HIV Injection Risk Behaviors among HIV-Negative People Who Inject Drugs Experiencing Homelessness, 23 U.S. Cities

ABSTRACT

Despite recent declines in numbers of people who inject drugs (PWID) diagnosed with HIV, clusters of HIV among PWID are ongoing, especially among PWID experiencing homelessness. Using data from the National HIV Behavioral Surveillance in 2018, we evaluated the association between homelessness and injection risk and prevention behaviors among HIV-negative PWID who were recruited by respondent-driven sampling in 23 U.S. cities. Interviewers assessed sociodemographic characteristics, history of overdose, and behavioral risk and prevention factors for HIV. Adjusted prevalence ratios (aPR) and 95% CI were obtained using Poisson regression models. Of 10,614 HIV-negative PWID participants, 7275 (68.5%) reported experiencing homelessness. Homeless PWID were more likely than those who were not to be younger age, white, unemployed, without health insurance, in poverty, experiencing psychological distress, and incarcerated in the past 12 months. PWID experiencing homelessness were significantly more likely to report injection risk behaviors [share syringes/equipment (aPR = 1.26; 95% CI = 1.20–1.33), non-fatal opioid overdose (aPR = 1.64; 95% CI = 1.49–1.79)] and prevention behaviors [testing for HIV in past 12 months (aPR = 1.18; 95% CI = 1.12–1.24) and using syringe services programs (aPR = 1.09; 95% CI = 1.03–1.16)] than PWID not experiencing homelessness. Homelessness among PWID is associated with injection risk behaviors and non-fatal overdose.

KEYWORDS:

• People who inject drugs
• respondent-driven sampling
• homelessness
• HIV
• HIV prevention
• syringe services programs

Acknowledgements

The authors thank National HIV Behavioral Surveillance (NHBS) staff and participants. We also acknowledge the contributions of the Behavioral Surveillance Team and the Behavioral and Clinical Surveillance Branch at CDC and the NHBS Study Group Members. NHBS Study Group Members include: Atlanta, GA: Pascale Wortley, Jeff Todd, David Melton; Baltimore, MD: Colin Flynn, Danielle German; Boston, MA: Monina Klevens, Rose Doherty, Conall O’Cleirigh; Chicago, IL: Antonio D. Jimenez, Thomas Clyde; Dallas, TX: Jonathon Poe, Margaret Vaaler, Jie Deng; Denver, CO: Alia Al-Tayyib, Daniel Shodell; Detroit, MI: Emily Higgins, Vivian Griffin, Corrine Sanger; Houston, TX: Salma Khuwaja, Zaida Lopez, Paige Padgett; Los Angeles, CA: Ekow Kwa Sey, Yingbo Ma, Hugo Santacruz; Memphis, TN: Meredith Brantley, Christopher Mathews, Jack Marr; Miami, FL: Emma Spencer, Willie Nixon, David Forrest; Nassau-Suffolk, NY: Bridget Anderson, Ashley Tate, Meaghan Abrego; New Orleans, LA: William T. Robinson, Narquis Barak, Jeremy M. Beckford; New York City, NY: Sarah Braunstein, Alexis Rivera, Sidney Carrillo Newark, NJ: Abdel R. Ibrahim, Afework Wogayehu, Luis Moraga; Philadelphia, PA: Kathleen A. Brady, Jennifer Shinefeld, Chrysanthus Nnumolu,; Portland, OR: Timothy W. Menza, E. Roberto Orellana, Amisha Bhattari; San Diego, CA: Anna Flynn, Onika Chambers, Marisa Ramos; San Francisco, CA: Willi McFarland, Jessica Lin, Desmond Miller; San Juan, PR: Sandra Miranda De León, Yadira Rolón-Colón, María Pabón Martínez; Seattle, WA: Tom Jaenicke, Sara Glick; Virginia Beach, VA: Jennifer Kienzle, Brandie Smith, Toyah Reid; Washington, DC: Jenevieve Opoku, Irene Kuo; CDC: Monica Adams, Christine Agnew Brune, Amy Baugher, Dita Broz, Janet Burnett, Susan Cha, Johanna Chapin-Bardales, Paul Denning, Dafna Kanny, Teresa Finlayson, Senad Handanagic, Terence Hickey, Kathryn Lee, Rashunda Lewis, Elana Morris, Evelyn Olansky, Taylor Robbins, Catlainn Sionean, Amanda Smith, Anna Teplinskaya, Lindsay Trujillo, Cyprian Wejnert, Ari Whiteman, Mingjing Xia.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Disclaimer

The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

Additional information

Notes on contributors

Ruthanne Marcus

Ruthanne Marcus, PhD, MPH, Associate Chief for Science, Behavioral and Clinical Surveillance Branch, Division of HIV/AIDS Prevention, National Center for HIV, Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention.

Susan Cha

Susan Cha, PhD, MPH, Epidemiologist, Behavioral Surveillance Team, Behavioral and Clinical Surveillance Branch, Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention.

Catlainn Sionean

Catlainn Sionean, PhD, Epidemiologist, Behavioral Surveillance Team, Behavioral and Clinical Surveillance Branch, Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention.

Dafna Kanny

Dafna Kanny, PhD, Epidemiologist, Behavioral Surveillance Team, Behavioral and Clinical Surveillance Branch, Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, for the National HIV Behavioral Surveillance StudyGroup.