Young injection drug users: Profile of predominantly suburban populations and the implications for HIV and hepatitis c infection risk

Background: In recent years, injection drug use has increasingly been located in non-Hispanic white suburban communities rather than in poor urban neighborhoods. Little is known about this new generation of persons who inject drugs (PWID) or their social networks pertaining to risk factors for drug initiation and transmission of HIV and hepatitis C. Methods: We conducted cross-sectional surveys (n=122) and qualitative interviews (sub-sample, n=29) of young PWID (ages 18-30, median 27) who were recruited using outreach methods in metropolitan Chicago. Analyses were performed in SAS v. 9.2, STATA v. 12 and Atlas.ti v. 7. Results: Young PWID are more likely to be non-Hispanic white (69%) or Hispanic (16%) and predominately suburban (68%). Non-Hispanic white PWID are more likely to inject with a syringe used by others (39%) and have overlapping injection and sexual networks (49%) than other racial/ethnic groups. From our qualitative interviews, the initiation of heroin use was primarily due to experimentation and/or having a family member or friend already initiated into drug use. Geographically, the urban and suburban settings converged on the west side of Chicago to purchase drugs, inject, and meet sexual partners. Conclusion: The new generation of PWID is more likely to be non-Hispanic white, suburban with moderately sized injection and sexual networks. In Chicago, we have identified a centralized area where interventions can be delivered to both suburban and rural PWID. Future research is needed to further elucidate heroin initiation by this new population.