Trends in homelessness and injection practices among young urban and suburban people who inject drugs: 1997-2017

• Published in: Drug and alcohol dependence Vol. 225; p. 108797
• Main Authors: Hotton, Anna, Mackesy-Amiti, Mary-Ellen, Boodram, Basmattee
• Format: Journal Article
• Language: English
• Published: Lausanne Elsevier B.V 01.08.2021; Elsevier Science Ltd
• Subjects: Access; Behavior change; Behavior modification; Blood diseases; Drugs; Hepatitis C; HIV; Homeless people; Homelessness; Human immunodeficiency virus; Injection; injection risk behavior; Mental health; meta-regression; Needle exchange programs; Needle sharing; Overdose; people who inject drugs; Pharmacies; Prevention programs; Psychological distress; Psychological stress; Psychosocial factors; Regression; Relapse; Risk; Risk behavior; Risk taking; Rural areas; Rural communities; Self destructive behavior; Sexually transmitted diseases; Sharing; STD; Suburban areas; Suicide; Syringes; Time; time trends; Trends; Young adults; Youth; time trends; injection risk behavior; homelessness; people who inject drugs; meta-regression
• ISSN: 0376-8716; 1879-0046; 1879-0046
• DOI: 10.1016/j.drugalcdep.2021.108797

•Among young PWID in Chicago, we observed a significant increase in homelessness over time.•Homelessness was associated with syringe and equipment sharing and exchange sex.•Results highlight the importance of addressing homelessness in public health interventions for young PWID. Among young people who inject drugs (PWID) homelessness is associated with numerous adverse psychosocial and health consequences, including risk of relapse and overdose, psychological distress and suicidality, limited treatment access, and injection practices that increase the risk of HIV and hepatitis C (HCV) transmission. Homeless PWID may also be less likely to access sterile syringes through pharmacies or syringe service programs. This study applied random-effects meta-regression to examine trends over time in injection risk behaviors and homelessness among young PWID in Chicago and surrounding suburban and rural areas using data from 11 studies collected between 1997 and 2017. In addition, subject-level data were pooled to evaluate the effect of homelessness on risk behaviors across all studies using mixed effects logistic and negative binomial regression with random study effects. There was a significant increase in homelessness among young PWID over time, consistent with the general population trend of increasing youth homelessness. In mixed-effects regression, homelessness was associated with injection risk behaviors (receptive syringe sharing, syringe mediated sharing, equipment sharing) and exchange sex, though we detected no overall changes in risk behavior over time. Increases over time in homelessness among young PWID highlight a need for research to understand factors contributing to youth homelessness to inform HIV/STI, HCV, and overdose prevention and intervention services for this population.