Injection risk behaviors among rural drug users: implications for HIV prevention

Abstract

Objective. The purpose of this study was to examine injection drug use (IDU) among a cohort of felony probationers from rural Appalachian Kentucky.

Methods. An interviewer-administered questionnaire given to 800 rural felony probationers ascertained data regarding demographics, drug use, criminal behavior, psychological distress, and HIV-risk behaviors.

Results. The sample was primarily white (95.1%) and male (66.5%) and the median age was 32.3 years (interquartile range: 25.2, 40.5). There were no cases of HIV in the sample. Of the 800 rural probationers, 179 (22.4%) reported lifetime IDU. Receptive syringe sharing (RSS) and distributive syringe sharing (DSS) were reported by 34.5% and 97.1% of the IDUs, respectively. Independent correlates of risky injection behaviors included cocaine injection (adjusted odds ratio (AOR): 14.9, 95% confidence interval (CI): 8.0, 27.7) and prescription opioid injection (AOR: 14.7, 95% CI: 7.7, 28.1).

Discussion. Although HIV was not prevalent, data suggest that the rural felony probationers in this sample were engaging in risky injection practices that could facilitate transmission of HIV. This is especially problematic since those involved in the criminal justice system may be more likely to be exposed to HIV. Therefore, prevention aimed at reducing HIV-risk behaviors among rural, criminally involved individuals is warranted.

Keywords:

• HIV
• rural
• probationer
• injection drug use

Acknowledgements

This study was supported by a grant from the National Institute on Drug Abuse to CGL (R01DA011580) and to CBO (K01-DA021309). The authors would also like to thank the study staff and participants.