Table 4.
Association of place and participant characteristics with condomless sex among people who inject drugs from 19 US metro areas in 2009, stratified by race/ethnicity12,13,14
| Latino (N=1,394) | Black (N=3,953) | White (N=2,354)15 | |||||
|---|---|---|---|---|---|---|---|
|
| |||||||
| Odds ratio (95% Confidence interval) | Adjusted odds ratio16 (95% Confidence interval) | Odds ratio (95% Confidence interval) | Adjusted odds ratio17 (95% Confidence interval) | Odds ratio (95% Confidence Interval) | Adjusted odds ratio18 (95% Confidence interval) | Adjusted odds ratio19 (95% Confidence interval) | |
| MSA variance (variance component) | 0.00 (0.00) | 0.00 (0.00) | 0.11 (0.03) | 0.04 (0.01) | 0.31 (0.08) | 0.24 (0.06) | 0.21 (0.06) |
| County variance (variance component) | 0.10 (0.03) | 0.04 (0.01) | 0.00 (0.00) | 0.00 (0.00) | 0.00 (0.00) | 0.00 (0.00) | 0.00 (0.00) |
| Zip code variance (variance component) | 0.00 (0.00) | 0.00 (0.00) | 0.00 (0.00) | 0.00 (0.00) | 0.05 (0.01) | 0.01 (0.00) | 0.03 (0.01) |
| Intercept | 4.16 (3.38, 5.11) | 9.35 (3.81, 22.99) | 4.07 (3.42, 4.84) | 1.48 (0.25, 8.81) | 4.98 (3.72, 6.67) | 8.70 (4.10, 18.46) | 10.20 (4.88, 21.32) |
| Region | |||||||
| Northeast (Reference) | 1.00 | -- | 1.00 | -- | 1.00 | -- | -- |
| South | 1.23 (0.74, 2.06) | -- | 1.39 (0.91, 2.13) | -- | 0.85 (0.42, 1.68) | -- | -- |
| Midwest | 0.76 (0.39, 1.49) | -- | 1.19 (0.67, 2.13) | -- | 0.47 (0.17, 1.30) | -- | -- |
| West | 1.14 (0.73, 1.79) | -- | 1.35 (0.83, 2.21) | -- | 0.71 (0.35, 1.42) | -- | -- |
| Metropolitan statistical area | |||||||
| Black isolation | 0.52 (0.18, 1.48) | -- | 0.64 (0.27, 1.53) | -- | 1.21 (0.28, 5.24) | -- | -- |
| Latino isolation | 1.92 (0.48, 7.68) | -- | 1.04 (0.37, 2.92) | -- | 0.57 (0.11, 3.09) | -- | -- |
| County | |||||||
| Percent of unaffordable rental units among lowest income households | 0.98 (0.96, 1.02) | -- | 1.03 (1.00, 1.05)* | 1.02 (1.00, 1.04)* | 0.98 (0.95, 1.02) | -- | -- |
| Average number of months on waiting lists for assisted housing | 1.00 (0.99, 1.01) | -- | 1.00 (0.99, 1.01) | -- | 0.99 (0.98, 1.01) | -- | -- |
| Drug arrest rates per 1,000 residents | 0.97 (0.94, 1.00)* | 0.97 (0.93, 1.01) | 0.99 (0.97, 1.01) | -- | 1.01 (0.97, 1.04) | -- | -- |
| ZCTA | |||||||
| Density per square mile of off-premise alcohol outlets | 0.99 (0.99, 1.00)* | 1.00 (0.99, 1.01) | 1.00 (0.98, 1.00) | -- | 0.99 (0.99, 1.00) | -- | -- |
| Density per square mile of abandoned residential units | 1.00 (1.00, 1.00) | -- | 1.00 (1.00, 1.00) | -- | 1.00 (1.00, 1.00) | -- | -- |
| Percent of housing units with >1.5 people per room | 0.98 (0.94, 1.02) | -- | 1.02 (0.98, 1.06) | -- | 0.97 (0.93, 1.02) | -- | -- |
| Percent non-Hispanic black residents | 1.00 (0.99, 1.00) | -- | 1.00 (1.00, 1.00) | -- | 1.00 (0.99, 1.00) | -- | -- |
| Economic deprivation | 0.98 (0.92, 1.05) | -- | 1.00 (0.96, 1.05) | -- | 1.05 (0.99, 1.13) | -- | -- |
| Gentrification | 0.99 (0.91, 1.08) | -- | 0.99 (0.94, 1.04) | -- | 0.95 (0.87, 1.04) | -- | -- |
| Spatial access to drug treatment | 0.99 (0.94, 1.04) | -- | 1.02 (0.96, 1.08) | -- | 0.93 (0.88, 0.99)* | 0.93 (0.88, 1.00)* | -- |
| Spatial access to syringe exchange programs | 0.73 (0.53, 1.02) | -- | 0.96 (0.75, 1.22) | -- | 0.70 (0.51, 0.96)* | -- | 0.82 (0.59, 1.13) |
| Participant characteristics | |||||||
| Current age | 0.98 (0.97, 1.00)* | 0.99 (0.97, 1.00) | 0.98 (0.97, 0.99)* | 0.98 (0.97, 0.99)* | 0.97 (0.96, 0.98)* | 0.98 (0.97, 0.99)* | 0.98 (0.97, 0.99)* |
| Sex (male=1) | 1.52 (1.07, 2.16)* | 1.60 (1.11, 2.32)* | 1.63 (1.34, 1.98)* | 1.62 (1.31, 1.99)* | 2.62 (1.98, 3.46)* | 2.30 (1.70, 3.12)* | 2.27 (1.68, 3.07)* |
| Men who had sex with men | |||||||
| Men who had sex with men more than 1 year ago (reference) | 1.00 | -- | 1.00 | -- | 1.00 | -- | -- |
| Men who had sex with men in the past year | 0.32 (0.17, 0.61)* | -- | 0.31 (0.19, 0.51)* | -- | 0.16 (0.10, 0.27)* | -- | -- |
| Men who never had sex with men | 1.04 (0.58, 1.86) | -- | 0.57 (0.37, 0.86)* | -- | 1.09 (0.64, 1.83) | -- | -- |
| Currently married or living as married | 1.65 (1.12, 2.45)* | 1.84 (1.21, 2.78)* | 2.22 (1.70, 2.95)* | 2.18 (1.63, 2.91)* | 3.49 (2.09, 5.84)* | 3.78 (2.18, 6.55)* | 3.86 (2.22, 6.70)* |
| Annual income (5,000 USD vs. more) | 0.88 (0.67, 1.16) | 0.86 (0.64, 1.16) | 1.06 (0.89, 1.25) | 1.04 (0.87, 1.24) | 0.88 (0.70, 1.09) | 0.88 (0.69, 1.12) | 0.89 (0.69, 1.14) |
| Currently employed full-time | 1.25 (0.57, 2.71) | 1.24 (0.55, 2.79) | 1.04 (0.69, 1.58) | 0.96 (0.63, 1.47) | 0.94 (0.59, 1.49) | 0.79 (0.48, 1.29) | 0.77 (0.47, 1.26) |
| Incarceration | 1.36 (1.02, 1.81)* | -- | 1.30 (1.09, 1.55)* | -- | 1.71(1.36, 2.16* | 1.45 (1.13, 1.87)* | -- |
| Homelessness | 1.51 (1.14, 1.99)* | -- | 1.20 (1.02, 1.41)* | -- | 1.25 (0.99, 1.58) | 1.06 (0.81, 1.38) | 1.11 (0.85, 1.44) |
| Daily injection use | 0.71 (0.50, 1.00) | 0.80 (0.55, 2.79) | 0.87 (0.72, 1.05) | 0.96 (0.79, 1.16) | 0.69 (0.54, 0.88)* | 0.85 (0.65, 1.10) | 0.86 (0.66, 1.13) |
| Binge drinking | 1.76 (1.33, 2.31)* | 1.82 (1.36, 2.44)* | 1.41 (1.20, 1.66)* | 1.38 (1.16, 1.63)* | 1.39 (1.11, 1.74)* | 1.33 (1.04, 1.71)* | 1.31 (1.02, 1.68)* |
| Non-injection drug use | 1.08 (0.80, 1.46) | 0.97 (0.70, 1.35) | 1.14 (0.95, 1.36) | 1.05 (0.87, 1.26) | 1.17 (0.86, 1.58) | 1.22 (0.88, 1.69) | 1.20 (0.87, 1.66) |
| Exchanged sex for money or drugs | 1.43 (1.01, 2.02)* | -- | 1.52 (1.26, 1.84)* | -- | 1.74 (1.30, 2.33)* | 1.27 (0.92, 1.74) | 1.31 (0.95, 1.80) |
| Acquired condoms for free in the past year | 0.64 (0.49, 0.85)* | 0.69 (0.51, 0.92)* | 0.71 (0.60, 0.84)* | 0.77 (0.65, 0.92)* | 0.61 (0.49, 0.77)* | -- | -- |
| Result of most recent HIV test | |||||||
| Indeterminate result on most recent HIV test/or did not receive result (Reference) | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 |
| Negative result on most recent HIV test | 1.01 (0.70, 1.45) | 1.06 (0.73, 1.54) | 1.04 (0.83, 1.30) | 1.02 (0.81, 1.28) | 0.82 (0.59, 1.14) | 0.83 (0.59, 1.16) | 0.83 (0.59, 1.16) |
| Positive result on most recent HIV test | 0.11 (0.05, 0.21)* | 0.13 (0.06, 0.26)* | 0.25 (0.18, 0.35)* | 0.26 (0.18, 0.37)* | 0.06 (0.03, 0.10)* | 0.06 (0.03, 0.11)* | 0.06 (0.03, 0.11)* |
Note:
indicates significance at p<0.05; some estimates labeled as significant at p<0.05 include confidence intervals that include a value of 1.00 due to rounding to the second decimal place.
Multilevel analysis was conducted to assess the associations of place and participant characteristics with injection-related risk behavior. Among white PWID, random intercepts were included for MSAs and ZIP codes. Among Latino and black PWID random intercepts were respectively included for counties and MSAs
Refer to table 1 for definitions of place characteristics measured at MSA, county, and ZIP code levels and participant characteristics
“Plurality” guidelines from the Federal Office of Management and Budget were used to group Non-Hispanic biracial participants to the white and black racial categories.
Separate multivariable models were analyzed for density of drug treatment and syringe exchange program exposures to avoid multicollinearity
Homelessness, sex exchange, and incarceration were excluded from multivariable analysis because they were hypothesized to mediate the relationship of drug-related arrests to condomless sex.
Homelessness, sex exchange, and incarceration were excluded from multivariable analysis because they were hypothesized to mediate the relationship of housing affordability to condomless sex.
Receipt of condoms was excluded from multivariable analysis because it was hypothesized to mediate the relationship of drug treatment density to condomless sex
Incarceration and receipt of condoms were excluded from multivariable analysis because they were hypothesized to mediate the relationship of SEP density to condomless sex.