Are Lesbian, Gay, and Bisexual People Who Inject Drugs in Rural Communities More at Risk for Hepatitis C Virus? Restricted; Files Only

Abstract

Introduction Compared to urban areas, rates of hepatitis C virus (HCV) have surged in rural United States (U.S.) areas, and this increase is driven by injection drug use (IDU) and associated risk behaviors. While little is known about lesbian, gay and bisexual (LGB) risk for HCV among people who inject drugs (PWID) in rural areas, research from urban U.S. areas suggests that LGB PWID may be more vulnerable to HCV and associated injection-related risk behaviors compared to their heterosexual counterparts. The objective of this analysis is to describe the association between sexual orientation and HCV among rural PWID.

Methods This study analyzed survey and laboratory data collected by the Rural Opioid Initiative (ROI) from 2018 to 2020. Data were collected via respondent-driven sampling among people who use drugs in rural communities. Our analytic sample was limited to those who had reported a lifetime history of injecting, had a conclusive HCV test result, and had a valid response to ROI's sexual orientation question. Logistic regression was used to analyze the relationship between sexual orientation and HCV status, adjusting for nesting within the recruitment chain.

Results Among 1422 PWID, bisexual PWID had 48% higher odds of testing positive for HCV compared to heterosexual PWID, while lesbian and gay (L/G) PWID had 55% lower odds.

Conclusions The divergent relationships to HCV status among bisexual vs. L/G PWID indicate that these two groups face differing risk and protective factors that influence their acquisition of HCV. Further research is needed to explore these differing factors, particularly the protective factors experienced by local L/G communities that may also be used to protect bisexual PWID from HCV.

Table of Contents

I. Introduction .……………………………………..……………………………………….…..1

II. Methods …………………………………………………………………………….……...….3

           Overview …………………………………………………………………….………….…3

           Sample ………………………………………………………………………….……….…3

           Measures ……………………………………………………………………….…….……4

           Analysis …………………………………………………………………………...…..…..5

           Research Ethics ………………………………………………………………...………..5

III. Results ……………………………………………………………………………….………..5

IV. Discussion …………………………………………………………………………..….…....7

           Limitations ………………………………………………………………………….….…8

           Public Health Implications …………………………………………………….………9

References ………………………………………………………………………...……………..10

Figures ……………………………………………………………………………...………..…..13

About this Master's Thesis

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School	Rollins School of Public Health
Department	Epidemiology
Subfield / Discipline	Epidemiology - MPH & MSPH
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Epidemiology Health Sciences, Public Health
Stichwort	Injection Drug Use Lesbian Gay Bisexual Rural
Committee Chair / Thesis Advisor	Cooper, Hannah, Emory University

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