title: Incarceration and injection drug use in Baltimore, Maryland.
abstract: OBJECTIVE
  There is limited longitudinal research examining incarceration and subsequent changes in drug use among people who inject drugs (PWID) in the United States. The objective of the current study was to characterize the frequency of incarceration and estimate the association between incarceration and subsequent injection drug use among current and former PWIDs in one US city.
  
  
  METHODS
  ALIVE (AIDS Linked to the Intravenous Experience) is a prospective cohort study of current and former PWIDs, with semi-annual follow-up occurring since 1988.
  
  
  METHODS
  Baltimore, Maryland, USA.
  
  
  METHODS
  A total of 3245 participants with 48 738 study visits were included. Participants enrolled from 1988 to 2012 with a median of 13 follow-up visits per participant (Interquartile range = 7-25).
  
  
  METHODS
  Incarcerations were defined as any self-reported jail or prison stays in the previous 6 months that were ≥7 days or longer. The primary outcome was defined as any self-reported injection drug use in the previous 6 months.
  
  
  RESULTS
  At baseline, 29% were female, 90% African American and 33% HIV-positive. Fifty-seven per cent of participants experienced at least one incarceration episode. After adjusting for confounders, there was a positive association between incarceration and subsequent injection drug use [adjusted odds ratio (AOR) = 1.48, 95% confidence interval (CI) = 1.37-1.59]; however, stratified analysis showed that the effect was restricted to those who were not injecting at the time of incarceration (AOR = 2.11, 95% CI = 1.88-2.37).
  
  
  CONCLUSIONS
  In the United States, incarceration of people who had previously stopped injecting drugs appears to be associated with an increased risk of subsequent injecting.
authors.affiliation: Brown University, Department of Health Services, Policy and Practice, Providence, RI, USA.
authors.forename: Becky L
authors.initials: BL
authors.lastname: Genberg
authors.affiliation: Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, Baltimore, MD, USA.
authors.forename: Jacquie
authors.initials: J
authors.lastname: Astemborski
authors.affiliation: University of California-San Francisco, School of Nursing, San Francisco, CA, USA.
authors.forename: David
authors.initials: D
authors.lastname: Vlahov
authors.affiliation: Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, Baltimore, MD, USA.
authors.forename: Gregory D
authors.initials: GD
authors.lastname: Kirk
authors.affiliation: Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, Baltimore, MD, USA.
authors.forename: Shruti H
authors.initials: SH
authors.lastname: Mehta
mesh_terms: D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D015142:Baltimore / Q000453:epidemiology; D015331:Cohort Studies; D016001:Confidence Intervals; D005260:Female; D005500:Follow-Up Studies; D006679:HIV Seropositivity / Q000453:epidemiology* / Q000208:ethnology; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D011329:Prisoners / Q000706:statistics & numerical data*; D011446:Prospective Studies; D012307:Risk Factors; D015819:Substance Abuse, Intravenous / Q000453:epidemiology* / Q000209:etiology
keywords: HIV; incarceration; injection drug use; longitudinal analysis; observational study; relapse
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