AIDS and Behavior

, Volume 18, Issue 3, pp 452–463 | Cite as

Associations Between Injection Risk and Community Disadvantage Among Suburban Injection Drug Users in Southwestern Connecticut, USA

  • Robert HeimerEmail author
  • Russell Barbour
  • Wilson R. Palacios
  • Lisa G. Nichols
  • Lauretta E. Grau
Original Paper


Increases in drug abuse, injection, and opioid overdoses in suburban communities led us to study injectors residing in suburban communities in southwestern Connecticut, US. We sought to understand the influence of residence on risk and injection-associated diseases. Injectors were recruited by respondent-driven sampling and interviewed about sociodemographics, somatic and mental health, injection risk, and interactions with healthcare, harm reduction, substance abuse treatment, and criminal justice systems. HIV, hepatitis B and C (HBV and HCV) serological testing was also conducted. Our sample was consistent in geographic distribution and age to the general population and to the patterns of heroin-associated overdose deaths in the suburban towns. High rates of interaction with drug abuse treatment and criminal justice systems contrasted with scant use of harm reduction services. The only factors associated with both dependent variables—residence in less disadvantaged census tracts and more injection risk—were younger age and injecting in one’s own residence. This contrasts with the common association among urban injectors of injection-associated risk behaviors and residence in disadvantaged communities. Poor social support and moderate/severe depression were associated with risky injection practices (but not residence in specific classes of census tracts), suggesting that a region-wide dual diagnosis approach to the expansion of harm reduction services could be effective at reducing the negative consequences of injection drug use.


Injection drug use Suburbs Injection risk Community disadvantage index Harm reduction Substance abuse treatment Criminal justice 



This study was supported by a grant from the National Institute on Drug Abuse (1R01DA023408). Dr. Palacios was supported by a diversity supplement awarded to this Grant. The authors would especially like to thank John Hamilton, Joann Montgomery, and the staff at the Center for Human Services, part of the Recovery Network of Programs, who arranged for many of the seeds to contact our study. The authors also wish to thank Amisha Patel who performed the serological testing.

Conflict of interest

The authors declare no competing interests.


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Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Robert Heimer
    • 1
    Email author
  • Russell Barbour
    • 2
  • Wilson R. Palacios
    • 3
  • Lisa G. Nichols
    • 4
  • Lauretta E. Grau
    • 1
  1. 1.Department of Epidemiology of Microbial Diseases and the Center for Interdisciplinary Research on AIDSYale University School of Public HealthNew HavenUSA
  2. 2.The Center for Interdisciplinary Research on AIDSYale University School of Public HealthNew HavenUSA
  3. 3.Department of Criminology, College of Arts and SciencesUniversity of South FloridaTampaUSA
  4. 4.Department of Internal MedicineYale School of MedicineNew HavenUSA

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