232961 Homelessness and HIV risk factors associated with injection drug use in Houston, Texas, 2009

Monday, November 8, 2010

Syed Noor, MSS, MA, MPH , School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX
Alice Cates, MS , Department of Epidemiology and Disease Control, University of Texas School of Public Health, Houston, TX
Michael W. Ross, PhD , WHO Center for Health Promotion Research and Development, The University of Texas - Houston School of Public Health, Houston, TX
Jan Risser, PhD , Department of Epidemiology and Disease Control, University of Texas School of Public Health, Houston, TX
Background: The prevalence of HIV is higher among the homeless compared to non-homeless populations. This analysis examines homelessness as a factor affecting HIV risk behaviors associated with injection drug use. Methods: Our study includes 523 eligible injection drug users (IDUs), recruited into the 2009 cycle of the National HIV Behavioral Risk Surveillance project. Three separate multivariable logistic regression models were used to identify the association of homelessness with: 1) always using a new sterile needle; 2) sharing needles; and 3) sharing drug-preparation equipment. All three models were adjusted for potential confounders selected through univariate analyses using a cut point of p<0.1. Results: 251 (48%) of our sample population of IDUs reported being currently homeless. In all three models, homelessness was associated with risky injection behavior: homeless IDUs had lower odds of always using a new sterile needle (OR=0.57, 95% CI: 0.37-0.87) and greater odds of sharing needles (OR=2.21, 95% CI: 1.50-3.25) and of sharing drug-preparation equipment (OR=1.74, 95% CI: 1.13-2.66). In addition to homelessness, being arrested in the past 12 months (OR=1.52, 95% CI: 1.04-2.22) was associated only with sharing needles but not with using a new sterile needle or sharing equipment. Discussion: Our results show that structural/environmental factor such as homelessness, are associated with individual risk behaviors, like needle sharing. The findings underscore how important it is to considering structural/environmental factors with individual risk factors when designing interventions to reduce HIV risk. Interventions targeting system-level change may help to reduce the burden of HIV among the homeless injection drug user population.

Learning Areas:
Advocacy for health and health education
Planning of health education strategies, interventions, and programs
Protection of the public in relation to communicable diseases including prevention or control
Public health or related public policy
Social and behavioral sciences

Learning Objectives:
Learners will be able to 1. list factors contextual to injection drug related HIV risk among a sample of injection drug users. 2. compare HIV risk behaviors among homeless and non-homeless injection drug users. 3. explain the influence of structural/environmental factors, such as homelessness on injection drug use associated HIV risk behaviors like need sharing in Houston, Texas.

Keywords: Drug Injectors, Homelessness

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I conceptualized and conducted this analysis.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.