The social production of substance abuse and HIV/HCV risk: an exploratory study of opioid-using immigrants from the former Soviet Union living in New York City

Substance Abuse Treatment, Prevention, and Policy

Sal Florio²  Lisa A Marsch³  Sarah K Moore¹  Honoria Guarino¹ 

[1] Center for Technology and Health, National Development and Research Institutes, Inc., 71 W. 23rd St., 8th Fl., New York, NY, 10010, USA;Department of Behavioral Health, Chemical Dependency Services, Coney Island Hospital, 2201 Neptune Ave., Brooklyn, NY, 11224, USA;Center for Technology and Behavioral Health, Dartmouth Psychiatric Research Center, Department of Psychiatry, Dartmouth College, Rivermill Commercial Center, 85 Mechanic St., Ste. B4-1, Lebanon, NH 03766, USA

关键词: qualitative methods;    HCV risk;    HIV risk;    injection drug use;    opioid use;    Former Soviet Union immigrants;   

Others  :  834543
DOI  :  10.1186/1747-597X-7-2

 received in 2011-06-10, accepted in 2012-01-12,  发布年份 2012

【 摘 要 】

Background

Several former Soviet countries have witnessed the rapid emergence of major epidemics of injection drug use (IDU) and associated HIV/HCV, suggesting that immigrants from the former Soviet Union (FSU) may be at heightened risk for similar problems. This exploratory study examines substance use patterns among the understudied population of opioid-using FSU immigrants in the U.S., as well as social contextual factors that may increase these immigrants' susceptibility to opioid abuse and HIV/HCV infection.

Methods

In-depth interviews were conducted with 10 FSU immigrants living in New York City who initiated opioid use in adolescence or young adulthood, and with 6 drug treatment providers working with this population. Informed by a grounded theory approach, interview transcripts were inductively coded and analyzed to identify key themes.

Results

The "trauma" of the immigration/acculturation experience was emphasized by participants as playing a critical role in motivating opioid use. Interview data suggest that substance use patterns formed in the high-risk environment of the FSU may persist as behavioral norms within New York City FSU immigrant communities - including a predilection for heroin use among youth, a high prevalence of injection, and a tolerance for syringe sharing within substance-using peer networks. Multiple levels of social context may reproduce FSU immigrants' vulnerability to substance abuse and disease such as: peer-based interactional contexts in which participants typically used opioids; community workplace settings in which some participants were introduced to and obtained opioids; and cultural norms, with roots in Soviet-era social policies, stigmatizing substance abuse which may contribute to immigrants' reluctance to seek disease prevention and drug treatment services.

Conclusion

Several behavioral and contextual factors appear to increase FSU immigrants' risk for opioid abuse, IDU and infectious disease. Further research on opioid-using FSU immigrants is warranted and may help prevent increases in HIV/HCV prevalence from occurring within these communities.

【 授权许可】

   
2012 Guarino et al; licensee BioMed Central Ltd.

【 参考文献 】

• [1]U.S. Census Bureau: 2005-2009 American Community Survey 5-Year Estimates. Washington, DC; 2010.
• [2]United States Department of Homeland Security: Yearbook of Immigration Statistics: 2009. Washington, DC; 2010.
• [3]Laitin D: Identity information: the Russian-speaking nationality in the post-Soviet diaspora. European Journal of Sociology 1995, 36:281-316.
• [4]Uthmann R: Finding Stability: Post-Soviet Russian Immigrants in Portland, OR. In Master's Thesis. Washington State University, Department of History; 2005.
• [5]Hofman ET: The burden of culture? Health outcomes among immigrants from the former Soviet Union in the United States. Journal of Immigrant and Minority Health 2011. [Epub ahead of print]
• [6]Jeltova I, Fish MC, Revensen TA: Risky sexual behaviors in immigrant adolescent girls from the former Soviet Union: role of natal and host culture. Journal of School Psychology 2005, 43:3-22.
• [7]Hosler AS, Melnik TA, Spence MM: Diabetes and its related risk factors among Russian-speaking immigrants in New York State. Ethnicity & Disease 2004, 14:372-377.
• [8]Batash S, Khaykis I, Raicht RF, Bibi EJ: High prevalence of hepatitis C virus infection among immigrants from the former Soviet Union in the New York City metropolitan area: results of a community-based screening program. American Journal of Gastroenterology 2008, 103:922-927.
• [9]Hussey JM, Hallfors DD, Waller MW, Iritani BJ, Halpern CT, Bauer DJ: Sexual behavior and drug use among Asian and Latino adolescents: association with immigrant status. Journal of Immigrant Health 2007, 9:85-94.
• [10]Turner RJ, Lloyd DA, Taylor J: Stress burden, drug dependence and the nativity paradox among U.S. Hispanics. Drug and Alcohol Dependence 2006, 83:79-89.
• [11]Blake SM, Ledsky R, Goodenow C, O'Donnell L: Recency of immigration, substance use, and sexual behavior among Massachusetts adolescents. American Journal of Public Health 2001, 91:794-798.
• [12]Spunt B: The current New York City heroin scene. Substance Use and Misuse 2003, 38:1539-1549.
• [13]Hamid A, Curtis R, McCoy K, McGuire J, Conde A, Bushell W, Lindenmayer R, Brimberg K, Maia S, Abdur-Rashid S, Settembrino J: The heroin epidemic in New York City: current status and prognoses. Journal of Psychoactive Drugs 1997, 29:375-391.
• [14]Saini AN: Struggling to adjust, young Russian immigrants to U.S. turn to heroin. [http://www.worldpress.org/Americas/3028.cfm] webcite
• [15]Isralowitz R, Straussner SLA, Vogt I, Chtenguelov V: A preliminary exploration of immigrant substance abusers from the former Soviet Union living in Israel, Germany and the United States: a multinational perspective. In International Aspects of Social Work Practice in the Addictions. Edited by Straussner SLA, Harrison L. Philadelphia: The Haworth Press; 2002:119-136.
• [16]Kagan H, Shafer KC: Russian-speaking substance users in transition: new country, old problems. In Ethnocultural Factors in Substance Abuse Treatment. Edited by Straussner SLA. New York: The Guilford Press; 2001:250-271.
• [17]Isralowitz R, Sraussner SLA, Rosenblum A: Drug abuse, risk of infectious diseases and service utilization among former Soviet Union immigrants: a view from New York City. Journal of Ethnicity in Substance Abuse Treatment 2006, 5:91-96.
• [18]Isralowitz RE, Reznik A: Former Soviet Union immigrant and native-born adolescents in Israel: substance use and related problem behavior. Journal of Ethnicity in Substance Abuse Treatment 2007, 6:131-138.
• [19]Isralowitz R, Reznik A, Spear SE, Brecht ML, Rawson RA: Severity of heroin use in Israel: comparisons between native Israelis and former Soviet Union immigrants. Addiction 2007, 102:630-637.
• [20]Isralowitz R, Borkin S: Russian-speaking immigrants: factors associated with heroin use. In Drug Problems: Cross-cultural Policy and Program Development. Edited by Isralowitz R, Afifi M, Rawson R. Westport, CT: Auburn House; 2002:89-112.
• [21]Kozlov AP, Shaboltas AV, Toussova OV, Verevochkin SV, Masse BR, Perdue T, Beauchamp G, Sheldon W, Miller WC, Heimer R, Ryder RW, Hoffman IF: HIV incidence and factors associated with HIV acquisition among injection drug users in St. Petersburg, Russia. AIDS 2006, 20:901-906.
• [22]Krupitsky EM, Zvartau EE, Lioznov DA, Tsoy MV, Egorova VY, Belyaeva TV, Antonova TV, Brazhenko NA, Zagdyn ZM, Verbitskaya EV, Zorina Y, Karandashova GF, Slavina TY, Grinenko AY, Samet JH, Woody GE: Co-morbidity of infectious and addictive diseases in St. Petersburg and the Leningrad region, Russia. European Addiction Research 2006, 12:12-19.
• [23]Hamers FF, Downs AM: HIV in central and eastern Europe. The Lancet 2003, 361:1035-1044.
• [24]Kelly JA, Amirkhanian YA: The newest epidemic: a review of HIV/AIDS in central and eastern Europe. International Journal of STD & AIDS 2003, 14:361-371.
• [25]Joint United Nations Programme on HIV/AIDS (UNAIDS) and World Health Organization (WHO): Global Report: UNAIDS Report on the Global AIDS Epidemic, 2010. Geneva, Switzerland; 2010.
• [26]Joint United Nations Programme on HIV/AIDS (UNAIDS) and World Health Organization (WHO): AIDS Epidemic Update: December 2009. Geneva, Switzerland; 2009.
• [27]Atlani L, Carael M, Brunet J, Frasca T, Chaika N: Social change and HIV in the former USSR: the making of a new epidemic. Social Science & Medicine 2000, 50:1547-1556.
• [28]Rhodes T, Ball A, Stimson GV, Kobyshcha Y, Fitch C, Pokrovsky V, Bezruchenko-Novachuk M, Burrows D, Renton A, Andrushchak L: HIV infection associated with drug injecting in the Newly Independent States, eastern Europe: the social and economic context of epidemics. Addiction 1999, 94:1323-1336.
• [29]Rhodes T, Sarang A, Vickerman P, Hickman M: Policy resistance to harm reduction for drug users and potential effect of change. BMJ 2010, 341:c3439.
• [30]Elovich R, Drucker E: On drug treatment and social control: Russian narcology's great leap backwards. Harm Reduction Journal 2008, 5:23. BioMed Central Full Text
• [31]Deren S, Kang SY, Colon HM, Robles RR: The Puerto Rico-New York airbridge for drug users: description and relationship to HIV risk behaviors. Journal of Urban Health 2007, 84:243-254.
• [32]Deren S, Kang SY, Colon HM, Andia JF, Robles RR, Oliver-Velez D, Finlinson A: Migration and HIV risk behaviors: Puerto Rican drug injectors in New York City and Puerto Rico. American Journal of Public Health 2003, 93:812-816.
• [33]Rhodes T: The 'risk environment': a framework for understanding and reducing drug-related harm. International Journal of Drug Policy 2002, 13:85-94.
• [34]Rhodes T, Singer M, Bourgois P, Friedman SM, Strathdee SA: The social structural production of HIV risk among injecting drug users. Social Science & Medicine 2005, 61:1026-1044.
• [35]Rhodes T: Risk theory in epidemic times: sex, drugs and the social organization of 'risk behaviour'. Sociology of Health & Illness 1997, 19:208-227.
• [36]Charmaz K: Grounded theory in the 21st century: applications for advancing social justice studies. In The Sage Handbook of Qualitative Research. 3rd edition. Edited by Denzin NK, Lincoln YS. Thousand Oaks, CA: Sage; 2005:507-536.
• [37]Creswell JW: Qualitative Inquiry and Research Design: Choosing among Five Approaches, Second Edition. Thousand Oaks, CA: Sage; 2007.
• [38]Charmaz K: Constructing Grounded Theory: A Practical Guide through Qualitative Analysis. London: Sage; 2006.
• [39]Glaser BG, Strauss AL: The Discovery of Grounded Theory: Strategies for Qualitative Research. New Brunswick, NJ: Aldine Transaction; 1967.
• [40]Patton MQ: Qualitative Research and Evaluation Methods. 3rd edition. Thousand Oaks, CA: Sage; 2001.
• [41]Johnston LD, O'Malley PM, Bachman JG, Schulenberg JE: Monitoring the Future National Results on Adolescent Drug Use: Overview of Key Findings, 2009. Bethesda, MD: National Institute on Drug Abuse; 2010. (NIH Publication No. 10-7583)
• [42]Small W, Fast D, Krusi A, Wood E, Kerr T: Social influences upon injection initiation among street-involved youth in Vancouver, Canada: a qualitative study. Substance Abuse Treatment, Prevention, and Policy 2009, 4:8. BioMed Central Full Text
• [43]Harocopos A, Goldsamt LA, Kobrak P, Jost JJ, Clatts MC: New injectors and the social context of injection initiation. International Journal of Drug Policy 2009, 20:317-323.
• [44]Goldsamt LA, Harocopos A, Kobrak P, Jost JJ, Clatts MC: Circumstances, pedagogy and rationales for injection initiation among new drug injectors. Journal of Community Health 2010, 35:258-267.
• [45]Mateu-Gelabert P, Sandoval M, Meylakhs P, Wendel T, Friedman SR: Strategies to avoid opiate withdrawal: implications for HCV and HIV risks. International Journal of Drug Policy 2010, 21:179-185.
• [46]Dehne KL, Khodakevich L, Hamers FF, Schwartlander B: The HIV/AIDS epidemic in eastern Europe: recent patterns and trends and their implications for policy-making. AIDS 1999, 13:741-749.
• [47]Isralowitz RE: Toward an understanding of Russian speaking heroin addicts and drug treatment services in Israel. Journal of Social Work Practice in the Addictions 2001, 1:331-44.
• [48]Gandhi DH, Kavanagh GJ, Jaffe JH: Young heroin users in Baltimore: a qualitative study. The American Journal of Drug and Alcohol Abuse 2006, 32:177-188.
• [49]Simmons J, Singer M: I love you... and heroin: care and collusion among drug-using couples. Substance Abuse Treatment, Prevention, and Policy 2006, 1:7. BioMed Central Full Text
• [50]Perry PD, Hedges TL: Adolescent and young adult heroin and non heroin users: a quantitative and qualitative study of experiences in a therapeutic community. Journal of Psychoactive Drugs 2004, 36:75-84.
• [51]Rhodes T, Platt L, Maximova S, Koshkina E, Latishevskaya N, Hickman M, Renton A, Bobrova N, McDonald T, Parry JV: Prevalence of HIV, hepatitis C and syphilis among injecting drug users in Russia: a multi-city study. Addiction 2006, 101:252-266.
• [52]Rivara FP, Park MJ, Irwin CE Jr: Trends in adolescent and young adult morbidity and mortality. In Adolescent Health: Understanding and Preventing Risk Behaviors. Edited by DiClemente RJ, Santelli JS, Crosby RA. San Francisco: John Wiley & Sons; 2009:7-29.
• [53]Latkin CA, Donnell D, Metzger D, Sherman S, Aramrattna A, Davis-Vogel A, Minh V, Gandham S, Vongchak T, Perdue T, Celentano DD: The efficacy of a network intervention to reduce HIV risk behaviors among drug users and risk partners in Chiang Mai, Thailand and Philadelphia, USA. Social Science & Medicine 2009, 68:740-798.