Online Program

Drug use discrimination predicts formation of high-risk social ties

Monday, November 2, 2015

Natalie Crawford, PhD, Epidemiology and Biostatistics, Georgia State University, Atlanta, GA
Chandra L. Ford, PhD, MPH, MLIS, Department of Community Health Sciences, School of Public Health, University of California, Los Angeles, Los Angeles, CA
Abby Rudolph, PhD, PIRE, Calverton, MD
BoRin Kim, PhD, Department of Social Work, University of New Hampshire, Durham, NH
Crystal Fuller, PhD, MPH, Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY
Drug and sex networks with high disease burden facilitate HIV transmission even with relatively infrequent risk behaviors. Cross sectional studies suggests social marginalization due to membership with a stigmatized subgroup may act as a conduit for HIV transmission, creating a risk connection between those heavily burdened with HIV and those less burdened. Herein, we prospectively examined perceived discrimination as a risk factor for high-risk relationships among persons who are heavily drug-involved.

Individuals (n=502) who used non-injection crack, heroin and/or cocaine were followed over six months. Log-binomial regression models were used to determine the temporal relationship between discrimination and changes in the absolute and proportional number of sex, drug and injecting social ties.

Drug use discrimination, independent of individual risk behaviors significantly predicted an increase in the absolute number of sexual relationships, (Adjusted incidence rate ratio (AIRR:1.92; 95% confidence interval(95%CI):1.08-3.39), drug use relationships (AIRR:2.09; 95%CI:1.17-3.72) and injecting relationships (AIRR:3.29; 95%CI:1.09-9.89) over time. There was no relationship between discrimination and proportion of high-risk relationships.

Social networks, particularly those among drug users, are dynamic and while proportional network risk is important, it does not account for the flow of individuals moving in-and-out of the network. Absolute changes, however, provide information about new relationships thereby creating new opportunities for exposure to HIV. Future social network studies and behavioral interventions should consider how social marginalization isolates persons who use drugs and potentially influences formation of high-risk social ties. Interventions to increase social support may counteract the development of high-risk relationships and reduce HIV transmission.

Learning Areas:

Social and behavioral sciences

Learning Objectives:
Describe the relationship between social experiences of discrimination with high-risk relationships among heavy drug users to understand HIV transmission.

Keyword(s): HIV/AIDS, Drug Abuse

Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: n/a

Qualified on the content I am responsible for because: Dr. Crawford is an Assistant Professor in the Division of Epidemiology and Biostatistics at the Georgia State University School of public health. She received her PhD in Epidemiology from Columbia University’s Mailman School of Public Health in 2011 and completed her post-doctoral training at the University of Michigan as a Robert Wood Johnson Health and Society Scholar. Her broad research interests are examining the social processes that create and perpetuate racial and ethnic health disparities.
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.

Back to: 3364.0: HIV and Substance Use