Variables influencing condom use among intravenous drug users.

Correlates of condom use were identified using cross-sectional data from a convenience sample of 211 sexually active intravenous drug users enrolled in methadone maintenance in New York City. Sixty-eight percent did not use condoms at all in the previous month and only 11 percent used condoms every time. Nineteen percent were planning on conception, only 20 percent of whom had been tested for human immunodeficiency virus (HIV) antibody (all seronegative). Multiple logistic regression analysis indicated that condom use was independently associated with greater personal acceptance of condoms, greater partner receptivity to sexual protection, and recent entry to methadone treatment.     

广州市吸毒者安全套使用现状及其影响因素的调查分析

目的　了解广州市吸毒者安全套使用现状及其影响因素。方法　采用横断面调查方法 ,于 2 0 0 4年在广州市某戒毒所随机整群抽取部分戒毒者进行面对面问卷调查 ,并对调查结果进行统计分析。结果　共调查 373名吸毒者 ,承认进入戒毒所前 3个月内有发生性行为者 2 77人 ,占74 2 6 %。吸毒者中 ,以性换钱 /毒品时每次都使用安全套的占 75 0 0 % (18/ 2 4 ) ,而以钱 /毒品换性时每次都使用安全套的仅占 34 4 8% (10 / 2 9) ,与一般熟悉的朋友发生性行为时每次都使用安全套的占2 1 4 3% (9/ 4 2 ) ,与配偶或固定的男 /女朋友发生性行为时每次都使用安全套的占 10 91% (2 4 / 2 2 0 ) ,与不同性伴发生性行为时安全套使用率差异有显著性 (P <0 0 1)。吸毒者 (15 1名应答者 )使用安全套的原因 ,5 0 99%担心自己被传染性病 ,4 9 0 1%为了避孕 ;自己提出要用的占 4 6 36 % ,伴侣提出的占2 7 15 %。吸毒者 (2 12名应答者 )不使用安全套的主要原因 ,包括觉得没必要 (占 5 1 4 2 % )、没想到要用 (占 2 0 2 8% )、没有快感 (占 19 81% )、不方便买到 (占 4 72 % )和伴侣反对 (占 3 78% ) ,其中由于性伴反对而未能使用安全套的女性占 11 4 8% ,多于男性 (0 0 5 % ) (P <0 0 1)。在发生商业性性行为时 ,男性吸     

Correlates of needle sharing among injection drug users.

OBJECTIVES. The sharing of contaminated injection equipment is the primary mode of human immunodeficiency virus (HIV) transmission for injection drug users. This study examined demographic factors, life events, and drug use practices that are potential risk factors for sharing injection equipment. METHODS. Between February 1988 and March 1989, 2921 active injection drug users were interviewed and questioned about their backgrounds, life-styles, and patterns of injection drug use. RESULTS. Of 2524 participants who reported injecting drugs within the 6 months prior to study enrollment, 70.4% reported recent needle sharing. A multivariate analysis found needle sharing to be more frequent among those with a history of arrest and lower socioeconomic status, even after accounting for other demographic and drug use variables. In addition, recent needle sharing was higher in male homosexual or bisexual men than in their heterosexual counterparts. CONCLUSIONS. These data suggest that injection drug users have an economic motive to share needles and that the availability of free and legal needles may reduce levels of needle sharing.     

The why,when and whether of condom use among female and male drug users

Eight focus groups consisting of all male, all female and mixed male and female drug users were conducted to gain an indepth understanding of beliefs and behavior regarding the use of family planning services and contraceptives, particularly condom use in an effort to reduce the perinatal transmission of HIV. While participants often supported the use of condoms because of STDs and AIDS, their unplanned pregnancies and STD histories indicated inconsistent use, depending on the partner and the circumstances. The vast majority of both men and women did not like to use condoms because it interfered with the spontaneity and pleasure of sexual relations, though women seemed more willing to use condoms than their partners.Participants varied in their knowledge about the benefits of using a condom, in how and when to put it on, in the associations they made between condom use and trust and commitment, in the type of partner and conditions under which they would use condoms and in their willingness to consider condom use as an integral part of their lives.Issues of trust, commitment and condom use did not seem to have been resolved in the drug using community, particularly among younger people who appeared to have more difficulty in negotiating condom use. Promoting the use of condoms needs to be considered as part of a larger, multifaceted behavior change effort.Regina H. Kenen is Professor of Sociology, Trenton State College, Trenton, N.J. Kay Armstrong is Director of Research, Family Planning Council of Southeastern Pennsylvania.This three year project #U62/CCU306165-01 is funded by the Centers for Disease Control, Division of Prevention Services, to the Family Planning Council of Southeastern Pennsylvania and the City of Philadelphia's Coordinating Office of Drug and Alcohol Abuse Programs.     

Bacterial infections and skin cleaning prior to injection among intravenous drug users.

In a survey of 1,057 active intravenous drug users in Baltimore, MD, who were recruited through extensive community outreach, 12 reported endocarditis and 113 reported subcutaneous abscesses in the 6 months before being interviewed. Of all the persons surveyed, 556 reported cleaning their skin prior to injection at any time and 173 reported cleaning their skin all the time in the 6 months before the interview. The frequency of subcutaneous abscesses was lower among those who reported skin cleaning all the time; a similar trend was noted for frequency of endocarditis. The relatively simple procedure of encouraging intravenous drug users to clean their skin prior to injection will not eliminate but might reduce the frequency of these serious and expensive infectious complications of intravenous drug use.     

Determinants of condom use among intravenous drug users in Spain

Attitudes to and perception of health care delivery are consideredto be important factors for patient compliance in diabetes.To Investigate insulin-treated diabetic patients' use of, experienceof and attitudes to diabetes care a questionnaire was sent to561 patients, 20–50 years old, living in northern Sweden.Four hundred and eighty-eight patients (87%) participated inthe study. Data were analysed against social, medical and geographicalbackground factors. Female patients more often than men hadseen an ophthalmologist (93 versus 87%, p<0.05), a diabetesnurse specialist (74 versus 64%, p<0.05) and a chiropodist(49 versus 30%, p<0.001) at least once during the courseof their diabetes. Women also used the services of a medicalsocial worker (17 versus 10%, p-0.05) or a psychologist (14versus 8%, p<0.01) more often. More men than women were satisfiedwith the health care they had at the onset (65 versus 38%, p<0.001),but no gender difference in attitude to their present care wasfound. Diabetic patients with chronic complications comparedto those without were less satisfied both with the care theyreceived at the onset of diabetes (40 versus 61%, p<0.001)and at the time they answered the questionnaire (59 versus 72%,p<0.01). Patients in the most sparsely populated health districtwere more seldom able to be seen by the same physician (70 versus93% and 94%, p<0.001) and patient-physician continuity waspoorer over a 3 year period (48 versus 80%, p<0.001). Basedon results of this study, we conclude that use of, experienceof and attitudes to diabetes care are primarily related to genderand sickness factors. Living in sparsely populated areas probablyaffects the use and continuity of hearth care depending on themeans available. The differences demonstrated might be an argumentfor planning more individualized care for diabetic patientsin the future.     

暗娼与性伴之间安全套协商使用情况分析

目的 了解暗娼与嫖客或固定性伴之间安全套协商和使用情况，为暗娼的艾滋病综合干预措施的制定提供参考依据。方法 采用横断面调查，于2018年4－6月在云南省红河哈尼族彝族自治州蒙自市、建水县，依托娱乐服务场所招募≥16岁暗娼，估算样本量需476人，问卷调查收集其人口学特征、安全套协商及使用情况信息。采用logistic回归模型分析暗娼与不愿使用安全套的嫖客协商后安全套使用的影响因素。结果 共调查暗娼852人，年龄（24.29±8.44）岁。最近1个月性行为，有58.6%（499/852）的暗娼每次都要求嫖客使用安全套但嫖客不愿使用，协商后有88.4%（441/499）的暗娼每次与嫖客都使用安全套。有14.4%（99/687）的暗娼每次都要求固定性伴使用安全套，但固定性伴不愿使用，经协商后，54.5%（54/99）暗娼与固定性伴每次都使用安全套。最近1个月，暗娼说服不愿使用安全套的嫖客时，53.3%（266/499）的采用“强制要求”策略，19.4%（97/499）的采用“风险说服”策略，23.1%（115/499）的采用“强制要求及风险说服”策略，4.2%（21/499）的采用其他策略协商。4.4%（22/499）的暗娼感觉说服嫖客使用安全套困难。多因素logistic回归分析结果显示，和感觉说服嫖客使用安全套困难的暗娼相比，难度适中（OR=4.00，95% CI：1.55～10.32）、容易（OR=30.17，95% CI：3.22～282.44）的暗娼更容易成功协商嫖客每次都使用安全套。和采用其他策略与嫖客协商使用安全套的暗娼相比，采用“强制要求”策略者（OR=4.44，95% CI：1.41～14.01）、采用“强制要求及风险说服”策略者（OR=5.52，95% CI：1.55～19.73）更容易成功协商嫖客每次都使用安全套。结论 通过安全套协商策略，可促使不愿使用安全套的嫖客使用安全套。采用“强制要求”策略更容易成功协商嫖客每次都使用安全套，结合“风险说服”策略更有利于成功协商。     

Relative power between sexual partners and condom use among adolescents.

PURPOSE: To examine how the relative power of adolescent sexual partners in the domain of emotional intimacy is related to condom use. METHODS: Interviewed 228 adolescents who visited an STD clinic in San Francisco. Adolescents were aged 14-19 years, 69% were female, and they were ethnically diverse. We developed a measure of relative power in the domain of emotional intimacy, by adapting five items from existing measures and developing three items ourselves. The partner who had less desire for emotional intimacy was considered to have more power in that domain. We also measured relative decision-making power. Data were analyzed using logistic regression and Student's t-tests. RESULTS: Adolescents who had more power than their partners in the domain of emotional intimacy were more likely to get their way about condom use than adolescents who had less power in this domain. Decision-making power was not related to whether adolescents got their way about condom use. Young men reported greater emotional intimacy power and greater decision-making power than young women. However, gender was not related to getting one's way about condom use. CONCLUSIONS: The results suggest the importance of assessing relative power in the sexual relationships of adolescents when predicting condom use.     

Determinants of condom use among French heterosexuals with multiple partners.

In September 1988, a sample of French individuals between 18 and 49 years of age, who reported more than one sexual partner in the past six months and who considered themselves heterosexuals (n = 1088), were interviewed at home about risk perception of human immunodeficiency virus (HIV) transmission, sexual behavior, and condom use. Systematic or occasional use of condoms during the previous 12 months was reported by 46.9 percent of respondents. Among condom users, 38.7 percent declared they had never used condoms before the last 12 months, fear of acquired immunodeficiency syndrome (AIDS) rather than contraception being the main motivation of these recent users. Multivariate analysis indicates that voluntary testing for HIV, average or more than average fear of sexually transmitted diseases (STDs), and knowledge of HIV carrier in personal relations are associated with condom use.     

Response to overdose among injection drug users

BACKGROUND: Drug overdose is a leading cause of mortality among illicit drug users. This study characterizes responses to overdose among injection drug users (IDUs) in Baltimore, Maryland, and identifies factors associated with medically inappropriate response. METHODS: A cross-sectional survey was administered to 924 IDUs in an ongoing cohort study between August 2003 and September 2004. Self-reported experiences of witnessing overdose were obtained by structured interview. Multiple logistic regression identified associations between overdose information sources and medically inappropriate responses. RESULTS: Most IDUs (69.7%) reported ever witnessing an overdose. The most common responses were walking the victim around (70.8%), shaking them (64.9%), and inflicting pain (62.6%). One in four (25.8%) injected the victim with salt water. Two thirds (63.4%) called 911, but more than half delayed the call by 5 or more minutes. The most common reason cited for delaying or foregoing the 911 call was the belief that they could revive the victim themselves, followed by fear of police involvement. Most IDUs had received information on how to prevent or respond to an overdose, but most (73.2%) received this information from friends or other drug users. IDUs who got overdose information solely from lay sources were less likely to call 911 (adjusted odds ratio [AOR] = 0.66, 95% confidence interval [CI] = 0.46-0.94) and more likely to inject the victim with salt water (AOR = 2.06, 95% CI = 1.36-3.13) than IDUs who received no information at all. Injection drug users who received information from medical and social services providers only were less likely to delay the 911 call (AOR = 0.35, 95% CI = 0.22-0.72). CONCLUSIONS: Inappropriate overdose responses are widespread among IDUs in Baltimore. Interventions that provide overdose education and reduce police response to overdose events may improve witness response and reduce mortality associated with drug overdose.     

FSW和IDU艾滋病相关知识及行为调查

目的 了解广东省广州市番禺区女性性工作者(FSW)和静脉吸毒者(IDU)2类高危人群的艾滋病相关知识及行为现状,为进一步进行有针对性的行为干预提供依据。方法 在娱乐场所和监管场所按照随机抽样的方法选择407名FSW和437名IDU,由调查员对调查对象进行一对一的问卷调查,随后对2类人群的部分结果进行比较。结果 FSW、IDU人群的艾滋病知识知晓率分别为56.8%(231/407)和52.6%(230/437),差异无统计学意义;FSW人群中商业性行为未使用安全套的占19.4%(79/407),IDU人群有共用注射器吸毒行为的占27.5%(120/437);FSW和IDU人群获得艾滋病知识的途径均以电视为主,分别为85.5%(348/407)和89.5%(391/437);IDU在商业性行为时是否使用安全套的主要影响因素为年龄(OR=2.433,95% CI:1.162~5.095)。结论 FSW和IDU人群均存在感染和传播艾滋病的高风险,应采取有效措施对他们进行相关危险行为的干预。     

Determinants of needle sharing among intravenous drug users.

Data from 110 IV-drug abusing persons in methadone maintenance were analyzed to determine the correlates of needle sharing. Sharing was directly related to peer group behavior, attitudes conducive to sharing, economic motivation to share, not owning injection equipment, and fatalism about developing AIDS. Sharers were aware of their AIDS risk. Indicated measures to reduce needle sharing would be positive peer support groups to help resist pressures to share, legal and free access to fresh injection equipment, education on the utility of risk reduction, and increased treatment options for IV cocaine users.     

Consistency of condom use among low-income hormonal contraceptive users

CONTEXT: Hormonal contraceptive users may be at increased risk for HIV and other STDs. An understanding of their decisions and abilities to use condoms is needed to focus intervention programs aimed at improving their protective behaviors. METHODS: Between 1999 and 2001, 426 new users of depot medroxyprogesterone acetate (DMPA) and oral contraceptives were recruited from public clinics providing family planning services to low-income women and surveyed when they began their method and again three months later. Bivariate analyses examined the consistency of condom use across subgroups, and multivariate analyses assessed associations between consistent use and various characteristics. RESULTS: Among women who had used condoms consistently before starting on DMPA or the pill, 54% discontinued consistent use after taking these contraceptives. Overall, 20% of women consistently used condoms with their hormonal method, and such use did not vary significantly by contraceptive type. Seventy-five percent of women in non-monogamous relationships were inconsistent users, though nearly a third had been consistent users prior to beginning a hormonal method. Factors associated with an elevated likelihood of consistent use were the male partner's positive opinion of condoms (odds ratio, 3.3) and the woman's strong belief that condom use is important for vaginal intercourse (3.5) and even if the couple is using another form of birth control (4.1). CONCLUSIONS: Many women at highest risk for disease have a decreased likelihood of using condoms, and disease prevention programs should be customized to target these women. Educational efforts focusing on women's attitudes and negotiation skills may be the best means of increasing dual method use.     

Validity of self-reported needle exchange attendance among injection drug users: implications for program evaluation.

Some studies have indicated that needle exchange programs (NEPs) can be effective in reducing drug-related risks for human immunodeficiency virus (HIV) seroconversion; however, others have reported higher HIV incidence rates among NEP attendees. Since many studies rely on self-reports of NEP attendance, the authors investigated the extent to which differential misreporting of NEP attendance could bias risk estimates. Over a 3-year period from 1994 to 1997, self-reports of NEP attendance from participants in a prospective study in Baltimore, Maryland, were compared with NEP records. Of 1,315 participants, 459 (35%) had registered with the Baltimore NEP. There was 86.7% concordance between self-reported and actual NEP use; 11.0% reported NEP attendance but did not attend (overreported), and 2.2% reported not attending NEP but did attend (underreported). In multivariate analyses using generalized estimating equations, persons who overreported NEP attendance were more likely to have injected frequently (adjusted odds ratio (AOR) = 1.29, 95% confidence interval (CI): 1.04, 1.61), denied needle sharing (AOR = 0.69; 95% CI: 0.52, 0.89), and been an HIV seroconverter (AOR = 1.83, 95% CI: 1.11, 3.01). With Poisson regression to model predictors of HIV seroconversion, models that included measures of NEP attendance based on self-reports compared with actual program data underestimated a protective association by 18%. These findings have important implications for evaluations of NEPs.     

Self-efficacy estimates for drug use practices predict risk reduction among injection drug users

We used baseline outcome efficacy (OE) estimates for human immunodeficiency virus (HIV) risk reduction to predict subsequent risk reduction 6 months hence among 792 injection drug users in a prospective study. Declines in drug use, frequency of injection, and needle sharing were found among those with high OE scores after adjustment for baseline behavior and antecedent factors. No OE effect was found in multivariate analysis for shooting gallery attendance, a risk that substantially declined in this cohort. OE for needle disinfection was associated with reduced drug risk behaviors, but not for improved needle hygiene practices over time. The self-efficacy model is useful in understanding psychological factors in risk reduction among injection drug users.     

An experiential program to reduce AIDS risk among female sex partners of injection-drug users.

This article describes the development and implementation of an acquired immune deficiency syndrome (AIDS) intervention program for female sex partners of male injection-drug users. Four psychoeducational workshops were designed to motivate personal risk reduction, provide participants with necessary cognitive and behavioral skills, and enhance participants' perceived ability to enact positive changes in their lives. The development of the workshop modules was guided by traditional theories of health behavior change and social learning. Also included in the intervention are referral and advocacy services, personal risk reduction counseling, and human immunodeficiency virus (HIV) antibody testing. Preliminary results indicate that the program has made a significant impact on the AIDS risk of participants--91 percent of women who completed the program reported that they had made positive changes in their lives to reduce their risk of HIV infection.