Author

Anandam Hilde

Date

June 2009

Document Type

Thesis

Degree Name

M.P.H.

Department

Dept. of Public Health and Preventive Medicine

Institution

Oregon Health & Science University

Abstract

Background: Women injection drug users (IDUs) are at increased risk for infection with blood borne and sexually transmitted diseases, such as HIV and HCV. Their increased exposure is due to high risk practices (e.g. sharing syringes and other injection equipment, exchanging sex for drugs or money, sex with multiple partners and unprotected sex). Preventing the transmission of HIV and HCV among women IDUs requires thorough understanding of all variables that increase risk. Recently investigations suggest that the character and dynamic of social interactions may be important determinants of risk. Social and emotional isolation are facets of social interactions that have not been widely considered with respect to HIV or HCV risk. Methods: We collected data from 102 women IDUs through a self report questionnaire, to determine if there is an association between social and/or emotional isolation (self report isolation scale) and engagement in HIV/HCV risk behaviors (defined by 15 unsafe sex- and drug-related practices). All subjects were adult women (18 years of age or older) of any race/nationality who spoke English and who by self report had injected drugs at least one time over the past 30 days. Study participants were recruited from existing organizations that provide services to IDUs. Results: Data were analyzed using Chi-square and T tests and multivariate logistic regression models. We found that 50% of the women had above average or severe levels of isolation. Despite accessing harm reduction services a number of women engaged in high risk practices over the previous 30 days. One third injected with a syringe that had been used by someone else and close to half were either injected by another or used injection paraphernalia that had been used by someone else. Half of the sample had sex with another IDU and one third exchanged sex for money or drugs, of which, only one half always used condoms. An examination of the association between isolation and risk behaviors revealed that social isolation was positively associated with engagement in injection risk behaviors. In addition, a trend toward a positive association was found between social isolation and sex risk behaviors. Conclusion: This study provides important epidemiologic data. This population appears to be extremely isolated a factor that has been linked to poor health and health outcomes. In addition, many of these women engaged in high risk behaviors despite interventions and education about the dangerousness of such practices indicating that we can do a better job with prevention activities. Finally, this study adds to the current literature investigating how social network characteristics influence risk behaviors among injection drug users. The purpose of this study was to increase our knowledge about how social network characteristics, in particular social/emotional isolation may be important determinants of risk. This data provides insight into the motivations for risk behaviors allowing researchers to plan interventions that address issues of social isolation in order to combat the spread of HIV and HCV.

Identifier

doi:10.6083/M47H1GH2

School

School of Medicine

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