Injection and non-injection drug use and infectious disease in Baltimore City: differences by race

Addict Behav. 2014 Sep;39(9):1325-8. doi: 10.1016/j.addbeh.2014.04.020. Epub 2014 May 5.


Purpose: The current study examines differences in the prevalence of biologically-confirmed hepatitis C virus (HCV), HIV, and coinfection between Black and White adult cocaine/heroin users across three drug use subgroups identified in previous research (Harrell et al., 2012): non-injection smoking crack/nasal heroin users, heroin injectors, and polydrug injectors.

Results: 59% of the 482 participants in the study were male. Significant race differences emerged between drug use subgroup memberships. Non-injection smoking crack/nasal heroin users were predominantly Black (75%), while heroin injectors and polydrug injectors were predominantly White (69% and 72%, respectively). Polydrug injectors accounted for nearly three quarters of the HCV positive diagnoses in Whites. Though HIV disease status, stratified by race, did not differ significantly between drug use subgroups, the non-injection smoking crack/nasal heroin subgroup contained over half of the HIV positive diagnoses in the sample and was predominantly Black. Despite much lower rates of injection, Blacks (8%) had a higher prevalence of coinfection than Whites (3%; X(2) (2)=6.18, p=.015).

Conclusions: The current findings are consistent with trends in the recent HIV transmission statistics where sexual activity has overtaken injection drug use as a HIV risk factor. The current findings also provide further support to the notion of injection drug use as an exceedingly high-risk behavior for HCV and coinfection, specifically those who are polysubstance injectors.

Keywords: Cocaine; Coinfection; HCV; HIV; Heroin; Injection drug use; Non-injection drug use.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adolescent
  • Adult
  • African Continental Ancestry Group / statistics & numerical data*
  • Baltimore / epidemiology
  • Cocaine-Related Disorders / epidemiology
  • Comorbidity
  • European Continental Ancestry Group / statistics & numerical data*
  • Female
  • HIV Infections / epidemiology*
  • Hepatitis C / epidemiology*
  • Heroin Dependence / epidemiology
  • Humans
  • Male
  • Middle Aged
  • Prevalence
  • Risk Factors
  • Substance Abuse, Intravenous / epidemiology
  • Substance-Related Disorders / epidemiology*
  • Young Adult