The purpose of this application is to evaluate the impacts of methamphetamine and a range of social, structural, and environmental factors on initiation into injection drug use, HIV risk behavior and sexually transmitted infection (STI) incidence among street-involved youth. Globally, it is estimated that there are as many as 100 million street-involved youth, and illicit drug use and related harms (e.g., infectious diseases) have consistently been shown to be elevated among this population. Thus, there is an urgent need for data to inform interventions aimed at addressing the health needs of this growing population. In particular, given the challenges preventing harms (e.g., HIV infection) that occur after youth begin drug injecting, data to inform strategies to prevent initiation into injection drug use are urgently needed. We propose to undertake this work in a western Canadian setting where the explosive growth in methamphetamine use has mirrored a steady growth in the use of this drug in the western United States. While these trends are a source of growing concern due to methamphetamine's relationship with rising HIV risk behavior among men who have sex with men and adult IDU, the epidemiology of methamphetamine use and its relationship to sexual and injection-related HIV risk behavior remain poorly defined. Vancouver, Canada, is ideally suited for the proposed study for several reasons. First, the city is presently experiencing an explosive rise in the use of methamphetamine among street-involved youth, and past experience demonstrates that drug market trends in Vancouver are often reflected in other western US cities, and the city is known to be a North American port of entry for several illicit drugs and precursor chemicals which subsequently flow into the US. Thus, this research will provide valuable data to inform US drug trends and interventions. Vancouver is also home to a large and visible street-youth problem and street-based illicit drug market, and the risk environment in which street youth become involved in illicit drugs has not been well described. Herein, we propose to create an open prospective cohort study of 500 street-involved youth aged 14 to 25 who will complete a standardized questionnaire and provide biological specimens on a semi-annual basis. Given the local drug use and risk environment characteristics, as well as the local laboratory capacity, our proposed research plan offers an ideal opportunity to examine the impact of evolving drug use patterns and a range of social, structural, and environmental factors on the rates of initiation into injection drug use, sexual risk behavior and STI incidence. This research also presents a unique opportunity to create a cohort of street-involved non-injecting youth which will enable comparisons with an ongoing study of adult injection drug users. Together, this research will address several questions central to the urgent challenges facing street-involved youth in North America as a result of the growth of methamphetamine use and illicit drug injecting, and will allow for the evaluation of a range of individual and contextual determinants of HIV risk behavior and STI incidence among this population.

Public Health Relevance

While increasing methamphetamine use among youth is a source of growing concern due to methampheta- mine's relationship with rising HIV risk behavior among men who have sex with men and adult injection drug users, the epidemiology of methamphetamine use and its relationship to initiation of injection drug use, HIV risk behaviour, and sexually transmitted infection incidence among high-risk youth remains poorly defined. This research will fill this void by evaluating patterns of methamphetamine use and other illicit drug patterns, as well as the risk environment in which drugs are used, to describe their effects on initiation of injection drug use, sexual risk behavior, and incidence of sexually transmitted infections among a cohort of 500 street-involved youth.

Agency
National Institute of Health (NIH)
Institute
National Institute on Drug Abuse (NIDA)
Type
Research Project (R01)
Project #
4R01DA028532-04
Application #
8433213
Study Section
Behavioral and Social Science Approaches to Preventing HIV/AIDS Study Section (BSPH)
Program Officer
Lambert, Elizabeth
Project Start
2010-04-15
Project End
2015-02-28
Budget Start
2013-03-01
Budget End
2014-02-28
Support Year
4
Fiscal Year
2013
Total Cost
$366,702
Indirect Cost
$27,163
Name
University of British Columbia
Department
Type
DUNS #
251949962
City
Vancouver
State
BC
Country
Canada
Zip Code
V6 1-Z3
Marshall, B D L; DeBeck, K; Simo, A et al. (2015) Gang involvement among street-involved youth in a Canadian setting: a gender-based analysis. Public Health 129:74-7
Cheng, Tessa; Wood, Evan; Nguyen, Paul et al. (2015) Crack pipe sharing among street-involved youth in a Canadian setting. Drug Alcohol Rev 34:259-66
Hadland, Scott E; DeBeck, Kora; Kerr, Thomas et al. (2014) Use of a medically supervised injection facility among street youth. J Adolesc Health 55:684-9
Nolan, Seonaid; Dias Lima, Viviane; Fairbairn, Nadia et al. (2014) The impact of methadone maintenance therapy on hepatitis C incidence among illicit drug users. Addiction 109:2053-9
Uhlmann, Sasha; DeBeck, Kora; Simo, Annick et al. (2014) Health and social harms associated with crystal methamphetamine use among street-involved youth in a Canadian setting. Am J Addict 23:393-8
Montaner, Julio S G; Lima, Viviane D; Harrigan, P Richard et al. (2014) Expansion of HAART coverage is associated with sustained decreases in HIV/AIDS morbidity, mortality and HIV transmission: the "HIV Treatment as Prevention" experience in a Canadian setting. PLoS One 9:e87872
Richardson, Lindsey; DeBeck, Kora; Feng, Cindy et al. (2014) Employment and risk of injection drug use initiation among street involved youth in Canadian setting. Prev Med 66:56-9
Barker, Brittany; Kerr, Thomas; Alfred, Gerald Taiaiake et al. (2014) High prevalence of exposure to the child welfare system among street-involved youth in a Canadian setting: implications for policy and practice. BMC Public Health 14:197
Lima, Viviane Dias; Kerr, Thomas; Wood, Evan et al. (2014) The effect of history of injection drug use and alcoholism on HIV disease progression. AIDS Care 26:123-9
Cheng, Tessa; Wood, Evan; Nguyen, Paul et al. (2014) Increases and decreases in drug use attributed to housing status among street-involved youth in a Canadian setting. Harm Reduct J 11:12

Showing the most recent 10 out of 27 publications