International Journal of Drug Policy - 2014

Volume 25 Issue 3 May 2014

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International Journal of Drug Policy 25 (2014) 516–524 Contents lists available at ScienceDirect International Journal of Drug Policy j o u r n a l h o m e p a g e : w w w . e l s e v i e r . c o m / l o c a t e / d r u g p o Research paper Activity spaces among injection drug users in San Francisco Alexis N. Martinez a,∗ , Jennifer Lorvick b , Alex H. Kral b a Department of Sociology, San Francisco State University, United States b Urban Health Program, RTI International, San Francisco, CA, United States a r t i c l e i n f o Article history: Received 18 May 2013 Received in revised form 7 November 2013 Accepted 13 November 2013 Keywords: Activity spaces Geographic mobility HIV Overdose Syringe sharing Injection drug use San Francisco GIS a b s t r a c t Background: Representations of activity spaces, defined as the local areas within which people move or travel in the course of their daily activities, are unexplored among injection drug users (IDUs). The purpose of this paper is to use an activity space framework to study place and drug user health. Methods: Data for this analysis is from an epidemiological study of street-recruited IDUs in San Francisco (N = 1084). Study participants reported geographic intersections of where they most often slept at night, hung out during the day, and used drugs during a 6 month time period. We used GIS software to construct and map activity space routes of street-based network paths between these intersections. We further identified if syringe exchange program (SEP) locations intersected with, participant activity space routes. We used logistic regression to estimate associations between activity space variables and HIV serostatus, syringe sharing, and non-fatal overdose, after adjusting for individual and Census tract covariates. Results: Mean activity space distance for all participants was 1.5 miles. 9.6% of participants had a SEP located along their activity space. An increase in activity space distance was associated with a decrease in odds of being HIV positive. An increase in residential transience, or the number of different locations slept in by participants in a 6 month time period, was associated with higher odds of syringe sharing. Activity space distance was not independently associated with overdose or syringe sharing. Discussion: Research that locates individuals in places of perceived importance is needed to inform place- ment and accessibility of HIV and overdose prevention programs. More attention needs to be given to the logistics of collecting sensitive geospatial data from vulnerable populations as well as how to maximize the use of GIS software for visualizing and understanding how IDUs interact with their environment. © 2013 Published by Elsevier B.V. Background Activity spaces refer to the local areas within which individ- uals habitually move about in the course of their daily activities (Sherman, Spencer, Preisser, Gesler, & Arcury, 2005). Previously described as an experience of place, activity spaces have been extensively theorized and studied across multiple disciplines and traditions, with a particular focus on the utility for understand- ing healthcare accessibility across a diversity of populations (Fryer et al., 1999; Graves, 2008; Guagliardo, 2004; Nemet & Bailey, 2000; Newsome, Walcott, & Smith, 1998; Parker & Campbell, 1998; Townley, Kloos, & Wright, 2009). Though place is an expanding area of interest in the intersecting fields of substance use, harm reduction and HIV/AIDS research, approaches to studying its influ- ence on health outcomes often rely on static measures of individual residence.(Kwan, 2013) The spatial accessibility of health services, ∗ Corresponding author at: Department of Sociology, San Francisco State Univer- sity, 1600 Holloway Avenue, San Francisco, CA 94132, United States. Tel.: +1 415 338 2269. E-mail address: (A.N. Martinez). such as syringe exchange programs, is one promising area in which activity space research could impact health outcomes of mobile populations at high risk for injection-related morbidity and mor- tality. Research in the field of primary medical care and cancer screening has shown that if a health care service is located within an individual activity space, utilization will increase (Dulin et al., 2010; Elkin et al., 2010; Engelman et al., 2002; Fryer et al., 1999; Kwan, 2013; Lian, Struthers, & Schootman, 2012; Mei-Po Kwan & Weber, 2003; Smith et al., 2013). Activity space methods have not been used to examine accessibility of prevention programs among street-based injection drug users (IDUs), a mobile population at high risk for HIV infection and overdose (Brouwer, Rusch, et al., 2012; Cooper, Bossak, Tempalski, Des Jarlais, & Friedman, 2009; DiMaggio, Bucciarelli, Tardiff, Vlahov, & Galea, 2008; Green et al., 2009; Stopka et al., 2012). Geospatial analyses of HIV and overdose have the potential to inform drug-related policy and prevention programs, such as where to place new syringe exchange programs, HIV testing sites, or drug treatment programs (DiMaggio et al., 2008; El-Bassel et al., 2011; Goldenberg, Strathdee, Perez-Rosales, & Sued, 2012; Richardson et al., 2013; Taylor et al., 2011). A previous study of all heroin-related overdoses in San Francisco from 1997 to 0955-3959/$ – see front matter © 2013 Published by Elsevier B.V.

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