships, and HIV among drug users in New York City. AIDS Behav. 2006; 10(6): 707–15.

    Article  PubMed  Google Scholar 

  7. Riehman KS, Kral AH, Anderson R, Flynn N, Bluthenthal RN. Sexual relationships, secondary syringe exchange, and gender differences in HIV risk among drug injectors. J Urban Health. 2004; 81(2): 249–59.

    Article  PubMed  Google Scholar 

  8. Garcia de la Hera M, Ferreros I, del Amo J, et al. Gender differences in progression to AIDS and death from HIV seroconversion in a cohort of injecting drug users from 1986 to 2001. J Epidemiol Community Health. 2004; 58(11): 944–50.

    Article  PubMed  Google Scholar 

  9. Spijkerman IJ, Langendam MW, van Ameijden EJ, Coutinho RA, van den Hoek A. Gender differences in clinical manifestations before AIDS diagnosis among injecting drug users. Eur J Epidemiol. 1998; 14(3): 213–8.

    Article  PubMed  CAS  Google Scholar 

  10. Gollub EL, Rey D, Obadia Y, Moatti JP. Gender differences in risk behaviors among HIV+ persons with an IDU history. The link between partner characteristics and women’s higher drug-sex risks. The Manif 2000 Study Group. Sex Transm Dis. 1998; 25(9): 483–8.

    Article  PubMed  CAS  Google Scholar 

  11. Singh BK, Koman JJ 3rd, Williams JS, Catan VM, Souply KL. Sex differences in self-report of physical health by injection drug users. Int J Addict. 1994; 29(2): 275–83.

    PubMed  CAS  Google Scholar 

  12. McDonald C, Loxley W, Marsh A. A bridge too near? Injecting drug users’ sexual behaviour. AIDS Care. 1994; 6(3): 317–26.

    Article  PubMed  CAS  Google Scholar 

  13. Dwyer R, Richardson D, Ross MW, Wodak A, Miller ME, Gold J. A comparison of HIV risk between women and men who inject drugs. AIDS Educ Prev. 1994; 6(5): 379–89.

    PubMed  CAS  Google Scholar 

  14. Montgomery SB, Hyde J, De Rosa CJ, et al. Gender differences in HIV risk behaviors among young injectors and their social network members. Am J Drug Alcohol Abuse. 2002; 28(3): 453–75.

    Article  PubMed  Google Scholar 

  15. Doherty MC, Garfein RS, Monterroso E, Latkin C, Vlahov D. Gender differences in the initiation of injection drug use among young adults. J Urban Health. 2000; 77(3): 396–414.

    Article  PubMed  CAS  Google Scholar 

  16. Latkin CA, Mandell W, Knowlton AR, et al. Gender differences in injection-related behaviors among injection drug users in Baltimore, Maryland. AIDS Educ Prev. 1998; 10(3): 257–63.

    PubMed  CAS  Google Scholar 

  17. Evans JL, Hahn JA, Page-Shafer K, et al. Gender differences in sexual and injection risk behavior among active young injection drug users in San Francisco (the UFO Study). J Urban Health. 2003; 80(1): 137–46.

    Article  PubMed  Google Scholar 

  18. Frears D. House passes bill that lifts ban on using federal money for needle exchanges. Washington Post 2009.

  19. Pershing B. Spending bill spares D.C. needle exchange, Chesapeake cleanup plan. Washington Post 2011.

  20. Opinion EB. Bargaining away the District’s rights. Washington Post 2011.

  21. Dvorak P. End of needle exchange marks loss of a bulwark in D.C.’s AIDS fight. Washington Post 2011;2/24/11.

  22. Magnus M, Kuo I, Phillips G 2nd, et al. Elevated HIV prevalence despite lower rates of sexual risk behaviors among black men in the District of Columbia who have sex with men. AIDS Patient Care STDS. 2010; 24(10): 615–22.

    Article  PubMed  Google Scholar 

  23. Magnus M, Kuo I, Shelley K, et al. Risk factors driving the emergence of a generalized heterosexual HIV epidemic in Washington, District of Columbia networks at risk. Aids. 2009; 23(10): 1277–84.

    Article  PubMed  Google Scholar 

  24. Kuo I, Greenberg AE, Magnus M, et al. High prevalence of substance use among heterosexuals living in communities with high rates of AIDS and poverty in Washington, DC. Drug Alcohol Depend. 2011;117:139–44.

    Google Scholar 

  25. Abdul-Quader AS, Heckathorn DD, McKnight C, et al. Effectiveness of respondent-driven sampling for recruiting drug users in New York City: findings from a pilot study. J Urban Health. 2006; 83(3): 459–76.

    Article  PubMed  Google Scholar 

  26. Abdul-Quader AS, Heckathorn DD, Sabin K, Saidel T. Implementation and analysis of respondent driven sampling: lessons learned from the field. J Urban Health. 2006; 83(6 Suppl): i1–5.

    Article  PubMed  Google Scholar 

  27. Abdul-Quader AS, Heckathorn DD, Sabin K, Saidel T, Ramirez-Valles J, Heckathorn DD, Vázquez R, Diaz RM, Campbell RT. From networks to populations: the development and application of respondent-driven sampling among IDUs and Latino gay men. AIDS Behav. 2005; 9(4): 387–402.

    Article  Google Scholar 

  28. Deiss RG, Brouwer KC, Loza O, Lozada RM, Ramos R, FirestoneCruz MA, Patterson TL, Heckathorn DD, Frost SD, Strathdee SA. High-risk sexual and drug using behaviors among male injection drug users who have sex with men in 2 Mexico–US border cities. Sex Transm Dis. 2008; 35: 243–249.

    Article  PubMed  Google Scholar 

  29. Heckathorn D. Respondent-driven sampling: a new approach to the study of hidden populations. Social Problems. 1997; 44(2): 174–99.

    Article  Google Scholar 

  30. Heckathorn D. Respondent-driven sampling II: deriving valid population estimates from chain-referral samples of hidden populations. Social Problems. 2002; 49(1): 11–34.

    Article  Google Scholar 

  31. Heckathorn D. Extensions of respondent-driven sampling: analyzing continuous variables and controlling for differential recruitment. Sociological Methodology 2007;37:151–207.

    Google Scholar 

  32. Magnani R, Sabin K, Saidel T, Heckathorn D. Review of sampling hard-to-reach and hidden populations for HIV surveillance. Aids. 2005; 19(Suppl 2): S67–72.

    Article  PubMed  Google Scholar 

  33. McKnight C, Des Jarlais D, Bramson H, et al. Respondent-driven sampling in a study of drug users in New York City: notes from the field. J Urban Health. 2006; 83(6 Suppl): i54–9.

    Article  PubMed  Google Scholar 

  34. Ramirez-Valles J, Heckathorn DD, Vazquez R, Diaz RM, Campbell RT. From networks to populations: the development and application of respondent-driven sampling among IDUs and Latino gay men. AIDS Behav. 2005; 9(4): 387–402.

    Article  PubMed  Google Scholar 

  35. Semaan S, Santibanez S, Garfein RS, Heckathorn DD, Des Jarlais DC. Ethical and regulatory considerations in HIV prevention studies employing respondent-driven sampling. Int J Drug Policy 2008. Am J Public Health. 2010;100:582–3.

    Google Scholar 

  36. Stormer A, Tun W, Guli L, et al. An analysis of respondent driven sampling with Injection Drug Users (IDU) in Albania and the Russian Federation. J Urban Health. 2006; 83(6 Suppl): i73–82.

    Article  PubMed  Google Scholar 

  37. Lansky A, Drake A, DiNenno E, Lee CW. HIV behavioral surveillance among the U.S. general population. Public Health Rep. 2007; 122(Suppl 1): 24–31.

    PubMed  Google Scholar 

  38. Woods WJ, Lindan CP, Hudes ES, Boscarino JA, Clark WW, Avins AL. HIV infection and risk behaviors in two cross-sectional surveys of heterosexuals in alcoholism treatment. J Stud Alcohol. 2000; 61(2): 262–6.

    PubMed  CAS  Google Scholar 

  39. Unger JB, Kipke MD, De Rosa CJ, Hyde J, Ritt-Olson A, Montgomery S. Needle-sharing among young IV drug users and their social network members: the influence of the injection partner’s characteristics on HIV risk behavior. Addict Behav. 2006; 31(9): 1607–18.

    Article  PubMed  Google Scholar 

  40. Bennett GA, Velleman RD, Barter G, Bradbury C. Gender differences in sharing injecting equipment by drug users in England. AIDS Care. 2000; 12(1): 77–87.

    Article  PubMed  CAS  Google Scholar 

  41. Wisniewski AB, Apel S, Selnes OA, Nath A, McArthur JC, Dobs AS. Depressive symptoms, quality of life, and neuropsychological performance in HIV/AIDS: the impact of gender and injection drug use. J Neurovirol. 2005; 11(2): 138–43.

    Article  PubMed  Google Scholar 

  42. Cruz MF, Mantsios A, Ramos R, et al. A qualitative exploration of gender in the context of injection drug use in two US-Mexico border cities. AIDS Behav. 2007; 11(2): 253–62.

    Article  PubMed  Google Scholar 

  43. Strathdee SA, Galai N, Safaiean M, et al. Sex differences in risk factors for hiv seroconversion among injection drug users: a 10-year perspective. Arch Intern Med. 2001; 161(10): 1281–8.

    Article  PubMed  CAS  Google Scholar 

  44. Mandell W, Kim J, Latkin C, Suh T. Depressive symptoms, drug network, and their synergistic effect on needle-sharing behavior among street injection drug users. Am J Drug Alcohol Abuse. 1999; 25(1): 117–27.

    Article  PubMed  CAS  Google Scholar 

  45. Latkin CA, Mandell W. Depression as an antecedent of frequency of intravenous drug use in an urban, nontreatment sample. Int J Addict. 1993; 28(14): 1601–12.

    PubMed  CAS  Google Scholar 

  46. Purcell DW, Mizuno Y, Metsch LR, et al. Unprotected sexual behavior among heterosexual HIV-positive injection drug using men: associations by partner type and partner serostatus. J Urban Health. 2006; 83(4): 656–68.

    Article  PubMed  Google Scholar 

  47. Burt RD, Hagan H, Sabin K, Thiede H. Evaluating respondent-driven sampling in a major metropolitan area: comparing injection drug users in the 2005 Seattle area national HIV behavioral surveillance system survey with participants in the RAVEN and Kiwi studies. Ann Epidemiol. 2005; 20(2): 159–67.

    Article  Google Scholar 

  48. Abramovitz D, Volz EM, Strathdee SA, Patterson TL, Vera A, Frost SD. Using respondent-driven sampling in a hidden population at risk of HIV infection: who do HIV-positive recruiters recruit? Sex Transm Dis. 2009; 36(12): 750–6.

    Article  PubMed  Google Scholar 

  49. Lansky A, Abdul-Quader AS, Cribbin M, et al. Developing an HIV behavioral surveillance system for injecting drug users: the National HIV Behavioral Surveillance System. Public Health Rep. 2007; 122(Suppl 1): 48–55.

    PubMed  Google Scholar 

  50. Platt L, Wall M, Rhodes T, et al. Methods to recruit hard-to-reach groups: comparing two chain referral sampling methods of recruiting injecting drug users across nine studies in Russia and Estonia. J Urban Health. 2006; 83(6 Suppl): i39–53.

    Article  PubMed  Google Scholar 

  51. Robinson WT, Risser JM, McGoy S, et al. Recruiting injection drug users: a three-site comparison of results and experiences with respondent-driven and targeted sampling procedures. J Urban Health. 2006; 83(6 Suppl): i29–38.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

For their assistance and expertise throughout the study, the authors acknowledge Dr. Amanda Castel of GWU SPHHS; Dr. Amy Lansky, Dr. Elizabeth DiNenno, Ms. Tricia Martin, and Dr. Isa Miles of CDC; and the WORD UP Community Advisory Board Members. Interviewers Luz Montanez, Julie Archer, Ashley Clegg, Megan Condrey, Daniel Choi, Keith Egan, and Mariel Marlow. This study could not have been conducted without the enormous support of our many community partners. For their participation in and support of NHBS, the study team would like to acknowledge the participants of the study and the citizens of the District of Columbia, without whom this study would not have been possible.

Funding source

This study was funded by District of Columbia, Department of Health/HIV/AIDS, Hepatitis, STD and Tuberculosis Administration (DC DOH/HAHSTA), Contract Number POHC-2006-C-0030, funded in part by Grant Number PS000966-01, from the US Department of Health and Human Services (DHHS)/Centers for Disease Control and Prevention (CDC). All co-authors have reviewed and approved of the final draft of the paper including those from DC DOH/HAHSTA. Under the Partnership contract, DC DOH/HAHSTA had the right to review and approve the manuscript. The content of this publication does not necessarily reflect the views or policies of DHHS/CDC and responsibility for the content rests solely with the authors.

Author information

Authors and Affiliations

  1. Department of Epidemiology and Biostatistics, The George Washington University School of Public Health and Health Services, Washington, DC, USA

    Manya Magnus, Irene Kuo, Gregory Phillips II, Anthony Rawls, James Peterson, Luz Montanez & Alan E. Greenberg

  2. District of Columbia, Department of Health, HIV/AIDS, Hepatitis, STD and Tuberculosis Administration, Washington, DC, USA

    Tiffany West-Ojo, Yujiang Jia & Jenevieve Opoku

  3. Family and Medical Counseling Service, Inc, Washington, DC, USA

    Flora Hamilton & Angela Wood

  4. District of Columbia, Department of Health, HIV/AIDS, Hepatitis, STD and Tuberculosis Administration, Washington, DC, USA

    Nnemdi Kamanu-Elias

Authors
  1. Manya Magnus
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Irene Kuo
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Gregory Phillips II
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Anthony Rawls
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. James Peterson
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Luz Montanez
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Tiffany West-Ojo
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Yujiang Jia
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Jenevieve Opoku
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Nnemdi Kamanu-Elias
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Flora Hamilton
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Angela Wood
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Alan E. Greenberg
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Manya Magnus.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Magnus, M., Kuo, I., Phillips, G. et al. Differing HIV Risks and Prevention Needs among Men and Women Injection Drug Users (IDU) in the District of Columbia. J Urban Health 90, 157–166 (2013). https://doi.org/10.1007/s11524-012-9687-5

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11524-012-9687-5

Keywords

Search

Navigation