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- Title
Variation in HIV Transmission Behaviors Among People Who Use Drugs in Rural US Communities.
- Authors
Jenkins, Wiley D.; Friedman, Samuel R.; Hurt, Christopher B.; Korthuis, P. Todd; Feinberg, Judith; Del Toro-Mejias, Lizbeth M.; Walters, Suzan; Seal, David W.; Fredericksen, Rob J.; Westergaard, Ryan; Miller, William C.; Go, Vivian F.; Schneider, John; Giurcanu, Mihai
- Abstract
This cross-sectional study investigates the association of factors among people who use drugs in rural communities with HIV transmission–associated behaviors. Key Points: Question: What are the frequency and distribution of HIV transmission behaviors among people who use drugs (PWUD) who live in rural areas? Findings: In this cross-sectional study of 3048 PWUD living in rural areas of the US, substantial proportions of individuals reported drug injection (84.9%), sharing syringes (41.8%), condomless sex (80.0%), and transactional sex (7.5%). Study sites had significant variation in participant characteristics (eg, race and sexual orientation) and HIV transmission behaviors, and some participant characteristics (eg, age and sexual orientation) were more frequently associated with transmission behaviors. Meaning: These findings suggest that "rural PWUD" may not be a homogeneous construct for which universal interventions may be equally effective across populations and regions and that identification of local characteristics and behaviors may be needed for effective measures to be developed and implemented. Importance: People who use drugs (PWUD) continue to be at risk of HIV infection, but the frequency and distribution of transmission-associated behaviors within various rural communities is poorly understood. Objective: To examine the association of characteristics of rural PWUD with HIV transmission behaviors. Design, Setting, and Participants: In this cross-sectional study, surveys of PWUD in rural communities in 10 states (Illinois, Kentucky, New Hampshire, Massachusetts, North Carolina, Ohio, Oregon, Vermont, West Virginia, and Wisconsin) were collected January 2018 through March 2020 and analyzed August through December 2022. A chain-referral sampling strategy identified convenience sample seeds who referred others who used drugs. Rural PWUD who reported any past 30-day injection drug use or noninjection opioid use "to get high" were included. Exposures: Individual characteristics, including age, race, gender identity, sexual orientation, partnership status, drug of choice, and location, were collected. Main Outcomes and Measures: Past 30-day frequency of behaviors associated with HIV transmission, including drug injection, syringe sharing, opposite- and same-gender partners, transactional sex, and condomless sex, was assessed. Results: Of 3048 rural PWUD (mean [SD] age, 36.1 [10.3] years; 225 American Indian [7.4%], 96 Black [3.2%], and 2576 White [84.5%] among 3045 with responses; and 1737 men [57.0%] among 3046 with responses), most participants were heterosexual (1771 individuals [86.8%] among 2040 with responses) and single (1974 individuals [68.6%] among 2879 with responses). Opioids and stimulants were reported as drug of choice by 1636 individuals (53.9%) and 1258 individuals (41.5%), respectively, among 3033 individuals with responses. Most participants reported recent injection (2587 of 3046 individuals [84.9%] with responses) and condomless sex (1406 of 1757 individuals [80.0%] with responses), among whom 904 of 1391 individuals (65.0%) with responses indicated that it occurred with people who inject drugs. Syringe sharing (1016 of 2433 individuals [41.8%] with responses) and transactional sex (230 of 1799 individuals [12.8%] with responses) were reported less frequently. All characteristics and behaviors, except the number of men partners reported by women, varied significantly across locations (eg, mean [SD] age ranged from 34.5 [10.0] years in Wisconsin to 39.7 [11.0] years in Illinois; P <.001). In multivariable modeling, younger age (adjusted odds ratio [aOR] for ages 15-33 vs ≥34 years, 1.36; 95% CI, 1.08-1.72) and being single (aOR, 1.37; 95% CI, 1.08-1.74) were associated with recent injection; younger age (aOR, 1.49; 95% CI, 1.20-1.85) and bisexual orientation (aOR vs heterosexual orientation, 2.27; 95% CI, 1.60-3.23) with syringe sharing; gender identity as a woman (aOR vs gender identity as a man, 1.46; 95% CI, 1.01-2.12), bisexual orientation (aOR vs heterosexual orientation, 2.59; 95% CI, 1.67-4.03), and being single (aOR, 1.71; 95% CI, 1.15-2.55) with transactional sex; and bisexual orientation (aOR vs heterosexual orientation, 1.60; 95% CI, 1.04-2.46) and stimulants as the drug of choice (aOR vs opioids, 1.45; 95 CI, 1.09-1.93) with condomless sex with someone who injects drugs. Conclusions and Relevance: This study found that behaviors associated with HIV transmission were common and varied across communities. These findings suggest that interventions to reduce HIV risk among rural PWUD may need to be tailored to locally relevant factors.
- Subjects
UNITED States; HIV infection transmission; HIV infection risk factors; CONFIDENCE intervals; RURAL conditions; CROSS-sectional method; MULTIVARIATE analysis; COMMUNITIES; RISK assessment; HEALTH behavior; RESEARCH funding; DESCRIPTIVE statistics; STATISTICAL sampling; ODDS ratio; DRUG abusers
- Publication
JAMA Network Open, 2023, Vol 6, Issue 8, pe2330225
- ISSN
2574-3805
- Publication type
Article
- DOI
10.1001/jamanetworkopen.2023.30225