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Upton EM, Rudolph AE, Ward PJ, Havens JR, Young AM. Extent and implications of omitted ties on network measures in a longitudinal social network survey of people who use drugs. Drug Alcohol Depend 2022; 238:109554. [PMID: 35850026 PMCID: PMC9514791 DOI: 10.1016/j.drugalcdep.2022.109554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 06/23/2022] [Accepted: 06/30/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Previous research has revealed under-reporting of personal network members (i.e., alters) in studies involving people who use drugs (PWUD). This analysis (1) characterizes relationships that were more likely to be omitted but later recalled with prompting and (2) identifies network structural characteristics most impacted by these omissions among a sample of PWUD in rural Appalachian Kentucky, an epicenter of the opioid epidemic. METHODS Data were collected through longitudinal assessments as part of the Social Networks Among Appalachian People (SNAP) study (2008-2017). Study participants completed interviewer-administered questionnaires that collected social network data via free-listing at baseline and six-month intervals. At visit 5, after free-listing, interviewers prompted participants with the names of previously reported alters. We used modified Poisson regression with generalized estimating equations to identify individual- and relationship-level characteristics associated with an alter being reported only after prompting. We examined the impact of including vs. excluding relationships reported after prompting on local and global sociometric network measures (i.e., betweenness centrality, bridging, density, mean degree, transitivity, cliques, and 2-cores). RESULTS Relationships reported only after prompting were more likely to be immediate family (Adjusted Prevalence Ratio [APR]:1.29; 95% Confidence Interval [CI]: 1.03-1.63) and less likely to involve sex (APR:0.54; 95% CI: 0.43-0.67). Considerable differences were observed for participant positional rankings of betweenness centrality and bridging, and differences in network density and average degree pre- and post-prompting were statistically significant. CONCLUSION Longitudinal network studies that aim to assess transmission dynamics, information diffusion, or peer influence should consider the effects of omitted relationships.
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Affiliation(s)
- Elizabeth M Upton
- Department of Mathematics and Statistics, Williams College, Williamstown, MA, USA.
| | - Abby E Rudolph
- Department of Epidemiology and Biostatistics, Temple University College of Public Health, Philadelphia, PA, USA
| | - Patrick J Ward
- Department of Epidemiology, University of Kentucky College of Public Health, Lexington, KY, USA; Department of Biostatistics, UNC-Chapel Hill, Chapel Hill, NC, USA
| | - Jennifer R Havens
- Center on Drug and Alcohol Research, Department of Behavioral Science, University of Kentucky College of Medicine, Lexington, KY, USA
| | - April M Young
- Department of Epidemiology, University of Kentucky College of Public Health, Lexington, KY, USA; Center on Drug and Alcohol Research, Department of Behavioral Science, University of Kentucky College of Medicine, Lexington, KY, USA
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Rudolph AE, Dembo RS, Tobin K, Latkin C. Perceived HIV Treatment Norms Modify the Association Between HIV-Related Stigma and Adherence to Antiretroviral Therapy Among Persons Living with HIV in Baltimore, Maryland. AIDS Behav 2022; 26:537-548. [PMID: 34338899 PMCID: PMC8807774 DOI: 10.1007/s10461-021-03409-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2021] [Indexed: 02/03/2023]
Abstract
Adherence to antiretroviral therapy (ART) is associated with reduced HIV-related morbidity/mortality and ongoing transmission; however, the extent to which this association is modified by perceived HIV treatment norms is unknown. 270 PLWH completed a survey to assess demographics, risk behaviors, stigma, ART adherence, and perceived HIV treatment norms (Baltimore, 2014-2017). We used modified Poisson regression to examine effect modification by perceived HIV treatment norms. The association between HIV-related stigma and ART adherence was modified by perceived HIV treatment norms. Among individuals who perceived that friends/family were sub-optimally adherent, HIV-related stigma was negatively associated with ART adherence (Adjusted Risk Ratio [ARR] = 0.36; 95%CI 0.15-0.87). Among those who perceived optimal adherence among friends/family, the relationship between HIV-related stigma and ART adherence was not statistically significant (ARR = 1.07; 95%CI 0.65-1.76). Interventions to improve ART adherence among those who are sub-optimally adherent could focus on increasing perceptions of ART adherence among their friends/family.
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Affiliation(s)
- Abby E Rudolph
- Department of Epidemiology and Biostatistics, Temple University College of Public Health, 1301 Cecil B Moore Avenue, Ritter Annex 905, Philadelphia, PA, 19122, USA.
| | - Robert S Dembo
- Waisman Center, University of Wisconsin-Madison, 1500 Highland Ave., Madison, WI, 53705, USA
| | - Karin Tobin
- Department of Health, Behavior, and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Carl Latkin
- Department of Health, Behavior, and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
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Rudolph AE, Crawford ND, Latkin C, Lewis CF. Multiplex Relationships and HIV: Implications for Network-Based Interventions. AIDS Behav 2017; 21:1219-1227. [PMID: 27272657 DOI: 10.1007/s10461-016-1454-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The number of network members and the roles they play can influence risk behaviors and consequently intervention strategies to reduce HIV transmission. We recruited 652 people who use drugs (PWUD) from socially disadvantaged neighborhoods in New York City (07/2006-06/2009). Interviewer-administered surveys ascertained demographic, behavioral, and network data. We used logistic regression, stratified by exchange sex, to assess the relationship between HIV status and the number of network members with different roles, treated as independent and multiplex (i.e., drug + sex). Those with more multiplex risk ties were significantly more likely to be HIV positive, but only among those not reporting exchange sex (AOR = 3.2). Among those reporting exchange sex, men reporting recent male sex partners were more likely to report HIV positive status (AOR = 12.6). These data suggest that sex and drug relationships among PWUD are interrelated. Interventions that target multiplex rather than single-role relationships may be more effective in influencing behavior change.
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Affiliation(s)
- Abby E Rudolph
- Department of Epidemiology, Boston University School of Public Health, 715 Albany Street, T418E, Boston, MA, 02118-2526, USA.
| | - Natalie D Crawford
- Department of Behavioral Sciences and Health Education, Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Carl Latkin
- Department of Health Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Crystal Fuller Lewis
- Division of Social Solutions and Services Research, Nathan Kline Institute, Orangeburg, NY, USA
- Department of Psychiatry, New York University School of Medicine, New York City, NY, USA
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Ghosh D, Krishnan A, Gibson B, Brown SE, Latkin CA, Altice FL. Social Network Strategies to Address HIV Prevention and Treatment Continuum of Care Among At-risk and HIV-infected Substance Users: A Systematic Scoping Review. AIDS Behav 2017; 21:1183-1207. [PMID: 27125244 DOI: 10.1007/s10461-016-1413-y] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Social network analysis (SNA) and social network-based interventions (SNI) are important analytical tools harnessing peer and family influences critical for HIV prevention and treatment among substance users. While SNA is an effective way to measure social network influences, SNI directly or indirectly involves network members in interventions. Even though these methods have been applied in heterogeneous ways, leading to extensive evidence-based practices, systematic reviews are however, lacking. We searched five bibliographic databases and identified 58 studies involving HIV in substance users that had utilized SNA or SNI as part of their methodology. SNA was used to measure network variables as inputs in statistical/mathematical models in 64 % of studies and only 22 % of studies used SNI. Most studies focused on HIV prevention and few addressed diagnosis (k = 4), care linkage and retention (k = 5), ART adherence (k = 2), and viral suppression (k = 1). This systematic review highlights both the advantages and disadvantages of social network approaches for HIV prevention and treatment and gaps in its use for HIV care continuum.
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Affiliation(s)
- Debarchana Ghosh
- Department of Geography and Institute for Collaboration on Health Intervention and Prevention, University of Connecticut, 215 Glenbrook Road, AUST 421, U-4148, Storrs, CT, 06269, USA.
| | - Archana Krishnan
- Department of Communication, University at Albany, SUNY, Albany, NY, USA
| | - Britton Gibson
- Section of Infectious Diseases in AIDS Program, Department of Internal Medicine, Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Shan-Estelle Brown
- Section of Infectious Diseases in AIDS Program, Department of Internal Medicine, Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Carl A Latkin
- Department of Health, Behavior, and Society, Epidemiology, Johns Hopkins University-Bloomberg School of Public Health, Baltimore, MD, USA
| | - Frederick L Altice
- Section of Infectious Diseases in AIDS Program, Department of Internal Medicine, Yale School of Medicine, Yale University, New Haven, CT, USA
- Division of Epidemiology of Microbial Diseases, Yale School of Public Health, Yale University, New Haven, CT, USA
- Centre of Excellence on Research in AIDS (CERiA), University of Malaya, Kuala Lumpur, Malaysia
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Brothers S. Merchants, samaritans, and public health workers: Secondary syringe exchanger discursive practices. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2016; 37:1-8. [PMID: 27449813 DOI: 10.1016/j.drugpo.2016.06.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Revised: 02/07/2016] [Accepted: 06/01/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Secondary syringe exchangers (SSEs) are a vital component of harm reduction efforts among persons who inject drugs (PWIDs). However, little research has explored how secondary exchange occurs, nor why SSEs do their work. This study looks at secondary exchange as an act of resilience within the PWID risk environment. It asks how secondary syringe exchangers utilize syringes to improve their mental and material well-being. METHODS This article draws on findings from semi-structured in-depth interviews of 30 SSEs. It is also informed by 4 years of participant observation as a volunteer and site supervisor at the San Francisco Aids Foundation syringe exchange sites, and 1 year of participant observation with SSEs and their clients. RESULTS This study finds that SSEs use syringes as a resource to support three discursive practices - those of merchants, public health workers, and samaritans. These discursive practices correlate to their work and educational backgrounds, and to their accounts of charging for syringes, disseminating public health information, and helping their clients in various ways. CONCLUSION SSEs hold heterogeneous motivations and operate in multiple contexts. Many SSEs see themselves as, and behave as, informal health care workers or helpers in their community. They could be utilized, with minimal training and encouragement, to disseminate additional harm reduction information and materials.
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Affiliation(s)
- Sarah Brothers
- Department of Sociology, Yale University, 493 College Street, New Haven, CT 06511, United States.
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Dombrowski K, Khan B, McLean K, Curtis R, Wendel T, Misshula E, Friedman S. A reexamination of connectivity trends via exponential random graph modeling in two IDU risk networks. Subst Use Misuse 2013; 48:1485-97. [PMID: 23819740 PMCID: PMC3964346 DOI: 10.3109/10826084.2013.796987] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Patterns of risk in injecting drug user (IDU) networks have been a key focus of network approaches to HIV transmission histories. New network modeling techniques allow for a reexamination of these patterns with greater statistical accuracy and the comparative weighting of model elements. This paper describes the results of a reexamination of network data from the SFHR and P90 data sets using Exponential Random Graph Modeling. The results show that "transitive closure" is an important feature of IDU network topologies, and provides relative importance measures for race/ethnicity, age, gender, and number of risk partners in predicting risk relationships.
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Affiliation(s)
- Kirk Dombrowski
- 1Department of Sociology, University of Nebraska-Lincoln , Lincoln, NE , USA
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Individual and neighborhood correlates of membership in drug using networks with a higher prevalence of HIV in New York City (2006-2009). Ann Epidemiol 2013; 23:267-74. [PMID: 23523090 DOI: 10.1016/j.annepidem.2013.02.006] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2012] [Revised: 01/28/2013] [Accepted: 02/15/2013] [Indexed: 11/24/2022]
Abstract
PURPOSE To identify individual- and neighborhood-level correlates of membership within high HIV prevalence drug networks. METHODS We recruited 378 New York City drug users via respondent-driven sampling (2006-2009). Individual-level characteristics and recruiter-recruit relationships were ascertained and merged with 2000 tract-level U.S. Census data. Descriptive statistics and population average models were used to identify correlates of membership in high HIV prevalence drug networks (>10.54% vs. <10.54% HIV). RESULTS Individuals in high HIV prevalence drug networks were more likely to be recruited in neighborhoods with greater inequality (adjusted odds ratio [AOR], 5.85; 95% confidence interval [CI], 1.40-24.42), higher valued owner-occupied housing (AOR, 1.48; 95% CI, 1.14-1.92), and a higher proportion of Latinos (AOR, 1.83; 95% CI, 1.19-2.80). They reported more crack use (AOR, 7.23; 95% CI, 2.43-21.55), exchange sex (AOR, 1.82; 95% CI, 1.03-3.23), and recent drug treatment enrollment (AOR, 1.62; 95% CI, 1.05-2.50) and were less likely to report cocaine use (AOR, 0.40; 95% CI, 0.20-0.79) and recent homelessness (AOR, 0.32; 95% CI, 0.17-0.57). CONCLUSIONS The relationship between exchange sex, crack use, and membership within high HIV prevalence drug networks may suggest an ideal HIV risk target population for intervention. Coupling network-based interventions with those adding risk-reduction and HIV testing/care/adherence counseling services to the standard of care in drug treatment programs should be explored in neighborhoods with increased inequality, higher valued owner-occupied housing, and a greater proportion of Latinos.
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Rudolph AE, Linton S, Dyer TP, Latkin C. Individual, network, and neighborhood correlates of exchange sex among female non-injection drug users in Baltimore, MD (2005-2007). AIDS Behav 2013; 17:598-611. [PMID: 22983502 DOI: 10.1007/s10461-012-0305-z] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The "HIV risk environment" has been characterized as a dynamic interplay between structural and network factors. However, most HIV prevention research has not examined the independent and combined impact of network and structural factors. We aimed to identify individual, network, and neighborhood correlates of exchange sex (≥1 exchange sex partner, past 90 days) among female non-injection drug users (NIDUs). We used baseline data from 417 NIDUs enrolled in a randomized HIV prevention trial in Baltimore (2005-2007). Surveys ascertained demographic variables, drug/sex risk behaviors, neighborhood perceptions, and social/sexual network characteristics. Correlates of exchange sex were identified with descriptive statistics and log-binomial regression. Our findings suggest that sex and drug relationships among female NIDUs are interlinked and may be difficult to modify without altering social norms. Strengthening ties that provide social support but not drug support and reducing ties that provide both drug and social support may facilitate reductions in individual-level HIV-risk behaviors.
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Affiliation(s)
- Abby E Rudolph
- Department of Medicine, University of California San Diego School of Medicine, La Jolla, 92093-0507, USA.
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Border crossing to inject drugs in Mexico among injection drug users in San Diego, California. J Immigr Minor Health 2012; 14:281-6. [PMID: 21442300 PMCID: PMC3163238 DOI: 10.1007/s10903-011-9462-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
We examined correlates of ever injecting drugs in Mexico among residents of San Diego, California. From 2007 to 2010, injecting drug users (IDUs) in San Diego underwent an interviewer-administered survey. Logistic regression identified correlates of injection drug use in Mexico. Of 302 IDUs, 38% were Hispanic, 72% male and median age was 37; 27% ever injected in Mexico; 43% reported distributive syringe sharing there. Factors independently associated with ever injecting drugs in Mexico included being younger at first injection, injecting heroin, distributive syringe sharing at least half of the time, and transporting drugs over the last 6 months. One-quarter of IDUs reported ever injecting drugs in Mexico, among whom syringe sharing was common, suggesting possible mixing between IDUs in the Mexico-US border region. Prospective studies should monitor trends in cross-border drug use in light of recent Mexican drug policy reforms partially decriminalizing drug possession.
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Latkin C, Yang C, Tobin K, Penniman T, Patterson J, Spikes P. Differences in the social networks of African American men who have sex with men only and those who have sex with men and women. Am J Public Health 2011; 101:e18-23. [PMID: 21852650 DOI: 10.2105/ajph.2011.300281] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We compared social network characteristics of African American men who have sex with men only (MSMO) with social network characteristics of African American men who have sex with men and women (MSMW). METHODS Study participants were 234 African American men who have sex with men who completed a baseline social network assessment for a pilot behavioral HIV prevention intervention in Baltimore, Maryland, from 2006 through 2009. We surveyed the men to elicit the characteristics of their social networks, and we used logistic regression models to assess differences in network characteristics. RESULTS MSMO were significantly more likely than were MSMW to be HIV-positive (52% vs 31%). We found no differences between MSMO and MSMW in the size of kin networks or emotional and material support networks. MSMW had denser sexual networks, reported more concurrent and exchange partners, used condoms with more sexual partners, and reported interaction with a larger number of sexual partners at least once a week. CONCLUSIONS Although there were many similarities in the social and sexual network characteristics of MSMO and MSMW, differences did exist. HIV prevention interventions should address the unique needs of African American MSMW.
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Affiliation(s)
- Carl Latkin
- Johns Hopkins Bloomberg School of Public Health, Department of Health, Behavior and Society, Hampton House, 624 North Broadway, Room 737, Baltimore, MD 21205.
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Abstract
The purpose of this study was to examine the association between social network characteristics and peer norms related to sharing needles and shooting gallery use. Multivariate logistic regression modeling was used to identify factors that were independently associated with shooting gallery use among a sample of injection drug users recruited in Baltimore, Maryland. Of 842 study participants, 35% reported attending a shooting gallery in the past 6 months. Social networks of shooting gallery users were larger, had a greater number of injectors and crack smokers, were younger and less dense with fewer kin members compared to networks of non-gallery attenders. A greater proportion of those who used a gallery perceived that their peers shared needles and that peers would not disapprove if they used a dirty needle. Future research is needed to understand how social networks and peer norms are specific to behavioral settings and how this may impede adoption of preventive behaviors.
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Bryant J, Hopwood M. Secondary exchange of sterile injecting equipment in a high distribution environment: A mixed method analysis in south east Sydney, Australia. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2009; 20:324-8. [DOI: 10.1016/j.drugpo.2008.06.006] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2008] [Revised: 06/26/2008] [Accepted: 06/27/2008] [Indexed: 10/21/2022]
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Tempalski B, Cooper HL, Friedman SR, Des Jarlais DC, Brady J, Gostnell K. Correlates of syringe coverage for heroin injection in 35 large metropolitan areas in the US in which heroin is the dominant injected drug. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2008; 19 Suppl 1:S47-58. [PMID: 18295468 PMCID: PMC2706511 DOI: 10.1016/j.drugpo.2007.11.011] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2007] [Revised: 11/01/2007] [Accepted: 11/19/2007] [Indexed: 10/22/2022]
Abstract
BACKGROUND Scientific consensus holds that if, at the outset of the HIV/AIDS epidemic, injection drug users (IDUs) had had better access to sterile syringes, much of the epidemic among IDUs in the U.S. could have been prevented. In the context of preventing infectious diseases, 100% syringe coverage - that is, one sterile syringe per injector for each injection - is a public health goal. Notably, we know little about variations in syringe coverage within the U.S. and elsewhere, or about the social and political factors that might determine this coverage. METHODS Using data from Holmberg (1996), the 1990 United States Census, the 2000 Beth Israel National Syringe Exchange Survey (n=72), and estimates of IDUs in metropolitan areas (MSAs); (Friedman et al., 2004), we explore the impact of (1) political factors (ACT UP, outreach, early syringe exchange programme (SEP) presence, men who have sex with men (MSM) per capita, drug arrests, and police per capita); (2) local resources for SEPs; and (3) indicators of socioeconomic inequality on SEP coverage. We define "syringe coverage" as the ratio of syringes distributed at SEPs to the number of syringes heroin injectors need in a year. We calculated the number of syringes heroin injectors need in a year by multiplying an estimate of the number of IDUs in each MSA by an estimate of the average number of times heroin injectors inject heroin per year (2.8 times per day times 365 days). In this analysis, the sample was limited to 35 MSAs in which the primary drug of choice among injectors was heroin. RESULTS SEP coverage varies greatly across MSAs, with an average of 3 syringes distributed per 100 injection events (S.D.=0.045; range: 2 syringes per 10 injection events, to 3 syringes per 10,000 injection events). In bivariate regression analyses, a 1 unit difference in the proportion of the population that was MSM per 1000 was associated with a difference of 0.002 in SEP coverage (p=0.052); early SEP presence was associated with a difference of 0.038 in coverage (p=0.012); and having government funding was associated with a 0.040 difference in SEP coverage (p=0.021). CONCLUSIONS This analysis suggests that longer duration of SEP presence may increase syringe distribution and enhance successful programme utilization. Furthermore, MSAs with greater proportions of MSM tend to have better SEP coverage, perhaps providing further evidence that grassroots activism plays an important role in programme implementation and successful SEP coverage. This research provides evidence that government funding for SEPs contributes to better syringe coverage.
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Affiliation(s)
- Barbara Tempalski
- National Development and Research Institutes, Inc., New York, NY, USA.
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Tempalski B, Friedman R, Keem M, Cooper H, Friedman SR. NIMBY localism and national inequitable exclusion alliances: The case of syringe exchange programs in the United States. GEOFORUM; JOURNAL OF PHYSICAL, HUMAN, AND REGIONAL GEOSCIENCES 2007; 38:1250-1263. [PMID: 18978931 PMCID: PMC2170884 DOI: 10.1016/j.geoforum.2007.03.012] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
Syringe exchange programs (SEPs) aim to reduce the harm associated with injection drug use (IDU). Although they have been accepted as critical components of HIV prevention in many parts of the world, they are often unwelcome and difficult to set up and maintain, even in communities hardest hit by IDU-related HIV transmission. This research examines socio-cultural and political processes that shape community and institutional resistance toward establishing and maintaining SEPs. These processes are configured and reinforced through the socio-spatial stigmatizing of IDUs, and legal and public policy against SEPs. Overarching themes the paper considers are: (1) institutional and/or political opposition based on (a) political and law enforcement issues associated with state drug paraphernalia laws and local syringe laws; (b) harassment of drug users and resistance to services for drug users by local politicians and police; and (c) state and local government (in)action or opposition; and (2) the stigmatization of drug users and location of SEPs in local neighborhoods and business districts. Rather than be explained by "not in my back yard" localism, this pattern seems best conceptualized as an "inequitable exclusion alliance" (IEA) that institutionalizes national and local stigmatizing of drug users and other vulnerable populations.
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Affiliation(s)
- Barbara Tempalski
- Project Director, National Development and Research Institutes, Inc
- *Corresponding Author: Barbara Tempalski, Ph.D., M.P.H., National Development and Research Institutes, 71 West 23 Street, 8 Floor, New York, NY 10010, Ph: (212) 845 – 4474, Fax: (917) 438 – 0894,
| | - Risa Friedman
- Assistant Professor, Universidad San Francisco dQuito, Campus Cumbayá-Diego de Robles y Vía Interoceánica, Quito, Ecuador
| | - Marie Keem
- Doctoral Candidate, Teachers College Columbia University, New York, NY
| | - Hannah Cooper
- Investigator, National Development and Research Institutes, Inc
| | - Samuel R. Friedman
- Senior Research Fellow, Institute for AIDS Research, National Development and Research Institutes
- Senior Associate, Dept of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University
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