SOCIAL CIRCUMSTANCES OF INITIATION OF INJECTION DRUG USE AND EARLY SHOOTING
GALLERY ATTENDANCE

Implication For HIV Intervention Among Adolescent And Young Adult Injection
Drug Users

Studies of injection drug users (IDUs) have shown that young or recently
initiated IDUs are at increased risk for HIV infection, and that young or
recently initiated ("new") IDUs engage in high-risk sexual and injection
practices. Rates of HBV and HCV infection have been shown to exceed 50
percent among IDUs even within the first two years of starting injection
drug use.

Although it has been hypothesized that young IDUs do not frequent shooting
galleries (SGs) where multi-person use of injection equipment commonly
occurs, the authors stated, "SGs should nevertheless be considered as
high-risk settings for acquiring HIV and other blood-borne infections,
because repackaging and selling of used injection equipment continues to
take place in these settings."

Fuller and colleagues conducted a study to identify early high-risk
practices and salient social circumstances associated with early SG
attendance and HIV prevalence and incidence among new IDUs. They used
baseline data from a prospective cohort study of 226 IDUs recruited into
the Risk Evaluation and Assessment of Community Health [REACH II] study in
Baltimore between July 1997 and May 1999. Eligible subjects were ages
15-30, had injected for up to five years prior to the study, and reported
at least one injection in the six months before entering the study. The
authors examined demographic characteristics including age, sex,
race/ethnicity, education and juvenile arrest.

Of the 226 subjects, 75 (33 percent) reported early SG attendance. Median
age of participants was 25; 64 percent were African American; and 61
percent were female. More than half (62 percent) of the group had dropped
out of high school and had not obtained a GED. One-fifth (20 percent) had
been arrested as juveniles. Twenty-four participants tested seropositive
for HIV antibody (11 percent).

Using multiple regression analysis, the authors found that early SG
attendees were nearly three times more likely to be HIV-seropositive than
subjects who had not attended SGs. Early attendees were also five times
more likely to share injection equipment, over three times more likely to
report a high-risk injection network soon after initiating injection, and
twice as likely to be initiated by an older IDU, thus putting themselves at
increased risk for HCV and HIV.

Twelve percent of the subjects identified as homosexual or bisexual. Female
participants who identified themselves as lesbian or bisexual showed
significantly higher early SG attendance than other female participants.
Three male subjects identified themselves as gay or bisexual, and none
reported early SG attendance. "A major finding of this study was that new
IDUs in Baltimore are in need of increased harm reduction strategies given
their high incidence of HIV infection and lack of access to current harm
reduction services," the authors wrote. They suggest that future research
include quantitative and ethnographic studies of SGs "so that intervention
strategies can be carefully tailored to specific neighborhoods and IDU
communities....

Determining why and under what circumstances a new IDU would inject in a SG
so soon after initiating injection drug use may be useful for designing
programs aimed at this high-risk subgroup."