Identifying Which Place Characteristics are Associated with the Odds of Recent HIV Testing in a Large Sample of People Who Inject Drugs in 19 US Metropolitan Areas
This exploratory analysis investigates relationships of place characteristics to HIV testing among people who inject drugs (PWID). We used CDC’s 2012 National HIV Behavioral Surveillance (NHBS) data among PWID from 19 US metropolitan statistical areas (MSAs); we restricted the analytic sample to PWID self-reporting being HIV negative (N = 7477). Administrative data were analyzed to describe the 1. Sociodemographic Composition; 2. Economic disadvantage; 3. Healthcare Service/Law enforcement; and 4. HIV burden of the ZIP codes, counties, and MSAs where PWID lived. Multilevel models tested associations of place characteristics with HIV testing. Fifty-eight percent of PWID reported past-year testing. MSA-level per capita correctional expenditures were positively associated with recent HIV testing among black PWID, but not white PWID. Higher MSA-level household income and imbalanced sex ratios (more women than men) in the MSA were associated with higher odds of testing. HIV screening for PWID is suboptimal (58%) and needs improvement. Identifying place characteristics associated with testing among PWID can strengthen service allocation and interventions in areas of need to increase access to HIV testing.
KeywordsPlace characteristics HIV testing People who inject drugs National HIV Behavioral Surveillance US metropolitan statistical areas
This research was supported by two Grants from the National Institutes of Health: “Place Characteristics & Disparities in HIV in IDUS: A Multilevel Analysis of NHBS” (DA035101; Cooper, PI) and, “Metropolitan Trajectories of HIV Epidemics and Responses in US Key Populations” (DA037568; Cooper, Friedman, & Stall, PIs). It was also supported by the Centers and Disease Control and Prevention, and the National HIV Behavioral Surveillance System Study Group: Atlanta, GA: Jennifer Taussig, Shacara Johnson, Jeff Todd; Baltimore, MD: Colin Flynn, Danielle German; Boston, MA: Debbie Isenberg, Maura Driscoll, Elizabeth Hurwitz; Chicago, IL: Nikhil Prachand, Nanette Benbow; Dallas, TX: Sharon Melville, Richard Yeager, Jim Dyer, Alicia Novoa; Denver, CO: Mark Thrun, Alia Al-Tayyib; Detroit, MI: Emily Higgins, Eve Mokotoff, Vivian Griffin; Houston, TX: Aaron Sayegh, Jan Risser, Hafeez Rehman; Los Angeles, CA: Trista Bingham, Ekow Kwa Sey; Miami, FL: Lisa Metsch, David Forrest, Dano Beck, Gabriel Cardenas; Nassau-Suffolk, NY: Chris Nemeth, Lou Smith, Carol-Ann Watson; New Orleans, LA: William T. Robinson, DeAnn Gruber, Narquis Barak; New York City, NY: Alan Neaigus, Samuel Jenness, Travis Wendel, Camila Gelpi-Acosta, Holly Hagan; Newark, NJ: Henry Godette, Barbara Bolden, Sally D’Errico; Philadelphia, PA: Kathleen A. Brady, Althea Kirkland, Mark Shpaner; San Diego, CA: Vanessa Miguelino-Keasling, Al Velasco; San Francisco, CA: H. Fisher Raymond; San Juan, PR: Sandra Miranda De Leo´n, Yadira Rolo´n-Colo´n; Seattle, WA: Maria Courogen, Hanne Thiede, Richard Burt; St Louis, MO: Michael Herbert, Yelena Friedberg, Dale Wrigley, Jacob Fisher; Washington, DC: Marie Sansone, Tiffany West-Ojo, Manya Magnus, Irene Kuo; Behavioral Surveillance Team. We also thank the men and women who participated in NHBS and the staff at all NHBS sites.
Compliance with Ethical Standards
Conflict of interest
The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.
Each author has contributed to the conception and design of the work, the acquisition of data or the analysis of the data in a manner substantial enough to take public responsibility for it. In addition, each author believes that the paper represents valid work and has reviewed the final version of the manuscript and approves it for publication. The findings in this paper have not been published and are not being considered elsewhere for publication.
Emory University’s Institutional Review Board (IRB) approved this study’s protocols; each NHBS site’s IRB approved the NHBS protocol. CDC reviewed and approved the protocol as non-engaged research.
- 1.National Minority AIDS Council. African Americans, health disparities, and HIV/AIDS: recommendations for confronting the epidemic in Black America. Washington, DC: National Minority AIDS Council; 2006.Google Scholar
- 2.National Institute on Drug Abuse of the National Institutes of Health. NIH Health Disparities Strategic Plan, Fiscal Years 2009–2013. National Institute on Drug Abuse. Bethesda, MD: NIH; 2009.Google Scholar
- 3.National Center for HIV/AIDS VH, STD, and TB Prevention at the Centers for Disease Control and Prevention within the U.S. Department of Health and Human Services. Strategic plan: the division of HIV/AIDS prevention 2011 through 2015. Atlanta, GA: CDC; 2011.Google Scholar
- 4.Centers for Disease Control and Prevention. Revised recommendations for HIV testing of adults, adolescents, and pregnant women in health-care settings. MMWR Recomm Rep. 2006;55:1–17.Google Scholar
- 8.Spielberg F, Branson BM, Goldbaum GM, Lockhart D, Kurth A, Celum CL, et al. Overcoming barriers to HIV testing: preferences for new strategies among clients of a needle exchange, a sexually transmitted disease clinic, and sex venues for men who have sex with men. J Acquir Immune Defic Syndr. 2003;32:318–27.CrossRefGoogle Scholar
- 10.Rhodes T. The ‘risk environment’: a framework for understanding and reducing drug-related harm. Int J Drug Policy. 2002;13:85–94. ISSN 0955-3959.Google Scholar
- 13.Rhodes T, Wagner K, Strathdee SA, Shannon K, Davidson P, Bourgois P. Structural violence and structural vulnerability within the risk environment: theoretical and methodological perspectives for a social epidemiology of HIV risk among injection drug users and sex workers. In: O’Campo P, Dunn JR, editors. Rethinking social epidemiology: Towards a science of change. New York: Springer; 2012. pp. 205–30.Google Scholar
- 18.Cooper HLF, Bossak B, Tempalski B, Friedman SR, Des Jarlais DC. Temporal trends in spatial access to pharmacies that sell over-the-counter syringes in New York City health districts: relationship to local racial/ethnic composition and need. J Urban Health. 2009;8:929–45. https://doi.org/10.1007/s11524-009-9399-7.CrossRefGoogle Scholar
- 24.Cooper HLF, Des Jarlais DC, Tempalski B, Bossak B, Ross Z, Friedman SR. Drug-related arrest rates and spatial access to syringe exchange programs in New York City health districts: combined effects on the risk of injection-related infections among injectors. Health Place. 2012;18:218–28.CrossRefGoogle Scholar
- 26.Linton SL, Cooper HL, Kelley ME, Karnes CC, Ross Z, Wolfe ME, et al. Associations of place characteristics with HIV and HCV risk behaviors among racial/ethnic groups of people who inject drugs in the United States. Am J Epidemiol. 2016;26:619–30. https://doi.org/10.1016/j.annepidem.2016.07.012.Google Scholar
- 27.Cooper H, Friedman S, Tempalski B, Friedman R, Keem M. Racial/Ethnic disparities in injection drug use in 94 U.S. metropolitan statistical areas in 1998. Am J Epidemiol. 2005;15:326–34.Google Scholar
- 29.Centers for Disease Control and Prevention. National HIV Behavioral Surveillance. Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, Sexual Transmitted Diseases and Tuberculosis Prevention. 2017. https://www.cdc.gov/hiv/statistics/systems/nhbs/index.html. Accessed June 2017.
- 30.Broz D, Wejnert C, Pham HT, DiNenno E, Heffelfinger JD, Cribbin M, et al. HIV infection and risk, prevention, and testing behaviors among injecting drug users—National HIV Behavioral Surveillance System, 20 U.S. cities, 2009. MMWR. Surveillance Summaries. 2014;63:1–51.Google Scholar
- 32.Massey D, Denton N. American Apartheid: segregation and the making of the underclass. Cambridge, Massachusetts: Harvard University Press; 1993.Google Scholar
- 37.Link BG, Phelan JC. Fundamental sources of health inequalities. In: Policy challenges in modern health care. Piscataway, NJ: Rutgers University Press; 2005.Google Scholar
- 46.West HC, Sabol WJ, Greenman SJ, Li S. Prisoners in 2009. U.S. Department of Justice, Bureau of Justice Statistics. Washington, DC. December 2010, NCJ 231675. Revised 10.27.2011. http://www.bjs.gov/index.cfm?ty=pbdetail&iid=2232. Accessed 29 Nov 2016.
- 47.Maruschak LM, Berzofsky M, Unangst J, Carson EA, Bronson J. Medical Problems of State and Federal Prisoners and Jail Inmates, 2011–12. U.S. Department of Justice, Bureau of Justice Statistics. Washington, DC. February 2015, NCJ 248491. https://www.bjs.gov/content/pub/pdf/mpsfpji1112.pdf. Accessed 1 Dec 2016.
- 52.Dwyer M, Fish DG, Gallucci AV, Walker SJ. HIV Care in Correctional Settings. In: Guide for HIV/AIDS clinical care—2014 Edition. Rockville, MD: U.S. Department of Health and Human Services; 2014.Google Scholar
- 57.Denning P. Rethinking the treatment of dual disorders. In: Marlatt A, editor. Harm reduction: pragmatic strategies for managing high risk behaviors. 2d ed. New York: Guilford Press; 2012.Google Scholar
- 58.Denning P. Harm reduction therapy with families and friends of people with drug problems. J Clin Psychol. 2010;66:164–74.Google Scholar
- 59.Little J, Franskoviak P. We’re glad you came: harm reduction therapy in community settings. J Clin Psychol. 2010;66:175–88.Google Scholar
- 60.Marlatt GA, Larimer ME, Witkiewitz K, editors. Harm reduction: pragmatic strategies for managing high risk behaviors. New York: Guilford; 2012.Google Scholar
- 61.Springer E. Effective AIDS prevention with active drug users: the harm reduction model. J Subst Abuse Treat. 1991;4:141–57.Google Scholar
- 63.World Health Organization. Service delivery approaches to HIV testing and counselling (HTC): a strategic policy framework. 2012. http://apps.who.int/iris/bitstream/10665/75206/1/9789241593877_eng.pdf. Accessed 27 July 2017.
- 70.Cooper HLF, Tempalski B. Integrating place into research on drug use, drug users’ health, and drug policy. Special issue on place matters: drug users’ health and health policy. Guest Ed Int J Drug Policy. 2014;5:333–652.Google Scholar