Explaining the geographical variation of HIV among injection drug users in the United States

Subst Use Misuse. 2003 Dec;38(14):2049-63. doi: 10.1081/ja-120025125.

Abstract

Distinct physical and chemical types of street heroin exist worldwide, but their impact on behavior and disease acquisition is not well understood or documented. This article presents a hypothesis to explain the unequal diffusion of HIV among injection drug users in the United States by examining the distribution and use of one type of heroin--"Mexican black tar." Drawing on ethnographic, clinical, epidemiological, and laboratory data, we suggest that the chemical properties of black tar heroin promote the following safer injection practices: (1) the rinsing of syringes with water to prevent clogging; (2) the heating of cookers to promote dissolution; and (3) a rapid transition from venous injection to subcutaneous or intramuscular injections.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Blood-Borne Pathogens
  • Equipment Contamination / prevention & control
  • Geography
  • HIV Infections / epidemiology*
  • HIV Infections / prevention & control*
  • HIV Infections / transmission
  • HIV Seroprevalence
  • Heroin / administration & dosage
  • Heroin / chemistry*
  • Heroin / supply & distribution
  • Hot Temperature
  • Humans
  • Hygiene
  • Illicit Drugs / chemistry*
  • Illicit Drugs / supply & distribution
  • Residence Characteristics
  • Risk-Taking
  • San Francisco / epidemiology
  • Solubility
  • Substance Abuse, Intravenous / epidemiology
  • Substance Abuse, Intravenous / virology*
  • Syringes / virology*
  • United States / epidemiology
  • Viral Load

Substances

  • Illicit Drugs
  • Heroin