title: Explaining the geographical variation of HIV among injection drug users in the United States.
abstract: 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.
authors.affiliation: Urban Health Study, Department of Family and Community Medicine, University of California, San Francisco, California 94110, USA. ciccaron@fcm.ucsf.edu
authors.forename: D
authors.initials: D
authors.lastname: Ciccarone
authors.forename: P
authors.initials: P
authors.lastname: Bourgois
mesh_terms: 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
chemical_list: D013287:Illicit Drugs; D003932:Heroin