title: Associations of place characteristics with HIV and HCV risk behaviors among racial/ethnic groups of people who inject drugs in the United States.
abstract: Investigate whether characteristics of geographic areas are associated with condomless sex and injection-related risk behavior among racial/ethnic groups of people who inject drugs (PWID) in the United States.
  
  
  
  PWID were recruited from 19 metropolitan statistical areas for 2009 National HIV Behavioral Surveillance. Administrative data described ZIP codes, counties, and metropolitan statistical areas where PWID lived. Multilevel models, stratified by racial/ethnic groups, were used to assess relationships of place-based characteristics to condomless sex and injection-related risk behavior (sharing injection equipment).
  
  
  
  Among black PWID, living in the South (vs. Northeast) was associated with injection-related risk behavior (adjusted odds ratio [AOR] = 2.24, 95% confidence interval [CI] = 1.21-4.17; P = .011), and living in counties with higher percentages of unaffordable rental housing was associated with condomless sex (AOR = 1.02, 95% CI = 1.00-1.04; P = .046). Among white PWID, living in ZIP codes with greater access to drug treatment was negatively associated with condomless sex (AOR = 0.93, 95% CI = 0.88-1.00; P = .038).
  
  
  
  Policies that increase access to affordable housing and drug treatment may make environments more conducive to safe sexual behaviors among black and white PWID. Future research designed to longitudinally explore the association between residence in the south and injection-related risk behavior might identify specific place-based features that sustain patterns of injection-related risk behavior.
authors: Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA. Electronic address: sabriya.linton@emory.edu.
authors: Sabriya L
authors: SL
authors: Linton
authors: Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA.
authors: Hannah L F
authors: HL
authors: Cooper
authors: Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA.
authors: Mary E
authors: ME
authors: Kelley
authors: Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA.
authors: Conny C
authors: CC
authors: Karnes
authors: ZevRoss Spatial Analysis, Ithaca, NY.
authors: Zev
authors: Z
authors: Ross
authors: Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA.
authors: Mary E
authors: ME
authors: Wolfe
authors: Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA.
authors: Yen-Tyng
authors: YT
authors: Chen
authors: Institute for Infectious Disease Research, National Development and Research Institutes, New York, NY.
authors: Samuel R
authors: SR
authors: Friedman
authors: Baron Edmond de Rothschild Chemical Dependency Institute, Mount Sinai Beth Israel, New York, NY.
authors: Don
authors: D
authors: Des Jarlais
authors: Centers for Disease Control and Prevention, Atlanta, GA.
authors: Salaam
authors: S
authors: Semaan
authors: Institute for Infectious Disease Research, National Development and Research Institutes, New York, NY.
authors: Barbara
authors: B
authors: Tempalski
authors: Centers for Disease Control and Prevention, Atlanta, GA.
authors: Catlainn
authors: C
authors: Sionean
authors: Centers for Disease Control and Prevention, Atlanta, GA.
authors: Elizabeth
authors: E
authors: DiNenno
authors: Centers for Disease Control and Prevention, Atlanta, GA.
authors: Cyprian
authors: C
authors: Wejnert
authors: Centers for Disease Control and Prevention, Atlanta, GA.
authors: Gabriela
authors: G
authors: Paz-Bailey
mesh_terms: D000328:Adult; D003140:Communicable Disease Control / Q000379:methods*; D005006:Ethnicity / Q000706:statistics & numerical data; D005260:Female; D005843:Geography; D015658:HIV Infections / Q000453:epidemiology* / Q000523:psychology; D006306:Health Surveys; D019698:Hepatitis C, Chronic / Q000453:epidemiology* / Q000523:psychology; D006801:Humans; D015994:Incidence; D008297:Male; D020380:Needs Assessment; D061214:Patient Safety / Q000706:statistics & numerical data; D044469:Racial Groups / Q000706:statistics & numerical data; D018570:Risk Assessment; D012309:Risk-Taking; D012725:Sexual Behavior; D015819:Substance Abuse, Intravenous / Q000453:epidemiology*; D014481:United States / Q000453:epidemiology; D055815:Young Adult
keywords: Condom use; Drug treatment; HCV; HIV; Housing; Injection drug use; PWID