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     

Impact of drug treatment on subsequent sexual risk behavior in a multisite cohort of drug-using women: a report from the Women's Interagency HIV Study

BACKGROUND: The evidence that drug treatment programs are associated with changes in sexual behavior and, thus, have prevention benefits beyond addiction is inconclusive. We examined whether entry into drug treatment was associated with subsequent alterations in sexual behavior among a group of drug-using women. METHODS: Data were collected semiannually via structured interviews over 8 years. Generalized estimating equations evaluated the relationship between self-reported drug treatment at each visit and sexual abstinence and consistent condom use in the subsequent 6-month period. RESULTS: In this sample (N = 1,658; mean age, 37.3 years; 57.5% African American; 80.3% HIV positive; 49.6% crack/cocaine users), 40% reported being in a variety of drug treatment programs. Those undergoing drug treatment (vs. those not) were less likely to become sexually active (adjusted odds ratio [AOR], 0.83; 95% confidence interval [CI], 0.76-0.91); this association was unchanged when the frequency of attendance and number of different drug treatment programs were evaluated. Drug treatment was not associated with subsequent consistent condom, regardless of frequency of attendance, but involvement in at least three treatment programs was (AOR, 1.40; 95% CI, 1.00-1.97). CONCLUSIONS: Additional efforts are needed to integrate effective sexual risk reduction programs into drug treatment settings; expanding access to different types of drug treatment modalities may be indicated.     

Predictors of increased condom use following HIV intervention with heterosexually active drug users

Research with injection drug users (IDUs), at risk for acquiring and transmitting HIV, has focused primarily on their risky drug practices, with far less attention paid to their risky sex behaviors. The purpose of this study was to determine what variables were associated with an increase in condom use following an HIV intervention with 3357 IDUs in nine cities. Participants reported using condoms during 15% of their sexual encounters prior to the HIV intervention, and during 22% of their sexual encounters six months later. A logistic regression analysis indicated that individuals who increased their condom use were likely to be HIV seropositive (odds ratio OR = 2.49), to have received AIDS information prior to the intervention (OR = 1.28), to have multiple sex partners (OR = 2.14), to be single with multiple sex partners (OR = 1.34), or to have exchanged drugs or money for sex (OR = 1.33). Discussion focuses on the generally low incidence of condom use and the need for increased intervention, particularly among drug users in monogamous relationships and sex workers.     

Alcohol, drugs, and condom use among drug offenders: an event-based analysis

BACKGROUND: Studies of the association between substance use and condom use in specific sexual encounters often do not separate the effects of alcohol and different types of drugs. Because the pharmacological effects and social settings of various substances differ, their effects on unprotected intercourse may vary as well. GOAL: This study examined the relationship between alcohol and drug use and the use of condoms in sexual encounters with casual partners in a high-risk population of drug offenders. DESIGN: Participants in court-ordered drug diversion programs (n=536; 26% female) completed a questionnaire in which they reported on the circumstances of their most recent sexual encounter with a casual partner. RESULTS: In multivariate logistic models, alcohol use in conjunction with sex was not related to decreased condom use in either men or women. Amphetamines (smoked or injected) were associated with decreased condom use, while cocaine, marijuana, and orally-administered amphetamines were not significantly associated with condom use. CONCLUSIONS: In this high-risk sample, links between substance use and unprotected sex differ with type of drug used.     

Intra-couple communication dynamics of HIV risk behavior among injecting drug users and their sexual partners in Northern Vietnam

This paper elucidates the social context of HIV risk behavior and intra-couple risk communication among injecting drug users (IDUs) and their main sex partner. Data on shared injection equipment, unprotected sex with multiple partners, unprotected sex with a main partner and couples' dynamics and risk communication were gathered through separate in-depth interviews with 11 active male IDUs and 11 of their primary female sex partners in Northern Vietnam. The majority of IDUs' sex partners does not inject drugs and is monogamous. In contrast, most IDUs reported a wide range of risky practices including needle sharing and unprotected sex with multiple, often concurrent, sex partners. Men rarely used condoms with primary partners. Many IDUs worried about their HIV-status, but none disclosed their injecting or sexual practices to their sex partners, leaving their partners unaware of their HIV risk. Among women who worried about HIV/AIDS, the vast majority was unable to influence their partner's needle sharing or extramarital affairs and most would not initiate condom use because they feared their partner's reaction. Couple-based interventions to facilitate risk communication combined with programs to promote condom use among male IDUs, may help to reduce HIV transmission from IDUs to their primary partners.     

Public opinion about syringe exchange programmes in the USA: an analysis of national surveys

Background: Despite scientific evidence demonstrating their effectiveness, syringe exchange programs (SEPs) have not been as widely embraced by policy-makers in the USA as in some other nations. One reason for this disjunction between science and policy may be the effect of public opinion.Methods: To better understand the role of public opinion in shaping SEP policies, we undertook a systematic search for all reported U.S. national surveys asking about support or opposition to SEPs. Relevant polls were identified through a national database of public opinion questions, and a similar search of a newspaper database. We present the survey findings. The wording of poll questions and the agenda of organisations sponsoring the polls are also examined.Results: Twenty-one questions from 14 different polls conducted from 1987 to 2000 were identified. Support for SEPs ranged from 29 to 66%. Surveys conducted by organisations with a public health agenda were more likely to suggest support for SEPs than those sponsored by organisations with a “family values” perspective. Question wording appeared to strongly influence support for SEPs. Poll questions that referred to “drug addicts” were less likely to indicate majority support for SEPs than those that avoided loaded terms or that provided public health information to respondents.Discussion: Public opinion regarding SEPs is very malleable, strongly affected by question wording or other biases of organisations sponsoring the polls. Therefore, there may be no clear national consensus on the desirability of SEPs. Our findings are particularly relevant for national policy, such as federal funding for SEPs.     

Do drug users in China who frequently receive detoxification treatment change their risky drug use practices and sexual behavior?

BACKGROUND: Relapse rates among treated drug users in China are high. We examined the associations between frequency of drug detoxification treatment and HIV-related risky drug practices and sexual behavior. METHODS: A cross-sectional study was conducted among drug users in two Anhui province detoxification centers in 2003. RESULTS: A total of 312 drug users were recruited. Seventy-seven percent of the subjects had ever received two or more detoxification treatments. The median number of detoxification treatments received was three, with an interquartile range of two to five treatments. More than 7 in 10 (72%) ever injected drugs; 19% shared needles and syringes in the past 30 days; 40% of drug users reported having both regular and commercial sex partners in the past year and 48% reported having only regular sex partners. Multiple Poisson regression analysis documented that the frequency of detoxification treatment was not associated with a decrease in drug practice (injection or sharing needles) and in unprotected sex. CONCLUSION: Drug users who frequently received detoxification treatment did not change their risky drug use practices and sexual behavior. Effective behavioral interventions and substitution maintenance treatment should become an integral part of detoxification programs in China.     

Gender and Sex Trading Among Active Methamphetamine Users in Cape Town,South Africa

Background: South Africa has experienced a tremendous rise in methamphetamine use since the year 2000. Sex trading is a global phenomenon that has been observed in active drug users and has been associated with risks for HIV infection and violence. Objectives: This paper describes and examines the correlates of sex trading among active methamphetamine users in Cape Town, South Africa. Methods: Through peer referral, 360 (201 male; 159 female) active methamphetamine users were recruited in a peri-urban township. Demographics, sex trading, drug use, trauma, and mental health were assessed by a structured clinical interview and computer survey. Logistic regression models were used to examine predictors of sex trading for men and women. Results: In the past 3 months, 40% of men and 33% of women endorsed trading sex for methamphetamine or money. Among these, they reported trading with same sex partners (33%), high rates of inconsistent condom use (73%), and incidences of physical (23%) and sexual (27%) assault when sex trading. Increased drug use severity was correlated with sex trading. Women with experiences of violence and trauma were also more likely to trade sex. Conclusions/importance: The results stress a need for linkage to drug treatment, as addiction may be fueling sex trading. Targeted interventions geared towards safe sex practices may reduce risky sexual behaviors. Women need interventions that are attuned to their specific vulnerabilities. More research is needed to explore the experiences of men who have sex with men given their particularly high rates of sex trading behavior.     

Patterns of HIV risk and alcohol use among African-American crack abusers

Although the association between heavy alcohol use and HIV risk has been studied in treatment populations, we know little about patterns of alcohol use and HIV risk among out-of-treatment African-American drug users. This study examines the extent to which alcohol use affects HIV risk in a sample of 495 African-American crack users who did not inject drugs. We present differences between levels of alcohol and crack use with regard to sexual practices (including sex while impaired), number of partners, frequency of sexual activity, and condom use. The findings suggest an intimate relationship between alcohol use, crack use, and sexual risks for HIV infection. Respondents who reported frequent use (15-30 days in the last 30 days) of alcohol, crack, or both displayed significantly greater risk than those who reported less than frequent use.     

苯丙胺类物质滥用者高危行为性别差异的分析

目的：了解不同性别苯丙胺类物质（amphetamine-type stimulants,ATS））滥用者一般人口学特征、毒品使用情况和高危行为的差异。方法：采用横断面调查研究,对来自上海强制隔离戒毒所的377名ATS滥用者进行调查。结果：不同性别的ATS滥用者在毒品滥用史,高危行为方面存在显著差异。女性患者首次使用年龄较男性更早,使用ATS后发生即刻性行为、有多个性伴侣的比例均高于男性,且性伴侣在性行为中更少使用安全套。此外,女性患者更多出现自杀观念和自杀行为。而男性患者使用ATS后的性冲动显著高于女性。结论：不同性别的ATS滥用者在毒品使用及高危行为方面存在差异。工作人员应当对不同性别的使用者制定针对性的干预措施。     

Impact of Social Network Characteristics on High-Risk Sexual Behaviors Among Non-Injection Drug Users

Sexually active non-injection drug users in New York City and their sexual partners or fellow drug users (N = 264) were recruited from 2002 to 2005, and associations between social network characteristics and sexual risk behaviors were examined. We assessed social networks, sexual practices, and drug use. Results suggest having a drug-centered social network, i.e., a network that includes a high proportion of individuals who provide, receive, or use drugs, increases the risk of engaging in high-risk sexual behaviors. The study's limitations are noted and longitudinal studies are needed to ascertain whether these associations are causal. Funding was provided by the National Institute on Drug Abuse.     

针具交换结合同伴宣传对吸毒者艾滋病知识及高危性行为的干预效果分析

目的:通过同伴宣传和针具交换项目提高干预对象关于艾滋病知识的知晓率,减少吸毒者传播和感染艾滋病病毒的高危行为,降低吸毒人群中艾滋病病毒的传播流行。方法:通过卫生工作人员和同伴宣传员向吸毒者提供并回收清洁针具、发放宣传折页、张贴宣传画以及对吸毒者进行面对面的宣传等措施在广西壮族自治区百色地区的注射吸毒者中开展了为期1 a的针具交换和同伴宣传项目。在干预前后分别进行基线和终期横断面调查,通过对比两次调查中吸毒者的艾滋病知识和自我报告的高危性行为等变化情况对干预效果进行评估。结果:终期调查时,吸毒者所有艾滋病知识的知晓率均显著高于基线调查时;在终期调查时吸毒者的单一性伴比例为50.5%,显著高于基线调查(27.6%)时,但是他们在婚外性行为中的安全套使用率却显著低于基线调查。结论:同伴宣传结合针具交换干预措施能显著提高吸毒者关于艾滋病方面的知识,显著降低吸毒者多性伴的比例,但是对于提高他们的安全套使用率方面却没有效果。     

Understanding condom use among heroin addicts in methadone maintenance using the information-motivation-behavioral skills model

The current study represents the application of a health behavior model to account for unsafe sexual behavior (as opposed to unsafe needle use) among heroin addicts in methadone treatment. The Information-Motivation-Behavioral Skills (IMB) model of HIV preventive behavior asserts that HIV prevention information, motivation, and behavioral skills are fundamental determinants of HIV preventive behavior. Participants (N = 156 heroin-addicted individuals in methadone treatment) completed assessments of their levels of HIV prevention information, motivation, behavioral skills, and safer sexual behavior. Overall measures of fit generated via structural equation modeling indicate that the IMB model adequately fits the data obtained. The constructs of the model accounted for a substantial proportion of the variance in safer sexual behavior, and tests of parameter estimates indicate that while information and motivation had direct and reliable associations with safer sexual behavior in this population, behavioral skills did not. Discussion focuses on the primary roles of HIV prevention information and motivation as determinants of safer sexual behavior in this population, on the lack of a significant contribution of HIV prevention behavioral skills, and on the implications for intervention of this pattern of findings.     

Cross-cultural approaches to harm reduction research: some considerations on the Brazil experience

Harm reduction initiatives for drug users comprise a range of approaches, including drug-user treatment, advocacy for changes in drug policy, needle exchange programs, bleach distribution, and broad-based interventions that focus on both safer drug use and less risky sexual behaviors. In many developing nations, harm reduction is a relatively new strategy, which focuses almost exclusively on the connections between drug use and the spread of HIV infection. In Brazil, harm reduction programs are few, and little has been documented about their scope, experience, and effectiveness. This paper reviews the status of Brazilian harm reduction initiatives in general, with a specific focus on lessons learned from the conduct of cross-national research in Rio de Janeiro. The study demonstrated the feasibility of implementing a community-based prevention program among an at-risk population of cocaine users in Brazil, and in other countries where there is little tradition of research with out-of-treatment drug users. Finally, the paper addresses aspects of the harm reduction movement that tend to hamper its progress in both developed and developing nations.     

Inconsistent condom use among HIV-infected patients with alcohol problems

BACKGROUND: Unsafe sexual behavior is common among persons with negative or unknown HIV status and it is augmented by alcohol use in some populations. We examined the association between alcohol consumption level (abstinent, moderate, at-risk) and inconsistent condom use in a cohort of HIV-infected individuals with a history of alcohol problems. METHODS: Subjects (n=345) had up to seven structured interviews over 36 months. Identical questions on alcohol consumption and inconsistent condom use were asked at each interview. We used generalized estimating equations (GEE) multivariate logistic regression for repeated measurements analysis. We adjusted for potential confounding factors and explored possible interactions. RESULTS: At baseline, 132 (38%) participants reported inconsistent condom use. We detected a significant (P=0.0002) interaction between alcohol consumption and injection drug use (IDU) variables. Among active injection drug users, at-risk drinking was associated with inconsistent condom use, adjusted odds ratio (OR; 95% confidence interval) 4.3 (1.5, 12.2). Among those who did not inject drugs, at-risk drinking and inconsistent condom use were not associated, 0.7 (0.4, 1.3). Inconsistent condom use was more common among women, those believing condoms to be 'a hassle', and persons living with a partner. CONCLUSION: In HIV-infected drug-injecting individuals, excessive use of alcohol is associated with unsafe sexual practices.     

Differences Found Between Women Injectors In and Out of Treatment: Implications for Interventions

SUMMARY

Women substance abusers, particularly those who are injecting drug users, are at high risk for HIV infection. It has been demonstrated that injecting drug users found out of drug treatment settings show different patterns of drug use and HIV risk than those who enter treatment. Previous studies, however, have not indicated the extent to which women injectors in and out of treatment exhibit these same differences. This study examines data from two studies sponsored by the National Institute on Drug Abuse to determine similarities and differences between women encountered by outreach efforts in four cities and those entering methadone treatment programs in the same cities.

The results indicate significant differences in race, drugs used (both injecting and non-injecting), injecting risk behavior, and treatment history. However, the two groups of women shared similar histories of first injecting use and sexual risk. Women who entered methadone treatment reported higher frequencies of injecting drug use and HIV risk behaviors, both direct (sharing needles) and indirect (sharing cookers, cotton, and water); yet they were also more likely to clean needles and to use new needles than the women encountered through outreach. The outreach women were more likely to be African American, to inject less than daily, and to use alcohol, crack, and non-injecting cocaine daily.

The results suggest that women injectors entering treatment and those encountered in outreach are very different in their injecting intensity and HIV risk behaviors. However, both groups are still at risk for HIV infection, particularly as a result of multiple sexual partners and little reported condom use. The need to identify the risk, reinforce risk reduction maintenance, and further develop HIV prevention strategies that successfully address both the needs of these women and the differences that exist between them will be essential to stopping the spread of HIV.     

北京市吸毒人群安全性行为知信行调查

目的：了解北京市吸毒人员有关安全性行为的知识、态度及行为情况，为预防控制艾滋病、性病在该人群的流行提供科学依据。方法：对北京市某自愿戒毒所277名吸毒者进行安全性行为的知识、态度及行为问卷调查，并对结果进行统计和分析。结果：吸毒人员关于性交时正确使用安全套能预防艾滋病的知晓率最高（93.9％），认为与临时性伴性交安全套应使用率显著高于与熟人的应使用率，与固定性伴性交安全套每次使用率最低。结论：吸毒人群中存在多性伴、不安全性行为等高危因素，在吸毒人群中开展安全性行为的宣传教育并深入推广安全套的使用，对控制艾滋病、性病的传播具有重要意义。     

Impact of social network characteristics on high-risk sexual behaviors among non-injection drug users

Sexually active non-injection drug users in New York City and their sexual partners or fellow drug users (N = 264) were recruited from 2002 to 2005, and associations between social network characteristics and sexual risk behaviors were examined. We assessed social networks, sexual practices, and drug use. Results suggest having a drug-centered social network, i.e., a network that includes a high proportion of individuals who provide, receive, or use drugs, increases the risk of engaging in high-risk sexual behaviors. The study's limitations are noted and longitudinal studies are needed to ascertain whether these associations are causal. Funding was provided by the National Institute on Drug Abuse.     

Characteristics of amphetamine users seeking information, help and treatment in Adelaide, South Australia

This study was designed as a needs assessment for interventions to respond to hazardous and harmful amphetamine use, including options for treatment. Research techniques from Rapid Assessment Methodology (RAM) were utilized to collect data. This included a survey of 100 amphetamine users, from which the data for the current paper has been drawn. This paper is focused on the characteristics of those who had sought information and help in the sample, and on those who were dependent on amphetamine and who felt they needed treatment, in comparison to those who were also dependent but did not feel the need for treatment. Findings in regard to treatment-seekers were largely consistent with previous Australian and overseas research, and thus underscore the importance of considering psychological morbidity, both prior and subsequent to amphetamine use, in treatment settings for amphetamine users. Having previously sought general information about amphetamines, safer drug use and blood-borne diseases was best predicted by higher sexual risk-taking and poorer physical functioning. Having previously sought help for an amphetamine-related concern or problem was best predicted by higher severity of dependence on amphetamines and poorer social functioning. Peers were considered to be important sources of information and help, as were GPs. In developing interventions for amphetamine users, consideration should be given to the characteristics of those who seek particular types of assistance. \[Vincent N, Shoobridge J, Ask A, Allsop S, Ali R. Characteristics of amphetaminal users seeking information, help and treatment in Adelaide, South Australia. Drug Alcohol Rev 1999;18:63-73]     

Predictors of Non-use of Condoms Among Drug Users in China: implications for HIV harm reduction

In China, the majority of drug users do not use condoms when they engage in premarital and extramarital sex behaviors. The first step to promote safer sex is to identify factors associated with the non-use of condoms. Using a sample of 450 heroin users from a detoxification center in China, this short report documents and examines predictors of non-use of condoms. The results show that non-use of a condom is associated with unmarried males of low income. In addition, attitude factors are important; those who have heard of 'safer sex' and believe in the importance of condom use are more likely to use a condom in premarital and extramarital sex. The findings suggest the importance of educational campaigns to promote the awareness of condom use and its utility.