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Journal of Urban Health : Bulletin of the New York Academy of Medicine logoLink to Journal of Urban Health : Bulletin of the New York Academy of Medicine
. 2000 Sep;77(3):396–414. doi: 10.1007/BF02386749

Gender differences in the initiation of injection drug use among young adults

Meg C Doherty 1, Richard S Garfein 1, Edgar Monterroso 2, Carl Latkin 3, David Vlahov 1,
PMCID: PMC3456045  PMID: 10976613

Abstract

To characterize the circumstances surrounding initiation of injecting drug use, data were collected from 229 young, recently initiated injection drug users enrolled through community-based recruitment in Baltimore, Maryland. Gender differences in the pattern of initiation, the number of persons present at initiation, risky injection, and sexual behaviors at initiation, as well as behaviors after initiation, were examined. Overall, men and women were similar statistically with respect to age at initiation (19.5 years) and risk behaviors at initiation. While men were initiated by men (77%), women were more often initiated by women (65%), most of whom were friends (75%) or relatives (23%). The percentage of women infected with human immunodeficiency virus (HIV) was slightly greater than that of men, 17% versus 11% (P<.2), whether initiated by a man or a woman. Persons who self-initiated had a lower HIV prevalence and fewer HIV-related risk behaviors. Analysis of variance assessed differences in the HIV risk profiles of female and male IDUs who were intiated by someone of the same sex, of the opposite sex, or who self-initiated. These results indicated that (1) young women and men had similar patterns of injection initiation; (2) most women were initiated by female friends, runing counter to earlier literature claims that women were initated to injection drug use by male sex partners; and (3) women initiated by men had a marginally greater mean score on the HIV risk profile.

Key Words: Gender Differences, Human Immunodeficiency Virus, Initiation, Injection Drug Use, Intravenous, Substance Abuse

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References

  • 1.Report on the Global HIV/AIDS Epidemic: June 1998. Geneva, Switzerland: UNAIDS, WHO; 1998. [Google Scholar]
  • 2.Fennema JSA, Ameijden EJC, Hoek A, Coutinho RA. Young and recentonset injecting drug users are at hihger risk for HIV. Addiction. 1997;92(11):1457–1465. doi: 10.1111/j.1360-0443.1997.tb02867.x. [DOI] [PubMed] [Google Scholar]
  • 3.Battjes RJ, Leukefeld CG, Pickens RW. Age at first injection and HIV risk among intravenous drug users. Am J Drug Alcohol Abuse. 1992;18(3):263–273. doi: 10.3109/00952999209026066. [DOI] [PubMed] [Google Scholar]
  • 4.Hser YI, Anglin MD, McGlothlin W. Sex differences in addict careers. 1. Initiation of use. Am J Drug Alcohol Abuse. 1987;13(1&2):33–57. doi: 10.3109/00952998709001499. [DOI] [PubMed] [Google Scholar]
  • 5.Zinberg NE. Drug, Set, and Setting: the Basis for Controlled Intoxicant Use. New Haven CT: Yale University Press; 1984. [Google Scholar]
  • 6.Chein I, Gerard DL, Lee RS, Rosenfeld E. The Road to H: Narcotics, Delinquency, and social Policy. New York: Basic Books; 1964. [Google Scholar]
  • 7.Fiedman SR, Jarlais DC, Neaigus A, et al. AIDS and the new drug injector. Nature. 1989;339:333–339. doi: 10.1038/339333a0. [DOI] [PubMed] [Google Scholar]
  • 8.Stenbecka M. Initiation into intravenous drug abuse. Acta Psychiatr Scand. 1990;81:459–462. doi: 10.1111/j.1600-0447.1990.tb05481.x. [DOI] [PubMed] [Google Scholar]
  • 9.Hughes PH, Barker NW, Crawford GA, Jaffe JH. The natural history of a heroin epidemic. Am J Public Health. 1972;62:995–1001. doi: 10.2105/ajph.62.7.995. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 10.Alarcón R. The spread of heroin abuse in a community. Community Health. 1969;1(3):155–161. [PubMed] [Google Scholar]
  • 11.Kral AH, Bluthenthal RN, Erringer EA, Lorvick J, Edlin BR. Risk factors among IDUs who give injections to or receive injections from other drug users. Addiction. 1999;94(5):675–683. doi: 10.1046/j.1360-0443.1999.9456755.x. [DOI] [PubMed] [Google Scholar]
  • 12.Crofts N, Louie R, Rosenthal D, Jolley D. The first hit; circumstances surrounding initiation into injection. Addiction. 1996;91(8):1187–1196. doi: 10.1046/j.1360-0443.1996.918118710.x. [DOI] [PubMed] [Google Scholar]
  • 13.Latkin CA, Mandell W, Knowlton AR, et al. Gender differences in injection-related behaviors among injection drug users in Baltimore, Maryland. AIDS Educ Prev. 1998;10(3):257–257. [PubMed] [Google Scholar]
  • 14.Friedman SR, Neaigus A, Jose B, Goldstein M, Curtis R, Des Jarlais DC. Gender differences in HIV seroprevalence among new drug injectors vary by city and by social network. Paper presented at:HIV Injection in Women Conference; February 22–25, 1995; Washington, DC. Abstract 82.
  • 15.Gamella JF. The spread of intravenous drug use and AIDS in a neighborhood in Spain. Med Anthropol Q. 1994;8:131–160. doi: 10.1525/maq.1994.8.2.02a00010. [DOI] [Google Scholar]
  • 16.Anglin MD, Hser YI, McGlothlin WH. Sex differences in addict careers. 2. Becoming addicted. Am J Drug Alcohol Abuse. 1987;13(1&2):59–71. doi: 10.3109/00952998709001500. [DOI] [PubMed] [Google Scholar]
  • 17.Hser YI, Anglin MD, Booth MW. Sex differences in addict careers. 3. Addiction. Am J Drug Alcohol Abuse. 1987;13(3):231–251. doi: 10.3109/00952998709001512. [DOI] [PubMed] [Google Scholar]
  • 18.Almog YJ, Anglin MD, Fisher DG. Alcohol and heroin use patterns of narcotics addicts: gender and ethnic differences. Am J Drug Alcohol Abuse. 1993;19(2):219–238. doi: 10.3109/00952999309002682. [DOI] [PubMed] [Google Scholar]
  • 19.Hartel D. Context of HIV risk behavior among female injecting drug users and female sexual partners of injecting drug users. In: Battjes RJ, Sloboda Z, Grace WC, editors. The Context of HIV Risk Among Drug Users and Their Sexual Partners. Rockville, MD: US Department of Health and Human Services; 1994. pp. 41–47. [PubMed] [Google Scholar]
  • 20.Powis B, Griffiths P, Gossop M, Strang J. The differences between male and female drug users: community samples of heroin and cocaine users compared. Subst Use Misuse. 1996;31:529–543. doi: 10.3109/10826089609045825. [DOI] [PubMed] [Google Scholar]
  • 21.Gerstein DR, Judd LL, Roviner SA. Carrer dynamics of female heroin addicts. Am J Drug Alcohol Abuse. 1979;6:1–23. doi: 10.3109/00952997909007029. [DOI] [PubMed] [Google Scholar]
  • 22.Helzer JE, Robins LN, Davis DH. Antecedents of narcotic use and addiction. A study of 898 Vietmam Veterans. Drug Alcohol Depend. 1975;1:183–190. doi: 10.1016/0376-8716(76)90028-4. [DOI] [PubMed] [Google Scholar]
  • 23.Ronald PJM, Robertson JR. Initial and current drug use: how are they related? Addiction. 1993;88:1225–1231. doi: 10.1111/j.1360-0443.1993.tb02145.x. [DOI] [PubMed] [Google Scholar]
  • 24.Friedman SR, Neaigus A, Jose B, et al. Female injecting drug users get infected sooner than males. Paper presented at:Ninth Intenational Conference on AIDS; June 7–11, 1993; Berlin. Abstract PO-DO3-35122.
  • 25.Jarlais DC, Friedman SR, Perlis T, et al. Risk behavior and HIV infection among new drug injectors in the era of AIDS in New York City. J. Acquir Immune Defic Syndr Human Retrovirol. 1999;20(1):67–72. doi: 10.1097/00042560-199901010-00010. [DOI] [PubMed] [Google Scholar]
  • 26.Sotheran JL, Wenston JA, Rockwell R, Des Jarlais DC, Friedman SR. Injecting drug users: why do women share syringes more often than men? Paper presented at:American Public Health Association Annual Meeting; November 8–12, 1992; Washington, DC.
  • 27.Dwyer R, Richardson D, Ross MW, Wodak A, Miller ME, Gold J. A comparison of HIV risk between women and men who inject drugs. AIDS Educt Prev. 1994;6:379–389. [PubMed] [Google Scholar]
  • 28.Barnard MA. Needle sharing in context: patterns of sharing among men and women injectors and HIV risks. Addiction. 1993;88:805–812. doi: 10.1111/j.1360-0443.1993.tb02094.x. [DOI] [PubMed] [Google Scholar]
  • 29.Hindin R, Bigelow C, Vickers-Lahti M, Lewis B, McCusker J. Gender differences in sharing behavior among intravenous drug users (IVDUs). Paper presented at:Eighth International AIDS Conference; July 19–24, 1992; Amsterdam. Abstract 8:C287.
  • 30.Wells EA, Clark LL, Caslyn DA, Saxon AJ, Jackson TR, Wrede AF. Reporting of HIV risk behaviors by injection drug using heterosexual couples in methadone maintenance. Drug Alcohol Depend. 1994;36:33–38. doi: 10.1016/0376-8716(94)90007-8. [DOI] [PubMed] [Google Scholar]
  • 31.Davies AG, Dominy NJ, Peters AD, Richardson AM. Gender differences in HIV risk behaviour of injecting drug users in Edinburgh. AIDS Care. 1996;8:517–527. doi: 10.1080/09540129650125489. [DOI] [PubMed] [Google Scholar]
  • 32.Neaigus A, Friedman SR, Jose B, et al. High-risk personal networks and syringe sharing as risk factors for HIV infection among new drug injectors. J Acquir Immune Defic Syndr Human Retrovirol. 1996;11:499–509. doi: 10.1097/00042560-199604150-00011. [DOI] [PubMed] [Google Scholar]
  • 33.Murphy S, Waldorf D. Kickin' down to the street doc: shooting galleries in the San Francisco Bay area. Comtemp Drug Probl. 1991;18:9–29. [Google Scholar]
  • 34.Doherty MC, Garfein RS, Monterroso EM, Brown D, Vlahov D. Correlates of HIV infection among young adult short-term injection drug users. AIDS. 2000;14:717–726. doi: 10.1097/00002030-200004140-00011. [DOI] [PubMed] [Google Scholar]
  • 35.Page B. Aggregation of in-depth interviews: Cultural patterns among intravenous durg users. Paper presented at:Annual Meeting of the Society for Applied Anthropology; March 29–April 2, 1995; Albuquerque, NM.
  • 36.Edlin BR, Irwin KL, Faruque S, et al. Intersecting epidemics—crack cocaine use and HIV infection among inner-city young adults. N Engl J Med. 1994;331:1422–1427. doi: 10.1056/NEJM199411243312106. [DOI] [PubMed] [Google Scholar]
  • 37.Edlin BR, Irwin KL, Ludwig DD, et al. High-risk sex behavior among young streetrecruited crack cocaine smokers in three American cities: an interim report. J Psychoactive Drugs. 1992;24:363–371. doi: 10.1080/02791072.1992.10471660. [DOI] [PubMed] [Google Scholar]
  • 38.Chiasson MA, Stoneburner RL, Hildebrandt DS, Ewing WE, Telzak EE, Jaffe HW. Heterosexual transmission of HIV-1 associated with the use of smokable freebase cocaine (crack) AIDS. 1991;5:1121–1126. doi: 10.1097/00002030-199109000-00011. [DOI] [PubMed] [Google Scholar]
  • 39.Jarlais DC, Casriel C, Friedman SR, Rosenblum A. AIDS and the transition to illicit drug injection—results of a randomized trial prevention program. Br J Addict. 1992;87:493–498. doi: 10.1111/j.1360-0443.1992.tb01950.x. [DOI] [PubMed] [Google Scholar]
  • 40.Griffiths P, Gossop M, Powis B, Strang J. Extent and nature of transitions of route among heroin addicts in treatment—preliminary data from the Drug Transitions Study. Br J Addict. 1992;87:485–491. doi: 10.1111/j.1360-0443.1992.tb01949.x. [DOI] [PubMed] [Google Scholar]
  • 41.Yamaguchi K, Kandel DB. Patterns of drug users from adolescence to young adulthood: III. Predictors of progression. Am J Public Health. 1984;74(7):673–681. doi: 10.2105/ajph.74.7.673. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 42.Chen K, Kandel DB. The natural history of drug use from adolescence to the midthirties in a general population sample. Am J Public Health. 1995;85(1):41–47. doi: 10.2105/ajph.85.1.41. [DOI] [PMC free article] [PubMed] [Google Scholar]

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