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Drug use Discrimination Predicts Formation of High-Risk Social Networks: Examining Social Pathways of Discrimination

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Abstract

Experiences of discrimination, or social marginalization and ostracism, may lead to the formation of social networks characterized by inequality. For example, those who experience discrimination may be more likely to develop drug use and sexual partnerships with others who are at increased risk for HIV compared to those without experiences of discrimination. This is critical as engaging in risk behaviors with others who are more likely to be HIV positive can increase one’s risk of HIV. We used log-binomial regression models to examine the relationship between drug use, racial and incarceration discrimination with changes in the composition of one’s risk network among 502 persons who use drugs. We examined both absolute and proportional changes with respect to sex partners, drug use partners, and injecting partners, after accounting for individual risk behaviors. At baseline, participants were predominately male (70%), black or Latino (91%), un-married (85%), and used crack (64%). Among those followed-up (67%), having experienced discrimination due to drug use was significantly related to increases in the absolute number of sex networks and drug networks over time. No types of discrimination were related to changes in the proportion of high-risk network members. Discrimination may increase one’s risk of HIV acquisition by leading them to preferentially form risk relationships with higher-risk individuals, thereby perpetuating racial and ethnic inequities in HIV. Future social network studies and behavioral interventions should consider whether social discrimination plays a role in HIV transmission.

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Funding

This study was funded by the National Institute on Drug Abuse (R01 DA 019964-01). The authors also thank the Robert Wood Johnson Foundation Health & Society Scholars program for its financial support. We would also like to acknowledge the support of the HIV/AIDS Substance Use Training and Trauma Program. Finally, the authors would like to thank the START staff and participants for their invaluable contributions.

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Authors and Affiliations

  1. Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, 1518 Clifton Rd NE, Atlanta, GA, 30322, USA

    Natalie D. Crawford

  2. Department of Community Health Sciences, School of Public Health, University of California at Los Angeles, Los Angeles, CA, USA

    Chandra Ford

  3. Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA

    Abby Rudolph

  4. College of Health and Human Services, University of New Hampshire, Durham, NH, USA

    BoRin Kim

  5. Division of Social Solutions and Services Research, Nathan Kline Institute for Psychiatric Research, New York State Office of Mental Health, Latham, NY, USA

    Crystal M. Lewis

Authors
  1. Natalie D. Crawford
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  5. Crystal M. Lewis
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Corresponding author

Correspondence to Natalie D. Crawford.

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Conflict of interest

There are no conflicts of interest to disclose.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional review board of the New York Academy of Medicine and Columbia University Medical Center.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Appendix 1: The relationship between experiences of discrimination and changes in the absolute number of risk network members over 6, 12 and 18 months among PWUD, NYC 2006–2009

Appendix 1: The relationship between experiences of discrimination and changes in the absolute number of risk network members over 6, 12 and 18 months among PWUD, NYC 2006–2009

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Crawford, N.D., Ford, C., Rudolph, A. et al. Drug use Discrimination Predicts Formation of High-Risk Social Networks: Examining Social Pathways of Discrimination. AIDS Behav 21, 2659–2669 (2017). https://doi.org/10.1007/s10461-016-1639-8

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