Metropolitan area characteristics, injection drug use and HIV among injectors

Epidemics, behaviors, and programs to change behaviors and ameliorate epidemics are shaped by the characteristics of geographically and socially defined communities. This chapter presents the rationale, methods, and selected findings from a study of injection drug users, HIV, and services for drug injectors in the 96 largest metropolitan areas in the United States. It presents data that show that metropolitan areas vary widely in the prevalence of injectors in their populations; in HIV prevalence among injectors; and in the percentage of injectors who are in drug abuse treatment. Furthermore, theoretically specified locality characteristics, such as inequality, legal repression of drug users and others, the degree of popular organization and mobilization for helping drug users, fiscal constraints and others, help predict the values of these variables in metropolitan areas. These findings help us to identify metropolitan area characteristics, including some that can be changed by public authorities or as a result of popular demand and social movements, which can be targeted for intervention to address drug-related health issues. Future research on the social and geographic causation of injection drug use, of its sequelae, and of programs like drug treatment and syringe exchange is clearly warranted, and should include research interventions that change metropolitan area characteristics in ways that reduce drug-related problems.