Faculty Bibliography

The harm reduction movement formed during a period in which social movements of the working class and the excluded were weak, neo-liberalism ideologically triumphant, and potential opposition movements were viewed as offering "tinkering" with the system rather than a total social alternative. This climate shaped and limited the perspectives, strategies, and tactics of harm reductionists almost everywhere. In many countries, this period was also marked by a "political economy of scapegoating" that often targeted drug users as the cause of social woes. This scapegoating took the form of "divide and rule" political initiatives by business and political leaderships to prevent social unrest in a long period of worldwide economic trends toward lowered profit rates and toward increasing income inequality. However, times have changed. Mass strikes and other labor struggles, opposition to the World Trade Organisation and other agencies of neo-liberalism, community-based protests against belt-tightening, and other forms of social unrest have been increasing in many countries. This opens up the possibility of new allies for the harm reduction movement, but also poses difficult problems for which we need to develop answers. On-the-ground experience in alliance formation needs to be combined with careful discussion of and research about what approaches work to convince other movements to work for and with harm reduction, and which approaches do not. Class differences within the harm reduction movement are likely to become more salient in terms of (a) creating internal tensions, (b) increasingly, opening up new ways in which working class harm reductionists can organize within their own communities and workplaces, and (c) producing different strategic orientations that will need to be discussed and debated. As a movement, we will need to find ways to accommodate and discuss differing perspectives, needs, and assessments of opportunities and threats without paralyzing harm reduction activities.

In a population-representative sample of 202 18-24-year-old women in a neighborhood with widespread injection of drugs and HIV, 14% reported unprotected anal sex with men in the past year. Independent significant predictors were illegal drug use, having a main partner who takes the lead in deciding what to do during sex, and less self-deception. Having ever had anal sex was associated with having ever been infected with hepatitis B.

BACKGROUND:Sex risks and drug use are related. This relation in youth is described. GOAL/OBJECTIVE:To determine how stigmatized drug use is related to sexual risk behaviors and network characteristics among youth. STUDY DESIGN/METHODS:In-person interviews were conducted with both a probability household sample (n = 363) and a targeted, street-recruited sample of cocaine, heroin, crack, or injected drug users (n - 165) comprising 18- to 24-year-olds in an inner city neighborhood. Drug use in the preceding 12 months was scaled hierarchically, lowest to highest social stigma, as none, marijuana, noninjected cocaine, noninjected heroin, crack, and injected drugs. RESULTS:Users of the more stigmatized drugs had more sex partners. They were more likely to report a history of concurrent sex partners, sex with someone who also had engaged in sex with a network member, commercial sex work, and unprotected sex. Findings showed crack use and drug injection to be associated more strongly with increased sex risk among women than among men. CONCLUSIONS:Young users of the more stigmatized drugs are at much greater network and behavior risk for sexually transmitted diseases. Drug use prevention, harm reduction interventions, or both may lower this risk.

To assess whether human immunodeficiency virus (HIV)-infected and/or hepatitis C virus (HCV)-infected noninjecting heroin users (NIUs) are a potential sexual transmission bridge to "lower risk" partners, 180 HIV- or HCV-infected NIUs recruited in New York City were interviewed about their sexual behaviors and partnerships. Sixty-two percent were former injecting drug users (IDUs). Partners reported not to be HIV infected, IDUs, or men who have sex with men were defined as lower risk. Among 54 HIV-infected NIUs, lower risk partners were reported by 54% of never IDUs and 23% of former IDUs (P=.02). Among 155 HCV-infected NIUs, lower risk partners were reported by 54% of never IDUs and 45% of former IDUs (not significant). Engaging in unprotected vaginal or anal sex and having lower risk partners was reported by 29% of HIV-infected never IDUs, 12% of HIV-infected former IDUs, 29% of HCV-infected never IDUs, and 34% of HCV-infected former IDUs. HIV-infected NIUs, particularly never IDUs, and, possibly, HCV-infected NIUs, are a potential sexual transmission bridge.

OBJECTIVES/OBJECTIVE:This study examined correlates of prevalent hepatitis C virus (HCV) infection among young adult injection drug users in 2 neighborhoods in New York City. METHODS:Injection drug users aged 18 to 29 years were street recruited from the Lower East Side and Harlem. Participants were interviewed about drug use and sex practices; venipuncture was performed for hepatitis B virus (HBV), HCV, and HIV serologies. RESULTS:In both sites, testing positive for HCV antibody (anti-HCV) was associated with having injected for more than 3 years. Additionally, HCV infection was positively associated with injecting with someone known to have had hepatitis (but the association was significant only in the Lower East Side) and with sharing cotton (but the association was statistically significant only in Harlem). Being in drug treatment and older than 24 years were associated with HCV in the Lower East Side but not in Harlem. Receiving money for sex was associated with anti-HCV positivity in Harlem but not in the Lower East Side. CONCLUSIONS:Several differences in factors associated with prevalent HCV infection existed among 2 populations of young injection drug users from the same city. Indirect transmission of HCV may occur.