Metropolitan Area Characteristics, InjectionDrug Use and HIV Among Injectors

摘要

Epidemics, behaviors, and programs to change behaviors and ameliorateepidemics are shaped by the characteristics of geographically and socially definedcommunities. This chapter presents the rationale, methods, and selected findingsfrom a study of injection drug users, HIV, and services for drug injectors in the96 largest metropolitan areas in the United States. It presents data that show thatmetropolitan areas vary widely in the prevalence of injectors in their populations; inHIV prevalence among injectors; and in the percentage of injectors who are in drugabuse treatment. Furthermore, theoretically specified locality characteristics, suchas inequality, legal repression of drug users and others, the degree of popular orga-nization and mobilization for helping drug users, fiscal constraints and others, helppredict the values of these variables in metropolitan areas. These findings help usto identify metropolitan area characteristics, including some that can be changed bypublic authorities or as a result of popular demand and social movements, which canbe targeted for intervention to address drug-related health issues. Future research onthe social and geographic causation of injection drug use, of its sequelae, and ofprograms like drug treatment and syringe exchange is clearly warranted, and shouldinclude research interventions that change metropolitan area characteristics in waysthat reduce drug-related problems.