Injecting remains a primary source of HIV-related harms globally, and people who inject drugs (PWID) have been shown to play a key role in the initiation of other individuals into injection drug use. However, no interventions to prevent injecting initiation by focusing on the role of PWID have to date demonstrated effectiveness, likely because they focus on individual-level behavior change rather than on modifying the social and structural factors that influence PWID to initiate others. Indeed, data from multiple urban centers in North America suggest that ongoing exposure to injecting increases the risk that populations at risk such as street youth initiate injecting, and that the majority of non-injectors are initiated into injecting by PWID. Reducing the exposure of street youth to injecting is therefore likely to reduce their risk of initiation into injection. We hypothesize that intervenions that reduce the frequency of public injecting may therefore have a secondary preventive impact on injecting initiation by limiting the exposure of non-injectors to injecting. This multi-country, mixed methods project will therefore investigate whether a range of interventions and factors shaping the risk environment for injecting risk among PWID (opioid substitution therapy, supervised injection facilities, stable housing, incarceration environments, public injecting, and gender) may also influence the risk that they initiate others into injecting. This study will seek o: 1) determine the prevalence and characteristics of PWID participation in injecting initiation across multiple study sites; 2) assess factors potentially influencing the risk that PWID facilitat injecting initiation; 3) investigate individual pathways and roles that increase the risk of PWID facilitating injecting initiation; and 4) test the impact of an existing structural or biomedical intervention on the risk that PWID will facilitate injecting initiation. To accomplish this, we wil conduct a prospective, multi-site study of PWID (n = 3,050) in North America and France employing quantitative and qualitative data from four separate cohort studies of PWID (San Diego, STAHR II; Tijuana, El Cuete IV; Vancouver, VIDUS II; Paris, Marseille, and Bordeaux, COSINUS). This project is the first study investigating whether biomedical and structural interventions to reduce HIV risk among PWID may also reduce their risk of facilitating injecting initiation. This addresses a gap in HIV prevention research and represents a novel and potentially groundbreaking research area with major implications for HIV prevention.

Public Health Relevance

Preventing the entry of drug-using individuals into injection drug use has been identified as a priority for public health experts, though there is a critical dearth of approaches and interventions to prevent this phenomenon. Recent research among drug-using populations has, however, demonstrated that people who inject drugs play a critical role in facilitating the entry of others into this activity; unfortunately, individual-level intervntions that rely on voluntary behavior change have failed to show effectiveness. This study, which includes data from four cohort studies of people who inject drugs across North America and France, will therefore investigate whether existing interventions such as opioid substitution therapy, supervised injection facilities, and de-incarceration, which all reduce the risk that injection drug users expose others to injecting, can have a secondary preventive impact on the likelihood that they initiate others into injecting.

Agency
National Institute of Health (NIH)
Institute
National Institute on Drug Abuse (NIDA)
Type
NIH Director’s New Innovator Awards (DP2)
Project #
1DP2DA040256-01
Application #
8968165
Study Section
Special Emphasis Panel (ZDA1)
Program Officer
Jenkins, Richard A
Project Start
2015-07-01
Project End
2020-06-30
Budget Start
2015-07-01
Budget End
2020-06-30
Support Year
1
Fiscal Year
2015
Total Cost
Indirect Cost
Name
University of California San Diego
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
804355790
City
La Jolla
State
CA
Country
United States
Zip Code
92093
Rafful, Claudia; Jain, Sonia; Sun, Xiaoying et al. (2018) Identification of a Syndemic of Blood-Borne Disease Transmission and Injection Drug Use Initiation at the US-Mexico Border. J Acquir Immune Defic Syndr 79:559-565
Werb, Dan (2018) Post-war prevention: Emerging frameworks to prevent drug use after the War on Drugs. Int J Drug Policy 51:160-164
Melo, Jason S; Mittal, Maria Luisa; Horyniak, Danielle et al. (2018) Injection Drug Use Trajectories among Migrant Populations: A Narrative Review. Subst Use Misuse 53:1558-1570
Guise, Andy; Melo, Jason; Mittal, Maria Luisa et al. (2018) A fragmented code: The moral and structural context for providing assistance with injection drug use initiation in San Diego, USA. Int J Drug Policy 55:51-60
Ospina-Escobar, Angelica; Magis-Rodríguez, Carlos; Juárez, Fatima et al. (2018) Comparing risk environments for HIV among people who inject drugs from three cities in Northern Mexico. Harm Reduct J 15:27
Rafful, Claudia; Orozco, Ricardo; Rangel, Gudelia et al. (2018) Increased non-fatal overdose risk associated with involuntary drug treatment in a longitudinal study with people who inject drugs. Addiction 113:1056-1063
Ben Hamida, Amen; Rafful, Claudia; Jain, Sonia et al. (2018) Non-injection Drug Use and Injection Initiation Assistance among People Who Inject Drugs in Tijuana, Mexico. J Urban Health 95:83-90
Rafful, Claudia; Melo, Jason; Medina-Mora, María Elena et al. (2018) Cross-border migration and initiation of others into drug injecting in Tijuana, Mexico. Drug Alcohol Rev 37 Suppl 1:S277-S284
Melo, J S; Garfein, R S; Hayashi, K et al. (2018) Do law enforcement interactions reduce the initiation of injection drug use? An investigation in three North American settings. Drug Alcohol Depend 182:67-73
Werb, Dan; Bluthenthal, R N; Kolla, G et al. (2018) Preventing Injection Drug use Initiation: State of the Evidence and Opportunities for the Future. J Urban Health 95:91-98

Showing the most recent 10 out of 22 publications