Cost of Outreach for HIV Prevention Among Drug Users and Youth at Risk

SUMMARY

Economic evaluation has become an increasingly important component in determining the effectiveness of HIV prevention programs. One type of intervention that governmental and nongovernmental organizations have supported to prevent the spread of HIV is outreach. We conducted a cost analysis at eight sites that provide outreach services to two populations at high risk for HIV infection: injection drug users and street youth. We assessed the potential benefit of HIV prevention through outreach services by comparing outreach costs with the medical costs of treating an HIV infected individual.

The average cost of outreach services was $13.30 per contact. The cost per contact for services to street youth was 78% higher than for drug users. Comparing the cost per contact with HIV treatment costs, if only two in 10,000 contacts reduce their high-risk behavior so as to avoid transmission of HIV, outreach would yield a net benefit. These results provide evidence that outreach programs compare favorably to other HIV prevention strategies in terms of cost.     

AIDS Prevention with Drug Users:

This article provides an overview of AIDS prevention with intravenous drug users. It is vital to prevent the spread of HIV among intravenous drug users and to slow the spread from them to their sexual partners and future progeny. The conceptual models of health psychology can help planners to understand the background and design the interventions that are needed, but these models do not fit perfectly to the problems associated with AIDS. The developemnt of one line of AIDS prevention research is described, involving group and individual education of intravenous drug abusers and their sexual partners. The problem of AIDS among drug abusers provides an opportunity for health psychologists to apply their craft to an area of national importance.     

Values and Identity: The Meaning of Work for Injection Drug Users Involved in Volunteer HIV Prevention Outreach

Most HIV behavioral interventions provide participants with preventive information emphasizing how not to behave, and have neglected to provide attractive and feasible alternatives to risky behavior. Interventions that emphasize cultural strengths may have more powerful effects and may help remove the stigma of HIV, which has hampered prevention efforts among African American communities. Starting in 1997, the SHIELD (Self-Help in Eliminating Life-Threatening Diseases) intervention trained injection drug users (N = 250) to conduct risk reduction outreach education among their peers. Many participants saw their outreach as “work,” which gave them a sense of meaning and purpose and motivated them to make other positive changes in their lives.     

静脉吸毒人群前瞻性队列研究2年随访HIV血清抗体保持率分析

目的:了解静脉吸毒人群前瞻性队列研究2年随访的HIV血清抗体阳转率和保持率情况。方法:于2002年11月,在四川省西昌市从社区招募了HIV血清抗体阴性的静脉吸毒人群前瞻性研究队列333人,队列每6个月随访1次和采集血样进行HIV抗体检测,以及分析队列本底的静脉吸毒人群社会人口学和HIV高危行为特征与队列保持率的关系。结果:静脉吸毒人群队列研究2年随访的HIV血清抗体阳转率为2.53/100人年(95%CI,1.10-3.97)和保持率为75.7%(252/333)。在多因素logistic回归模型分析中,与队列保持率的关系有统计学意义的变量为:彝族(OR,0.52;95%CI,0.29-0.91)、6个月回访(OR,4.72;95%CI,2.69-8.28)、和近3个月静脉吸毒频率高(OR,2.06;95%CI,1.12-3.80)。结论:本研究队列静脉吸毒人群HIV血清抗体阳转率较高和彝族静脉吸毒人群队列保持率低。     

An Office-Based AIDS Prevention Program for High Risk Drug Users

SUMMARY

There is an urgent need to develop effective AIDS prevention programs to assist high-risk individuals to change their behavior. This article describes an office-based intervention program for out-of-treatment injection drug users (IDUs) and crack cocaine users recruited from street settings in a major urban area. The relationships of program elements to key aspects of the Health Belief Model and Social Learning Theory are discussed, as are operational considerations of working with this population in a non-treatment setting.     

Using Goal-Oriented Counseling; and Peer Support to Reduce HIV/AIDS Risk Among Drug Users Not in Treatment

SUMMARY

A six-month HIV/AIDS risk intervention program for injection drug and crack users not in treatment is described, incorporating behavioral contracting, social support, and social modeling as core elements. The program utilizes goal-oriented behavioral counseling and HIV testing in conjunction with social support by peers and project outreach workers to facilitate personal change by drug-using participants. The intervention incorporates both group workshops and individual counseling sessions plus monthly social events for participants, supportive peers, and project staff. Local drug users who have successfully reduced their own risk of HIV/AIDS are utilized as positive role models for risk reduction. In addition, outreach workers maintain structured supportive contacts with program participants on a scheduled basis. The efficacy of this enhanced intervention program in comparison with standard HIV testing and AIDS education is currently being evaluated in a follow-up study.     

Targeting HIV Prevention on African American Crack and Injection Drug Users

The use of drugs in the African American community, particularly crack cocaine, has been linked to sexual risk-taking behavior, which increases the likelihood that persons will become infected with Human Immuno Virus. In order to more fully understand risk-taking behavior and to target interventions among African American men and women, this study used data collected from 1277 individuals residing in Lexington and Louisville, Kentucky, who were recruited into National Institute on Drug Abuse (NIDA) Cooperative Agreement Project from 1993 to 1998. The study compared African Americans treated for Sexually transmitted diseases (STDs) (n = 292) with African Americans who reported never being treated for a STD (n = 504) with regard to HIV information, awareness, and the number of HIV tests between those with and without STD exposure. Additionally, we examine gender differences among African Americans who have and have not been exposed to STDs on risk behaviors and HIV knowledge, awareness, and testing. It was hypothesized that African American drug users in the STD group would engage in more risk behaviors than those who reported no STDs. Results indicated that individuals in both groups, the STD exposure group and the no STD group, engaged in similar HIV-risky behaviors. However, the STD group used a greater number of different drugs in their lifetime. The STD group reported they were more likely to get HIV and were more frequently tested for HIV. Females with an STD history were more likely to have been in drug user treatment and to perceive themselves as homeless. Both males and females in the STD group were more likely to report involvement in exchanging sex.     

Potential Use of Mass Media to Reach Urban Intravenous Drug Users with AIDS Prevention Messages

To access the potential of using the mass media to reach urban intravenous drug users (IVDUs) with AIDS prevention messages, we: 1) questioned 353 participants in a Baltimore IVDU cohort study on their media use and sources of AIDS information, 2) analyzed data on Baltimore AIDS public service announcement (PSA) airings during a 3-month period, and 3) discussed with media executives their willingness to air a variety of potential AIDS messages. Forty-seven percent of all respondents reported that they learned the most about AIDS from television. Participants watched television a median of 28 hours/week; 52% of IVDUs listened to radio 12 hours/week. Eight hundred eleven AIDS television PSAs were aired; 37% of PSAs were placed on news programs; 53% of respondents watched news programs. Acceptability of hypothetical prevention messages (e.g., on sexual abstinence, condom use, or safer drug use practices) varied with media reach (national vs local) and type (television vs radio). We conclude that media could reach IVDUs with AIDS prevention messages. Television could be used to direct IVDUs to local prevention programs and provide safe/safer sex messages. Explicit and detailed AIDS prevention messages would be acceptable to some local radio stations     

我国的药物滥用与艾滋病现状

我国的毒品问题严峻 ,与此同时 ,近年艾滋病(AIDS)的流行已进入快速增长期。艾滋病监测表明[1] ,目前全国 31个省、区、市均报告发现艾滋病病毒 (HIV)感染者。在毒品问题严重地区 ,HIV传播势头迅猛。据卫生部报告 ,我国自 1985年发现首例艾滋病病人至 2 0 0 2年底 ,感染HIV的人数已接近 10 0万。如果不采取有效措施 ,到 2 0 10年 ,中国的HIV AIDS将达到 10 0 0万 ![2 ]本文就近年来我国药物滥用和艾滋病状况做一文献综述。1药物滥用问题现状1 1药物滥用人数持续增长1 2新型毒品越来越多在我国 ,滥用毒品的种类主要是阿片类 ,其中以…     

Evaluation of an AIDS Education Model for Women Drug Users in Jail

This paper reports outcome evaluation results of an AIDS education program for drug-using women in jail, of whom the majority were current drug injectors, had high-risk sexual partners, and never used condoms for insertive sex. The women participated in four small-group health/HIV education sessions. Education participants and controls were followed-up 7 months after their release from jail; the two groups did not differ significantly on drug- or sex-related HIV risk behaviors at follow-up. However, being in drug dependency treatment (primarily methadone maintenance) at follow-up was associated with reduced heroin use, crack use, drug dealing, and criminal activity. Although improved HIV education in jail is important, better networks of community resources, including more accessible community drug dependency treatment, also must be developed to support drug-dependent women after their release from jail.     

Agents of Change: Peer Mentorship as HIV Prevention Among HIV-Positive Injection Drug Users

This paper presents a qualitative investigation of peer mentoring among HIV seropositive injection drug users in a randomized controlled trial, the INSPIRE study. Qualitative analyses of 68 in-depth open-ended interviews conducted in 2005 in Baltimore, New York, Miami, and San Francisco revealed that these individuals conceptualized themselves as change agents through the identity of peer mentor at the three related domains of individual, interpersonal, and community-level change. Implications for program development and future research of peer mentoring as a mechanism for HIV prevention are discussed. This study was funded by the Centers for Disease Control and Prevention and Health Resources and Services Administration (HRSA).     

Disparities in Community Readiness for HIV/AIDS Prevention

HIV and AIDS as a community issue have not been dealt with extensively in the literature. One model that offers promise for development of effective prevention and intervention efforts is the Community Readiness Model, a nine-stage model that assesses the level of readiness of a community to develop and implement prevention programming. Data are presented from a Community Readiness assessment of 30 rural U.S. communities: 10 African American, 10 Mexican American, and 10 White non-Mexican American. Four to five key respondent interviews were conducted via telephone in each community using the Community Readiness Assessment protocol during 1999–2000. Limitations of the study and implications for prevention are discussed. This study was funded by the National Institute on Drug Abuse.     

HIV/AIDS Education for Drug and Alcohol Treatment

No abstract available for this article.     

HIV Incidence,Retention, and Changes of High-Risk Behaviors Among Rural Injection Drug Users in Guangxi,China

Abstract

Background: A prospective observational study of HIV seroincidence among high-risk injection drug users (IDU) was carried out in Guangxi, China. The primary objectives of this study were (1) to estimate HIV seroincidence, (2) to estimate participant retention rate, and (3) to evaluate changes in drug use and sexual behavior over a one year period.

Methods: Five hundred HIV seronegative IDU were enrolled. HIV-1 incidence and retention rates were analyzed as a function of sociodemographic, behavioral, and recruitment variables. Changes in drug use and sexual behavior were analyzed at the baseline, 6-monfh and 12-monfh follow-up visits.

Results: At 12 months of follow-up, the HIV-1 incidence rate was 3.1 per 100 person years, [95% CI: (1.6%; 5.2%)] and participant retention rate was 87%. Reported changes in high-risk behaviors over 12-monfhs included significant decreases in the frequency of heroin injection, in direct or indirect sharing of injection equipment, and in the number of sexual partners.

Conclusions: HIV incidence is high among IDU in Guangxi, China despite a self-reported decrease in some high risk behaviors over the course of the Study.     

国家禁毒办和中英性病艾滋病防治合作项目联合举办“禁吸戒毒和艾滋病防治”研讨会

2005年7月26日至28日,国家禁毒办与中英性病艾滋病防治合作项目办联合在云南省禁毒教育科研基地举办了"禁吸戒毒和艾滋病防治"研讨会.本次研讨会的主题是研究禁吸戒毒与艾滋病防治政策的衔接.来自全国各省(自治区、直辖市)公安厅(局)禁毒部门分管禁吸戒毒工作的领导和监管部门分管强制戒毒工作的领导,以及全国部分一级强制戒毒所的所长共计90余人参加了研讨会.国家禁毒办、卫生部疾控司、卫生部艾滋病预防与控制中心和云南省公安厅有关领导到会致辞.     

AIDS Beliefs and Behaviors among Intravenous Drug Users in Bangkok

Prompted by an explosive epidemic of HIV-1 in early 1988 among Thai IVDUs under treatment for heroin use, a series of focus group discussions were conducted at six Bangkok detoxification clinics. In developing qualitative information on knowledge of and attitudes toward AIDS, and on drug use and sexual behavior, our objectives were to identify intervention measures, develop culturally-appropriate educational material, strengthen counseling, and sharpen the focus of needed quantitative research. An abundant store of diverse anecdotal responses and reactions emerged. We discuss the reliability and the policy and research implications of these findings.     

Factors Associated with Recent-Onset Injection Drug Use among Drug Users in Pakistan

Seventy-two recent-onset injection drug users and 241 non-injection drug users were recruited in Quetta and Lahore, Pakistan, in 2003. Trained interviewers administered questionnaires regarding drug use behaviors and perceived changes in drug cost/supply. Logistic regression identified independent correlates of recent-onset injection. In Lahore, a perceived increase in drug cost was associated with higher odds of recent-onset injection, with no association in Quetta. Recent-onset injection was also associated with family history of drug use, group drug use, and sharing snorting/chasing tools. Changes in perception of the drug supply may be associated with recent-onset injection drug use. Familial/social influences were also associated with recent-onset injection, suggesting peer-led interventions could discourage transition to injection drug use.