Transitions in Latent Classes of Sexual Risk Behavior Among Young Injection Drug Users Following HIV Prevention Intervention

We analyzed data from a large randomized HIV/HCV prevention intervention trial with young injection drug users (IDUs). Using categorical latent variable analysis, we identified distinct classes of sexual behavior for men and women. We conducted a latent transition analysis to test the effect of the intervention on transitions from higher to lower risk classes. Men who were in a high-risk class at baseline who received the intervention were 86 % more likely to be in a low-risk class at follow-up compared to those in the control group (p = 0.025). High-risk intervention participants were significantly more likely to transition to the class characterized by unprotected sex with a main partner only, while low-risk intervention participants were significantly less likely to transition to that class. No intervention effect was detected on the sexual risk behavior of women, or of men who at baseline were having unprotected sex with a main partner only.     

Alternative Strategies for Sexual Risk Reduction Used by Active Drug Users

Recent studies continue to document lack of consistent condom use by active drug users. However, personal HIV risk reduction strategies other than, or in addition to, condom use may be practiced. In this study, data from qualitative interviews with 92 active users of crack and injection drugs illustrate risk reduction strategies employed either instead of or in addition to condom usage. Findings are based on narrative accounts of methods used to reduce personal risk of contracting HIV during sexual acts. Precoital alternative strategies focused on partner selection techniques based on the belief that safe partners can be selected. Coital strategies included the selection of specific sex acts that were presumed to be safe or safer than others or cleanliness rituals or both. Postcoital strategies included techniques such as washing sex organs with bleach or lemon juice. Implications of these findings for intervention and prevention efforts are discussed.     

Sexual Risk Behaviors among Club Drug Users in Shanghai, China: Prevalence and Correlates

We surveyed 276 club drug users in Shanghai, China. Overall, 43.8 % reported ≥2 sex partners in the past 30 days, and 48.9 % reported having sex with non-regular partners, 67.4 % of whom had unprotected sex. Having ≥2 recent sex partners was associated with being 35 years or older, male, living with friends or others, introduced to club drug use by non-regular sex partners, using methamphetamine recently, self-identified as gay/lesbian or bisexual, had sexual debut before 20 years old, and recently had sex under the influence of drugs. Having unprotected sex with non-regular partners in the past 30 days was associated with lower education levels, having sex to obtain drugs, and lower levels of HIV/AIDS knowledge. Club drug users should be targeted for intervention programs. Future research needs to identify other protective and risk factors for sexual risk behaviors and design interventions to reduce club drug use and associated sexual risk behaviors.     

Sexual Risk Behavior Among Injection Drug Users Before Widespread Availability of Highly Active Antiretroviral Therapy

HIV testing and counseling has been associated with reductions in risk behaviors in some populations. This study examined whether involvement in a long-term study, including exposure to repeated HIV testing and counseling, was associated with increased condom use among injection drug users (IDUs) through a retrospective analysis of an IDU cohort from Baltimore, MD, during 1994–1998. Eligibility included being aged 18 years or older, injecting within 10 years and not having initiated antiretroviral therapy. A logistic model of high versus low risk, based on condom use, was used. Of 322 eligible IDUs, most were male (66%) and African-American (94%). No significant change in the odds of inconsistent condom use was observed with continued study exposure. Condom use remained low, indicating a need for interventions to reduce sexual risks and HIV transmission in this population.     

Hazardous Drinking and HIV Sexual Risk Behaviors Among Injection Drug Users in Developing and Transitional Countries

Studies in North America and Western Europe have reported an association between hazardous drinking and HIV sexual risk behaviors among injection drug users (IDUs). However, we lack such studies from developing and transitional countries, where different cultural norms and contexts of drinking may change this association. We used a multi-site study using standard survey instruments and methods to examine whether hazardous drinking is associated with HIV sexual risk behaviors (defined as unprotected sex and having multiple sex partners) among IDUs in 12 cities across different developing and transitional countries. Data were collected from May 1999 to November 2003. In individual site analyses, hazardous drinking was associated with increased HIV risk behaviors in 10 cities. Mixed effects models of the multi-site data, also, showed an association of hazardous drinking and HIV sexual risk behaviors. These findings in the context of the high prevalence of drinking in many sites point to the importance of addressing alcohol use in HIV education and prevention policy for IDUs.     

Use And Assessment Of Complementary And Alternative Therapies By Intravenous Drug Users

Intravenous drug users often have many health conditions in addition to their drug addiction, yet may be isolated from conventional sources of care. They have never before been examined for their use of complementary and alternative medicine (CAM) therapies. Our purpose was to study the prevalence and predictors of CAM use among persons with a history of intravenous drug use through a cross-sectional survey of intravenous drug users examining their utilization of health services, including CAM therapies. A total of 548 persons with a history of intravenous drug use, recruited from a needle-exchange program and a methadone maintenance clinic, both in Providence, Rhode Island, participated. Overall prevalence of any CAM use in the past 6 months, frequency of use of individual named CAM therapies and domains, and demographic and clinical characteristics associated with CAM users, reasons for CAM use and self-perceived effectiveness of CAM were also measured. Of the 548 participants, 45% reported use of at least one CAM therapy. The top three therapies—religious healing, relaxation techniques, and meditation—were all from the mind–body domain. Having a higher education and lower self-rated health were the two strongest predictors of CAM use, followed by having a regular doctor or clinic, being white and younger. There was a high level of self-perceived effectiveness of CAM therapies (4.1 on a scale of 1–5), and CAM users were likely to use CAM for reasons related to their addiction.     

Alcohol Use and Sexual Risk Taking Among Hazardously Drinking Drug Injectors Who Attend Needle Exchange

BACKGROUND: To determine if sex-risk days are also alcohol use days for active injection drug users. METHODS: Cross-sectional interview of 187 active injection drug users who scored positively (> or =8) on the Alcohol Use Disorders Identification Test who were recruited between February 1998 and October 1999 from a needle exchange program in Providence, Rhode Island. A sex-risk day was defined as "vaginal sex, anal sex or oral sex without a condom," measured by using a 30 day timeline follow-back procedure. RESULTS: The sample was 64% male and 87% white, and 85% met DSM-IV criteria for alcohol abuse/dependence. Of the total days analyzed (n = 5610), 19% were sex-risk days; on 52% of these days drinking also occurred. By using a generalized estimating equation model to cluster by subject, alcohol use was associated with sex-risk days (odds ratio, 1.76; 95% confidence interval, 1.35-2.29; p < 0.001), when we controlled for gender, age, race, education, cocaine use, injection frequency, exchanging sex for money or drugs, number of sexual partners, and perceived sexual risk of acquiring human immunodeficiency virus from partners. CONCLUSIONS: Alcohol use is associated with sex risk-taking behavior among injection drug users. A substantial majority of participants reported using alcohol before or during sexual relations, which temporally links alcohol use with human immunodeficiency virus injection risk.     

Implications of Cannabis Use and Heavy Alcohol Use on HIV Drug Risk Behaviors in Russian Heroin Users

Cannabis and heavy alcohol use potentially increase HIV transmission by increasing risky drug behaviors. We studied 404 subjects entering treatment for heroin dependence, in St. Petersburg, Russia. We used the HIV Risk Assessment Battery (RAB) drug subscale to measure risky drug behavior. Although all heavy alcohol users had risky drug behaviors, their drug RAB scores did not differ from non-heavy alcohol users in unadjusted or adjusted analyses. Cannabis use was significantly associated with drug RAB scores in unadjusted analyses (mean difference 1.7 points) and analyses adjusted for age, sex, and employment (mean difference 1.3 points). When also adjusting for stimulant use, the impact of cannabis use was attenuated and no longer statistically significant (mean difference 1.1 points). Because of the central role of risky drug behaviors in the Russian HIV epidemic, it is important to understand how the use of multiple substances, including cannabis and alcohol, impacts risky drug behaviors.     

An Evaluation of a Brief HIV Risk Reduction Intervention Using Empirically Derived Drug Use and Sexual Risk Indices

This paper presents the results of an evaluation of a brief, educational HIV risk reduction intervention implemented in a community setting. Participants were 7,733 not-in-treatment drug users. Multi-item needle and sex risk measures were developed to assess the efficacy of the intervention. Behavior change was assessed within 6 empirically derived homogeneous risk groups. Drug users in all 6 groups reduced their needle use and sexual risks after participating in the brief educational intervention. Sexual risks were reduced to a greater extent than were risks associated with needle use, both in relative terms and when measured as a percentage of risk exhibited at intake. Brief educational interventions may be more effective in reducing sexual risk behaviors than it was previously believed. Needle risk, on the other hand, appears to be more robust, especially among high frequency cocaine injectors. Theses findings suggest that HIV prevention strategies may be more effective and more efficient if drug users are triaged into an intervention appropriate to their level of needle risk.     

Use of Latent Class Analysis Approach to Describe Drug and Sexual HIV Risk Patterns among Injection Drug Users in Houston,Texas

Following latent class analysis (LCA) approach we examined patterns of HIV risk using two related domains of behavior: drug use, and sexual activity among 523 injection drug users (IDUs) recruited into the 2009 National HIV behavioral surveillance system. Using posterior probability of endorsing six drug and sexual items, we identified three distinct classes representing underlying HIV risk. Forty percent of our participants were at highest risk, 25 % at medium risk, and 35 % at lowest risk for HIV infection. Compared to the Lowest-risk class members, the Highest-risk class members had riskier drug and sexual behaviors and had higher prevalence of HIV cases (6 vs. 4 %). This analysis underscores the merit of LCA to empirically identify risk patterns using multiple indicators and our results show HIV risk varies among IDUs as their drug and sexual behaviors. Tailored and targeted prevention and treatment interventions for the dual risk pattern are required rather than for drug or sexual risk in silos.     

Recovery Rates After Treatment for Alcohol/Drug Dependence: Tobacco Users vs. Non-Tobacco Users

Because it bas been seen repeatedly that using another addictive drug frequently leads to relapse to using the initial drug of choice, most chemical-dependence treatment specialists recognize the necessity of addressing all drugs of abuse in the same treatment setting. This treatment philosophy, however, does not appear to apply to the drug nicotine. Although a significant number of persons with alcohol/drug dependence use tobacco on a regular basis, there do not appear to have been any studies conducted on the effect of nicotine use on outcome after treatment for alcohol/drug dependence. In a prospective study, the authors compared 12-month recovery rates after inpatient treatment for alcohol/drug dependence in tobacco users and non-tobacco users. Significantly better recovery rates were discovered for non-tobacco users than tobacco users, especially if the drug of choice was a sedative, such as alcohol or narcotics. Data presented here support the theory that continued nicotine use may be a relapse factor for resuming alcohol use.     

Joint Drug Purchases and Drug Preparation Risk Behaviors Among Puerto Rican Injection Drug Users

In the process of preparing jointly purchased drugs, injection drug users (IDUs) may share drug preparation materials and use a single syringe to distribute injectable drugs. The aim of this study was to examine the association of joint drug purchasing with drug preparation risk behaviors among Puerto Rican IDUs. The study sample comprised 555 IDUs from New York City and 297 from Puerto Rico. IDUs reported pooling money for 12% of the injection episodes in New York, and for 14% of the injection episodes in Puerto Rico. In both study sites, all correlation coefficients between frequency of pooling money and drug preparation behaviors were .30 or larger. After controlling for sociodemographics, drugs injected, and injection frequency, pooling money was significantly associated to all four drug preparation behaviors in both study sites. HIV prevention interventions need to be cognizant of the joint purchasing of drugs and its relationship to drug preparation risk behaviors.     

Chapter 9: Alcohol Use Among Adult Puerto Rican Injection Drug Users

SUMMARY

This study explores the association between race/ethnicity and alcohol use for a population of 27,117 Massachusetts injection drug users. This population had all entered the Massachusetts drug treatment system between 1996-2002. Through logistic regression methods, controlling for age, gender, education, employment and homelessness, the study identified that Puerto Rican IDUs were close to 40% less likely to have ever used alcohol compared to their African American counterparts and 60% less likely to have ever used alcohol compared to their White counterparts. To further verify this finding, a sensitivity analysis was conducted for a subsample (n = 469) of IDUs who were not in treatment and who were interviewed by trained interviewers rather than by administrative intake workers. This sensitivity analysis confirmed the relationship between race/ethnicity and alcohol use for IDUs. This finding suggests that drug treatment for Puerto Rican IDUs should focus on their opiate addiction rather than on poly-drug use.     

Dynamics of HIV Risk Behavior in HIV-Infected Injection Drug Users

Forty-six HIV-positive individuals with a history of injection drug use participated in a questionnaire and interview study assessing their HIV risk behaviors, and their HIV risk and prevention information, motivation, and behavioral skills related to injection drug use and sexual behavior. High levels of past and current risky injection drug use and sexual behavior were reported. HIV risk reduction information was generally high, and many participants reported proprevention attitudes and supportive perceived norms toward HIV risk reduction behaviors. However, many did not intend to engage in these preventive behaviors, and some reported deficits in prevention behavioral skills. Interview data revealed the presence of many perceived barriers to safer injection and sexual behaviors. These included withdrawal-related concerns, and concerns about negative social consequences of engaging in safer behaviors. Possible ways of incorporating these findings into interventions for reducing risk behaviors in seropositive injection drug users are discussed.     

吸毒人群艾滋病防治干预研究

目的评价以社区为基础针对吸毒人群实施减少毒品危害措施的干预效果.探索、建立可持续发展的社区艾滋病防治模式.方法针对新疆伊宁市吸毒人群开展为期两年的社区干预实验.设实验组和对照组.实验组充分利用当地资源,采取社会动员、外展服务、培训、讲座、专题小组讨论、社区或家庭帮教、同伴教育、HIV自愿检测与咨询、健康教育材料发放、低价针具销售和安全套促销等综合干预措施,对照组无特殊干预活动.通过对实验组吸毒者干预前后HIV血清流行率(吸毒人群HIV抗体筛查,Elisa法)、相关危险行为、安全套使用率和知识水平的比较以及实验、与对照组的组间比较评价研究效果.结果干预前,当地社区吸毒人群艾滋病防治知识匮乏,共用注射器比例72.7 %,安全套使用率23.5 %, HIV血清流行率74.2 %.干预后调查,实验组艾滋病防治知识知晓率普遍提高; 注射吸毒比例、月吸毒次数、共用注射器比例和共用人次有所下降、但其变化与文化程度关系密切,单纯干预只能针对部分人群产生效应.此外,实验组发生性关系平均人次也有所下降,安全套使用率明显提高. 对照组以上指标无明显变化.对实验组HIV筛查阴性吸毒者追踪调查表明,HIV血清流行率仅为34.8 % (HIV抗体筛查,Elisa法),远低于当地吸毒人群HIV血清流行率的平均水平.结论以减少毒品危害为原则的干预措施可有效减少吸毒人群的HIV感染风险和再传播风险,降低高危行为,提高知识水平.     

汕头市吸毒人群艾滋病预防行为干预效果研究

目的 探索开展吸毒人群艾滋病预防行为干预的有效方法及其效果。方法 采用整群随机抽样的方法,将263名吸毒者分为四个组,分别进行不同形式的艾滋病宣传教育和同伴劝告者教育干预,并在干预前后各进行一次问卷调查。结果 宣传教育及设立同伴劝告者干预,对改变艾滋病知识掌握程度均有明显效果。结论 应制定长期规划,在戒毒所内建立艾滋病宣传教育机制,并持续设立同伴劝告者,干预效果才会持久。     

Residential Transience and HIV Risk Behaviors Among Injection Drug Users

Housing instability has been linked to HIV risk behaviors. Many studies have focused on the implications of one’s housing structure or lack thereof. This study focuses on residential transience as an additional dimension of housing instability. Specifically, we assessed the associations between transience and four HIV risk behaviors. Transience was defined as moving twice or more in the past six months. Multivariate analyses of a sample of current injectors (n = 807) indicated that transience had an independent effect on HIV risk behaviors. Transient individuals were more likely to share needles and go to a shooting gallery than non-transient individuals. Transience was not associated with exchanging sex or having multiple sex partners when homelessness was included in the models. Further examination of the association between housing and HIV should consider the role of transience. Interventions that promote housing stability among IDUs and address HIV risk during times of instability are needed.