Injection and non-injection drug use and infectious disease in Baltimore City: differences by race.
OBJECTIVE
The current study examines differences in the prevalence of biologically-confirmed hepatitis C virus (HCV), HIV, and coinfection between Black and White adult cocaine/heroin users across three drug use subgroups identified in previous research (Harrell et al., 2012): non-injection smoking crack/nasal heroin users, heroin injectors, and polydrug injectors.


RESULTS
59% of the 482 participants in the study were male. Significant race differences emerged between drug use subgroup memberships. Non-injection smoking crack/nasal heroin users were predominantly Black (75%), while heroin injectors and polydrug injectors were predominantly White (69% and 72%, respectively). Polydrug injectors accounted for nearly three quarters of the HCV positive diagnoses in Whites. Though HIV disease status, stratified by race, did not differ significantly between drug use subgroups, the non-injection smoking crack/nasal heroin subgroup contained over half of the HIV positive diagnoses in the sample and was predominantly Black. Despite much lower rates of injection, Blacks (8%) had a higher prevalence of coinfection than Whites (3%; X(2) (2)=6.18, p=.015).


CONCLUSIONS
The current findings are consistent with trends in the recent HIV transmission statistics where sexual activity has overtaken injection drug use as a HIV risk factor. The current findings also provide further support to the notion of injection drug use as an exceedingly high-risk behavior for HCV and coinfection, specifically those who are polysubstance injectors.
Department of Clinical and Health Psychology, University of Florida, United States. Electronic address: LarryDKeenii@phhp.ufl.edu.
Larry
L
Keen
Department of Epidemiology, University of Florida, United States.
Maria
M
Khan
Department of Clinical and Health Psychology, University of Florida, United States.
Lisa
L
Clifford
Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center & Research Institute, United States.
Paul T
PT
Harrell
Department of Clinical and Health Psychology, University of Florida, United States.
William W
WW
Latimer
D000293:Adolescent; D000328:Adult; D015142:Baltimore / Q000453:epidemiology; D044383:Black People / Q000706:statistics & numerical data*; D019970:Cocaine-Related Disorders / Q000453:epidemiology; D015897:Comorbidity; D005260:Female; D015658:HIV Infections / Q000453:epidemiology*; D006526:Hepatitis C / Q000453:epidemiology*; D006556:Heroin Dependence / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors; D015819:Substance Abuse, Intravenous / Q000453:epidemiology; D019966:Substance-Related Disorders / Q000453:epidemiology*; D044465:White People / Q000706:statistics & numerical data*; D055815:Young Adult; D001741:Black or African American
Cocaine; Coinfection; HCV; HIV; Heroin; Injection drug use; Non-injection drug use