Dyadic analysis of criminal justice involvement and hiv risks among couples who inject drugs and their intimate partners in almaty, kazakhstan.

BACKGROUND: Incarceration increases HIV risk behaviors and strains intimate partnerships of couples of people who inject drugs (PWID) in Kazakhstan. Studies are yet to examine dyadic relationships between criminal justice involvement and injection drug and sexual HIV risk behaviors of couples who inject drugs in Kazakhstan. This study examined associations between individual and partner level criminal justice involvement and injection drug and sexual HIV risk behaviors among 216 intimate dyads (n = 432) of PWID in Almaty, Kazakhstan. METHODS: The Actor Partner Interdependence Model (APIM) using structural equation modeling examined individual (actor), partner and dyadic patterns (actor-partner) of associations between arrest, incarceration and drug crime conviction of dyads of male and female intimate partners of PWID using baseline data from Project Renaissance, a couples-focused HIV prevention intervention for PWID and their intimate partners. RESULTS: Results from the APIM identified significant associations between lifetime (ß=0.10, CI95%=0.01.20, p=.021) and recent (ß=0.12, CI95%=0.01.26, p=.045) arrest and increased risk of injection drug use with any partner for female partners. Partner-only effects were identified in which male PWID's recent arrest was associated with an increase in their study partners' injection drug risk behaviors (ß=0.10 CI95%=0.02, 0.20, p=.044). For female partners, prior incarceration was associated with increased engagement in injection drug risk behaviors (ß=0.10 CI95% =0.02, 0.20, p=.035) with any partner. For male partners' prior incarceration was associated with injection drug risk behaviors with their study partners (ß=0.10 CI95%= 0.02, 0.20. p<.05). Female partners prior drug crime conviction was associated with their own (ß=0.14 CI95%=0.01, 0.28, p=.048) and their intimate partners' (ß=0.18, CI95%=0.03, 0.33, p=.024) engagement in injection drug risk behaviors with any injecting partner. Recent drug crime conviction (ß=0.12, CI95%=0.01, 0.24, p=.038) and arrest (ß=0.13, CI95%, p=.022) was associated with increased engagement in sexual risk behaviors among female partners. CONCLUSION: Findings from this study identified differences in how criminal justice involvement impacts sexual and injection drug and sexual risk behaviors between male and female partners of PWID. Future research must investigate how structural interventions at the dyadic level could address the negative impact of criminal justice involvement on sexual and injection drug HIV risks within the contexts of couples who are PWID.

Using regression mixture models with non-normal data: Examining an ordered polytomous approach.

Mild to moderate skew in errors can substantially impact regression mixture model results; one approach for overcoming this includes transforming the outcome into an ordered categorical variable and using a polytomous regression mixture model. This is effective for retaining differential effects in the population; however, bias in parameter estimates and model fit warrant further examination of this approach at higher levels of skew. The current study used Monte Carlo simulations; three thousand observations were drawn from each of two subpopulations differing in the effect of X on Y. Five hundred simulations were performed in each of the ten scenarios varying in levels of skew in one or both classes. Model comparison criteria supported the accurate two class model, preserving the differential effects, while parameter estimates were notably biased. The appropriate number of effects can be captured with this approach but we suggest caution when interpreting the magnitude of the effects.