Explaining the geographical variation of HIV among injection drug users in the United States.
Distinct physical and chemical types of street heroin exist worldwide, but their impact on behavior and disease acquisition is not well understood or documented. This article presents a hypothesis to explain the unequal diffusion of HIV among injection drug users in the United States by examining the distribution and use of one type of heroin--"Mexican black tar." Drawing on ethnographic, clinical, epidemiological, and laboratory data, we suggest that the chemical properties of black tar heroin promote the following safer injection practices: (1) the rinsing of syringes with water to prevent clogging; (2) the heating of cookers to promote dissolution; and (3) a rapid transition from venous injection to subcutaneous or intramuscular injections.
Ciccarone
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Urban Health Study, Department of Family and Community Medicine, University of California, San Francisco, California 94110, USA. ciccaron@fcm.ucsf.edu
Bourgois
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P
D017848:Blood-Borne Pathogens; D004866:Equipment Contamination / Q000517:prevention & control; D005843:Geography; D015658:HIV Infections / Q000453:epidemiology* / Q000517:prevention & control* / Q000635:transmission; D015528:HIV Seroprevalence; D003932:Heroin / Q000008:administration & dosage / Q000737:chemistry* / Q000600:supply & distribution; D006358:Hot Temperature; D006801:Humans; D006920:Hygiene; D013287:Illicit Drugs / Q000737:chemistry* / Q000600:supply & distribution; D012111:Residence Characteristics; D012309:Risk-Taking; D012495:San Francisco / Q000453:epidemiology; D012995:Solubility; D015819:Substance Abuse, Intravenous / Q000453:epidemiology / Q000821:virology*; D013594:Syringes / Q000821:virology*; D014481:United States / Q000453:epidemiology; D019562:Viral Load
D013287:Illicit Drugs; D003932:Heroin