Assessing Spirituality in Addiction Treatment and Follow-Up

In this article, the authors present a brief review of the literature on the program of Alcoholics Anonymous with particular emphasis on data pertinent to how individuals "work the program." The authors describe the development of the Brown-Peterson Recovery Progress Inventory (B-PRPI) and present data on the demographic characteristics and "spiritual practices" of 93 successfully recovering members of twelve step groups. The authors present preliminary data supporting the validity and internal reliability of the B-PRPI and offer suggestions for its use in alcoholism, drug addiction, and codependency treatment programs and research settings.     

Prevalence and Correlates of HIV-Related Risk Behaviors Among Adolescents at Public Schools in Brasilia

This cross-sectional study examined prevalence and correlates of HIV risk behaviors among a random sample of 431 adolescents (aged 12–21 years) attending schools in the Brasilia Federal District. The results showed that 43% of the students were sexually experienced. Condoms were consistently used by 43% of the sexually active students during vaginal intercourse and by 27% during anal intercourse. About 32% and 16% of the participants reported current consumption of alcohol and illegal substances, respectively, with 17% and 4% reporting having sex under their influence. Having stable partners was the main reason for not using condoms. Other high-risk correlates included male gender, older age, having repeated a school year, alcohol consumption, sex under the influence of alcohol, heavier alcohol consumption, and illegal substance use. Access to condoms was not reported to be a problem. These data are useful for designing health education interventions in schools and for behavioral surveillance of adolescents.     

Brief report: The aging of the homeless population: Fourteen-year trends in San Francisco

BACKGROUND: Homelessness is associated with high rates of health and substance use problems. OBJECTIVE: To examine trends in the age, housing, health status, health service utilization, and drug use of the homeless population over a 14-year period. DESIGN: Serial cross-sectional. PARTICIPANTS: We studied 3,534 literally homeless adults recruited at service providers in San Francisco in 4 waves: 1990-1994, 1996-1998, 1999-2000, and 2003. MEASUREMENTS: Age, time homeless, self-reported chronic conditions, hospital and emergency department utilization, and drug and alcohol use. RESULTS: The median age of the homeless increased from 37 to 46 over the study waves, at a rate of 0.66 years per calendar year (P<.01). The median total time homeless increased from 12 to 39.5 months (P<.01). Emergency department visits, hospital admissions, and chronic health conditions increased. CONCLUSIONS: The homeless population is aging by about two thirds of a year every calendar year, consistent with trends in several other cities. It is likely that the homeless are static, aging population cohort. The aging trends suggest that chronic conditions will become increasingly prominent for homeless health services. This will present challenges to traditional approaches to screening, prevention, and treatment of chronic diseases in an aging homeless population.     

The Association of Partner Abuse with Risky Sexual Behaviors Among Women and Men with HIV/AIDS

Prior studies have found that partner abuse is related to risky sexual behavior. However, few studies have explored gender, sexual orientation, or substance use differences in this association, especially among people with HIV. We examined data from the Risk and Prevention survey from the HIV Cost and Services Utilization Study (HCSUS) sample on 726 sexually-active individuals in three gender/orientation groups (286 women, 148 heterosexual men, and 292 gay/bisexual men). The study assessed whether individuals with HIV who experienced or perpetrated abuse within a close relationship were likely to engage in unprotected intercourse with that same partner. Both abuse perpetration and victimization were significantly associated with having any unprotected intercourse. In multivariate tests, gender/orientation and substance use during sex moderated the perpetration effects. Secondary HIV prevention interventions need to take into account potentially abusive contexts in which sexual activity may occur for both men and women.     

Alcoholism and Marital Violence

In certain situations alcoholics who batter their partners become involved in alcohol treatment programs, but in other apparently similar situations, they participate in batterer treatment programs. This paper presents a comparison of men (in an ongoing relationship with a partner) enrolled in batterer programs (N = 39) or alcohol treatment programs (N = 52) on factors related to marital violence. Factors which were compared included: age, education, income, race, marital status, current level of marital stress, level of self esteem, socially desirable response bias, attitude toward marital violence, level of sex-role egalitarianism, history of childhood violence, level of violence in current relationship, and level of alcohol abuse. Very few differences between the men were found on any of the variables. The majority of men in both groups were alcoholics and used violent conflict tactics in their relationships. Implications for treatment of dually affected men are presented.     

HIV Risk Behaviors Among Homeless Injection Drug Users of Different Ethnicities

The objectives of this study were to assess the prevalence of HIV risk behaviors among homeless injection drug users (IDUs) and to determine whether these risk behaviors vary by ethnicity. A face-to-face interview was administered to 769 homeless IDUs in Portland, Oregon, from 1993 to 1996. Homeless IDUs had a high prevalence of needle sharing and sexual intercourse with casual partners, and a low prevalence of condom use. African Americans had the lowest rate of needle sharing, and Hispanics the highest. Compared to Whites, African Americans and Hispanics were both more likely to have had sex with casual partners in the last 30 days. African Americans were most likely to have used a condom with casual partners. Results indicate the need for more effective and culturally tailored interventions. Special efforts are needed to reduce needle sharing and increase condom use among Hispanic homeless IDUs, who exhibited the highest rates of risk behaviors.Correspondence should be directed to Jin T. Song, Oregon Health, Division, 800 NE Oregon St., Suite 550, Portland, Oregon 97232     

HIV Knowledge and Sexual Risk Behaviors of Street Children in Takoradi, Ghana

A pilot survey was conducted among 100 street children aged 11–19 years and data collected regarding HIV knowledge, risk behaviors, home and sexual experiences, and factors that contributed to their relocation to the street environment. Data indicated that 80% of the street children had at least minimal knowledge of HIV and 54% perceived themselves to be at risk for contracting HIV. More than three-fourths of the females, and over half of the boys reported ever having sex. There were significant differences between males and females for sexual activity, physical and sexual abuse, and prostitution, as girls were more likely to be sexually active, physically abused, and involved in prostitution.     

具有卖淫行为注射吸毒女性艾滋病危险行为调查分析

目的 比较有卖淫行为的女性注射吸毒人群、单纯的社区女性注射吸毒人群、低档场所暗娼的人口学特征和HIV感染相关的危险行为,为制定有效的干预措施提供科学依据.方法 利用2003-2005年四川省综合监测资料,以具有卖淫行为的注射吸毒女性为主要研究对象,采用监测问卷对CSW和IDU进行问卷调查. 结果2003-2005年女性注射吸毒者中有商业性行为的占37.0%～47.1%,IDU-CSW的安全套使用率较低档场所CSW安全套使用率低15%～20%.差异均有统计学意义(P<0.05).结论 HIV高危行为在具有注射吸毒和卖淫双重身份的女性人群中更具普遍性,对其开展有效的行为干预,将成为吸毒严重地区控制艾滋病传播的重要任务.     

Substance Use and HIV-Risk Behaviors Among Young Men Involved in the Criminal Justice System

Objectives: We examined the relationship between substance use and sexual HIV-risk behaviors among young men who have been incarcerated, in order to understand how HIV risks develop for this vulnerable population. Methods: A sample of 552 young men in a New York City jail was interviewed at the time of incarceration. Bivariate analyses were performed to examine demographic and sexual HIV-risk behavior differences between men with and without recent alcohol and marijuana use. Logistic regression was used to examine associations between alcohol and marijuana use and sexual HIV-risk behaviors in the 90 days prior to incarceration. Results: Respondents were predominantly Black (57%) or Latino (37%), with a mean age of 17.4 years. The most common substances used were marijuana (82%) and alcohol (65%). Alcohol use prior to incarceration was significantly associated with having three or more sexual partners in the same time period (OR = 2.40, p < .001), as well as with having unprotected sex with a long-term partner (OR = 1.72, p < .01). Marijuana use was significantly associated with having multiple sex partners (OR = 1.55, p < .01). Heavy alcohol and marijuana use did not result in an increased likelihood of sexual HIV-risk behaviors. Conclusions: High rates of substance use and unprotected sex may have unintended health consequences for incarcerated young men. Severity of substance use is not a significant predictor of risk behaviors, suggesting the importance of contextual and social factors. Results highlight the need for HIV prevention efforts for this population that take into account contextual and social factors.     

Trends and age-related characteristics of substance use in the hospitalized homeless population

We aimed to examine trends and characteristics of substance use (opioid, cocaine, marijuana, and heroin) among hospitalized homeless patients in comparison with other hospitalized patients in 3 states.This was a cross-sectional study, based on the 2007 to 2015 State Inpatient Data of Arizona, Florida, and Washington (n = 32,162,939). Use of opioid, cocaine, marijuana, heroin, respectively, was identified by the International Classification of Diseases, 9th Revision. Multi-level multivariable regressions were performed to estimate relative risk (RR) and 95% confidence intervals (CI). Dependent variables were the use of substances (opioid, cocaine, marijuana, and heroin), respectively. The main independent variable was homeless status. The subgroup analysis by age group was also conducted.Homeless patients were associated with more use of opioid (RR [CI]), 1.23 [1.20–1.26], cocaine 2.55 [2.50–2.60], marijuana 1.43 [1.40–1.46], and heroin 1.57 [1.29–1.91] compared to other hospitalized patients. All hospitalized patients including those who were homeless increased substance use except the use of cocaine (RR [CI]), 0.57 [0.55–0.58] for other patients and 0.60 [0.50–0.74] for homeless patients. In all age subgroups, homeless patients 60 years old or older were more likely to be hospitalized with all 4 types of substance use, especially, cocaine (RR [CI]), 6.33 [5.81–6.90] and heroin 5.86 [2.08–16.52] in comparison with other hospitalized patients.Homeless status is associated with high risks of substance use among hospitalized patients. Homeless elderly are particularly vulnerable to use of hard drugs including cocaine and heroin during the opioid epidemics.     

Characteristics of Treatment Completers versus Treatment Noncompleters in a Targeted Capacity Expansion and HIV/AIDS Education Program for Adolescents with Substance Use Disorders

This study examines and presents outcome analyses of characteristics of treatment completers versus treatment noncompleters in a Targeted Capacity Expansion (TCE) and HIV/AIDS Education Program for adolescents with substance use disorders, using a two-group nonrandomized design. The treatment completion rate was 47%, exceeding the national average of 40% for outpatient clients. These results suggest the importance of utilizing comprehensive assessments, providing linkages to assertive continuing care, and developing curricula to meet cultural, developmental, and gender-specific needs of adolescent clients. The TCE and HIV/AIDS Education Program appears to be an effective program for reducing and eliminating substance abuse among adolescents.     

Isolating the Nexus of Substance Use,Violence and Sexual Risk for HIV Infection Among Young Adults in the United States

Adults aged 18 to 29 are at significant sexual risk for HIV infection. Substance use and violence are known to be associated with sexual risk in certain groups, but few studies have examined these relationships in the general population of young adults. No studies have tested whether the contributions of substance use and violence to sexual risk are independent, and few have looked at whether drug use associations with risk are specific to certain substances. Using structural modeling techniques, we examined data for 3,437 adults aged 23–24, testing for associations between three measures of sexual risk for HIV, various forms of substance use, victimization and partner violence. Alcohol use and victimization predicted high risk sex in independent samples of single and married/cohabiting adults. Marijuana use, problem drug use, and partner violence were inconsistently related to sexual risk across measures and subsamples. HIV-prevention interventions designed for young adults in the general population should target individuals who use alcohol frequently and who are victims of violence, and should address both factors, in addition to sexual risk behavior.     

Substance Use and High Risk Sexual Behaviors among Women in Psychosocial Outpatient and Methadone Maintenance Treatment Programs

Objectives: The purpose of the present study was to assess the association between substance use/diagnosis and sexual risk behaviors among women enrolled in both psychosocial outpatient (PS) and methadone maintenance (MM) treatment and involved in a HIV prevention intervention study within the National Institute for Drug Abuse Clinical Trials Network. Methods: 515 sexually active women reported on unprotected sexual occasions (USO), anal sex, sex trading, sex with drug occasions, and multiple male sex partners at the baseline assessment. Results: Within the PS sample, cocaine use diagnosis was associated with more than twice the risk of having multiple partners, trading sex for drugs, having anal sex, or having sex with drugs; alcohol or opioid use diagnosis was associated with fewer risk behaviors. Within the MM sample, cocaine use, alcohol use and opiate use diagnoses were each associated with one to two risk behaviors. Associations between sexual risk and substance using days were less frequent in both samples. Conclusions: These findings highlight the need for integration of HIV sexual prevention interventions that address the relationship between sexual risk behavior and substance use diagnoses into substance abuse treatment programs.     

HIV Risk Behaviors and Their Correlates Among HIV-Positive Adults with Serious Mental Illness

HIV risk behaviors and their correlates were examined in a sample of 154 HIV-seropositive and seriously mentally ill adults (83% male, 56% sexually active). Most sexually active participants engaged in HIV risk behavior during the past 6 months, although the rates of these behaviors were generally not higher, and in some cases were lower, than those reported in studies of otherwise comparable noninfected people. Variables significantly associated with one or more HIV risk behaviors in bivariate analyses included being female, any limitation in instrumental functioning, not having a bipolar disorder, more psychotic mental health symptoms, problem drinking, and not receiving HIV counseling. The latter three variables accounted for 22% of the variance in the total number of HIV risk behaviors. Interventions to reduce risky sexual practices may be most appropriately provided through public mental health systems, given that this is the primary setting in which seriously mentally ill adults receive formal treatment.     

Correlates of HIV Knowledge and Sexual Risk Behaviors Among Female Military Personnel

Uniformed services personnel are at an increased risk of HIV infection. We examined the HIV/AIDS knowledge and sexual risk behaviors among female military personnel to determine the correlates of HIV risk behaviors in this population. The study used a cross-sectional design to examine HIV/AIDS knowledge and sexual risk behaviors in a sample of 346 females drawn from two military cantonments in Southwestern Nigeria. Data was collected between 2006 and 2008. Using bivariate analysis and multivariate logistic regression, HIV/AIDS knowledge and sexual behaviors were described in relation to socio-demographic characteristics of the participants. Multivariate logistic regression analysis revealed that level of education and knowing someone infected with HIV/AIDS were significant (P < 0.05) predictors of HIV knowledge in this sample. HIV prevention self-efficacy was significantly (P < 0.05) predicted by annual income and race/ethnicity. Condom use attitudes were also significantly (P < 0.05) associated with number of children, annual income, and number of sexual partners. Data indicates the importance of incorporating these predictor variables into intervention designs.     

云南省某县村民艾滋病知识态度行为调查

目的 了解农村居民艾滋病知识、态度及行为,为宣传教育活动提供本底资料.方法 选择艾滋病病毒感染率较高的10个村,以15～49岁村民为调查对象,用问卷调查表收集有关艾滋病知识、态度及行为方面资料.结果 共调查448人,其中246人听说过AIDS,占54.9%.在听说过的人中,96.3%认为AIDS是可怕的疾病,72.8%认为自己不会感染HIV.三种传播途径的正确回答率为79.9%～88.2%.40.8%未婚者有婚前性行为.35.9%回答避孕套既可避孕又可预防HIV.仅8.9%使用过避孕套,其中82.4%使用的目的是避孕而非防病.不使用避孕套的主要原因是采用其它避孕措施及未想过和不知道使用.如果提供避孕套,仅24.9%的人愿意使用.结论 村民对艾滋病的认识比较低,应尽快加强预防艾滋病宣传教育和推广避孕套工作,以预防艾滋病从注射毒品人群向一般人群传播.     

Writing About Risk: Use of Daily Diaries in Understanding Drug-User Risk Behaviors

As part of a larger syringe access and HIV risk study, a subsample of 23 current injection drug users completed daily diaries, highlighting activities related to syringe acquisition, use, and discard. Diaries have been previously utilized in a variety of psychological, public health, and nutrition studies to assess risk as well as correlated behaviors. We piloted the diary methodology in three northeastern U.S. cities (Hartford and New Haven, CT, and Springfield, MA) to learn about correlates of HIV risk. We discovered that the method provided advantages over several other qualitative and ethnographic methods. Results indicate that daily diaries elucidated (1) patterns of injection drug use, (2) sporadic and high-risk events, (3) HIV and hepatitis risk related to the syringe life cycle, and (4) emotional correlates of drug use. Furthermore, we witnessed an unexpected intervention effect that the diary may have in the lives of drug users.     

Age at Sexual Initiation and Sexual and Health Risk Behaviors Among Jamaican Adolescents and Young Adults

Current policies limit access to sexual and reproductive health services for adolescents younger than 16 years in Jamaica. Using data from a national survey, we explored the relationship between age at sexual initiation and subsequent sexual risk behaviors in a random sample of 837 Jamaican adolescents and young adults aged 15–24 years. In the sample overall, 21.0% had not yet had sex. Among the 661 sexually active participants, the mean age at first sex was 14.7 years. High percentages of sexually active youth reported engaging in risk behaviors such as inconsistent condom use (58.8%), multiple sex partners (44.5%), and transactional sex (43.0%). Age of sexual initiation for males was unrelated to subsequent sexual risk behaviors. However, earlier sexual debut for females was associated with their number of partners during the preceding year. Findings underscore the potential benefits of access to sexual and reproductive education and services at earlier ages than current policies allow. Interventions before and during the period of sexual debut may reduce sexual risk for Jamaican adolescents and young adults.