Title: The Association between Social Network Characteristics and HIV Testing Behavior among Users of Illicit Drugs
Description: INTRODUCTION: Human Immunodeficiency Virus (HIV) infection remains prevalent among the minority and drug using population in the United States. Testing for HIV is an important and cost effective way to reduce HIV prevalence. OBJECTIVE: To assess the HIV testing behavior of people who use non-injected drugs (PWND) and compare it to that of people who use injected drugs (PWID), in order to determine which factors, in terms of social context as well as individual risks, predict HIV testing among the PWND. METHOD: A cross-sectional study of HIV testing behavior of PWND compared to PWID was conducted and the data was analyzed by applying negative binomial regression models. Then, a negative binomial regression using generalized estimating equation (GEE) was employed in order to identify the predictive factors for HIV testing among PWND over a 2-year period. RESULTS: Individuals who reported using injected drugs tended to undergo HIV tests more often compared to those who used non-injected drugs, PR (95% CI) = 1.24 (1.02, 1.51), p = 0.03.

The interaction term between injection status and emotional support in relation to HIV testing was significant, 0.75 (0.59, 0.97), p = 0.03. PWID that had access to greater emotional support on average tended to test for HIV less frequently than did PWID with less emotional support. In stratified analyses, emotional support was negatively associated with testing among PWID and positively associated among PWND, though both relationships were borderline significant. HIV testing among users of illicit drugs was dependent on emotional support. According to the GEE models examining the factors predicting HIV testing among PWND, sexually transmitted infections, non-injected heroin use, being in drug treatment, engagement in sexual transactions, and instability in drug networks were the main factors contributing to being HIV tested, as well as frequency of testing. The positive influence of emotional support on these variables was borderline significant. CONCLUSION: People who use non-injected drugs are less likely to test for HIV compared to those who use injected drugs, though they may share similar risk factors for HIV transmission and acquisition.

To exert a greater impact on the HIV epidemic, interventions and policies encouraging HIV testing in this subpopulation, which remains under-recognized by both researchers and health practitioners in terms of the potential risks for contracting the HIV, are warranted.