Social space and judicial status: impact on utilization of HIV prevention programs among young
injecting drug users in San Francisco

Peter John Davidson, UC San Francisco

Background: Since 1997, the United States Public Health Service has recommended that injection drug users who cannot or will not stop injecting obtain and use a new needle for every injection. San Francisco has approximately 5,000 injecting drug users aged under 30. Among this high-risk population, HIV seroprevalence is 6% and hepatitis C (HCV) seroprevalence is 50%. Most young injectors in San Francisco acquire at least some of their needle needs through City-funded needle exchanges, however many still share and re-use needles, implying that there are other barriers to the acquisition and use of sufficient needles to prevent HIV and HCV transmission. The existing literature on barriers to the use of needle exchange has identified both operational issues, such as inconvenient or insufficient locations of operation, and structural issues, such as fear of identification or harassment by police, as potential barriers. However, there is little or no research on the ways an individual's exposure to the criminal justice system might impact on their willingness or ability to utilize HIV prevention programs such as needle exchange. Likewise, there is a long tradition of locating HIV prevention services in the communities in which high- risk populations are assumed to reside, however among this highly mobile and largely homeless population, notions of "neighborhood of residence" become largely meaningless. Young injectors move through (or avoid) multiple neighborhoods in the course of their day; understanding how and why they might see these areas as safe or unsafe; as easy to get to or as 'far away'; as places to visit briefly or as places to spend considerable parts of their day in, and understanding how these perceptions might change under the influence of factors such as their interactions with the criminal justice system, are crucial to understanding how and why they utilize, or under-utilize, or fail to utilize, core HIV prevention interventions such as needle exchange.

Goals: The two goals of this project are to quantitatively analyze relationships between judicial status and the closeness of compliance to standard of one needle per injection; and to qualitatively investigate understandings of social space held by young injecting drug users in San Francisco, CA, as they relate to locations of HIV prevention programs such as needle exchange.

Relevance to HIV/AIDS: Acquisition and use of sufficient needles is the single most effective HIV prevention intervention for those who cannot or will not stop injecting drugs. California has led the US in funding needle exchanges; understanding the barriers to the appropriate use of these programs is critical to ensuring the effectiveness of these programs for preventing the spread of HIV in California.

Methods: This study builds on an existing NIDA-funded prospective study of hepatitis C seroconversion being conducted by the University of California, San Francisco. By extending the quantitative data collection conducted as part of the above study, and by conducting a series of 30-40 qualitative interviews with participants of the above study, this project will examine the relationships between utilization of crucial HIV prevention intervention, the involvement of young injectors with the criminal justice system, and the relationships young injectors have with the physical locations in which needle exchanges are located.