title: Drug use Discrimination Predicts Formation of High-Risk Social Networks: Examining Social Pathways of Discrimination.
abstract: Experiences of discrimination, or social marginalization and ostracism, may lead to the formation of social networks characterized by inequality. For example, those who experience discrimination may be more likely to develop drug use and sexual partnerships with others who are at increased risk for HIV compared to those without experiences of discrimination. This is critical as engaging in risk behaviors with others who are more likely to be HIV positive can increase one's risk of HIV. We used log-binomial regression models to examine the relationship between drug use, racial and incarceration discrimination with changes in the composition of one's risk network among 502 persons who use drugs. We examined both absolute and proportional changes with respect to sex partners, drug use partners, and injecting partners, after accounting for individual risk behaviors. At baseline, participants were predominately male (70%), black or Latino (91%), un-married (85%), and used crack (64%). Among those followed-up (67%), having experienced discrimination due to drug use was significantly related to increases in the absolute number of sex networks and drug networks over time. No types of discrimination were related to changes in the proportion of high-risk network members. Discrimination may increase one's risk of HIV acquisition by leading them to preferentially form risk relationships with higher-risk individuals, thereby perpetuating racial and ethnic inequities in HIV. Future social network studies and behavioral interventions should consider whether social discrimination plays a role in HIV transmission.
authors.affiliation: Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, 1518 Clifton Rd NE, Atlanta, GA, 30322, USA. ncrawford@emory.edu.
authors.forename: Natalie D
authors.initials: ND
authors.lastname: Crawford
authors.affiliation: Department of Community Health Sciences, School of Public Health, University of California at Los Angeles, Los Angeles, CA, USA.
authors.forename: Chandra
authors.initials: C
authors.lastname: Ford
authors.affiliation: Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA.
authors.forename: Abby
authors.initials: A
authors.lastname: Rudolph
authors.affiliation: College of Health and Human Services, University of New Hampshire, Durham, NH, USA.
authors.forename: BoRin
authors.initials: B
authors.lastname: Kim
authors.affiliation: Division of Social Solutions and Services Research, Nathan Kline Institute for Psychiatric Research, New York State Office of Mental Health, Latham, NY, USA.
authors.forename: Crystal M
authors.initials: CM
authors.lastname: Lewis
mesh_terms: D000328:Adult; D004192:Discrimination, Psychological; D055030:Drug Users / Q000523:psychology* / Q000706:statistics & numerical data; D005006:Ethnicity / Q000523:psychology / Q000706:statistics & numerical data; D005260:Female; D015658:HIV Infections / Q000208:ethnology* / Q000209:etiology / Q000635:transmission; D006801:Humans; D007398:Interpersonal Relations; D008297:Male; D015995:Prevalence; D011446:Prospective Studies; D063505:Racism / Q000523:psychology* / Q000706:statistics & numerical data; D012309:Risk-Taking; D012747:Sexual Partners; D060756:Social Networking; D012944:Social Support; D012959:Socioeconomic Factors; D015819:Substance Abuse, Intravenous / Q000208:ethnology / Q000523:psychology*; D019966:Substance-Related Disorders / Q000150:complications* / Q000208:ethnology; D055815:Young Adult
keywords: Discrimination; HIV; Racial/ethnic inequities; Social networks; Substance use