HIV/AIDS-related behavior change among injecting drug users in different national settings

Evaluating the Mediating Role of Recall of Intervention Knowledge in the Relationship Between a Peer-Driven Intervention and HIV Risk Behaviors Among People Who Inject Drugs

Peer-driven interventions can be effective in reducing HIV injection risk behaviors among people who inject drugs (PWID). We employed a causal mediation framework to examine the mediating role of recall of intervention knowledge in the relationship between a peer-driven intervention and subsequent self-reported HIV injection-related risk behavior among PWID in the HIV Prevention Trials Network (HPTN) 037 study. For each intervention network, the index participant received training at baseline to become a peer educator, while non-index participants and all participants in the control networks received only HIV testing and counseling; recall of intervention knowledge was measured at the 6-month visit for each participant, and each participant was followed to ascertain HIV injection-related risk behaviors at the 12-month visit. We used inverse probability weighting to fit marginal structural models to estimate the total effect (TE) and controlled direct effect (CDE) of the intervention on the outcome. The proportion eliminated (PE) by intervening to remove mediation by the recall of intervention knowledge was computed. There were 385 participants (47% in intervention networks) included in the analysis. The TE and CDE risk ratios for the intervention were 0.47 [95% confidence interval (CI): 0.28, 0.78] and 0.73 (95% CI: 0.26, 2.06) and the PE was 49%. Compared to participants in the control networks, the peer-driven intervention reduced the risk of HIV injection-related risk behavior by 53%. The mediating role of recall of intervention knowledge accounted for less than 50% of the total effect of the intervention, suggesting that other potential causal pathways between the intervention and the outcome, such as motivation and skill, self-efficacy, social norms and behavior modeling, should be considered in future studies.

Understanding the public health consequences of suspending a rural syringe services program: a qualitative study of the experiences of people who inject drugs

BACKGROUND

Syringe services programs (SSPs) are evidence-based interventions that are associated with decreases in prevalence and incidence rates of HIV and viral hepatitis among people who inject drugs (PWID). SSPs are also effective conduits to deliver overdose prevention resources among PWID. In December 2015, the Kanawha-Charleston Health Department (KCHD) in West Virginia implemented a SSP; however, the program was indefinitely suspended in early 2018 following policy changes that would have forced the program to operate in ways that conflicted with established best practices. The purpose of this research is to explore the public health implications of the suspension of the KCHD SSP among rural PWID.

METHODS

We conducted semi-structured interviews with 27 PWID (59.3% male, 88.9% White) to explore access to sterile injection equipment and overdose prevention resources, high-risk injection practices, and HIV risk perceptions following the KCHD SSP suspension. Participants were recruited from street locations frequented by PWID. Interviews were audio-recorded and transcribed verbatim. We employed an iterative, modified constant comparison approach to systematically code and synthesize textual interview data.

RESULTS

Participants described the KCHD SSP as providing a variety of harm reduction services to PWID and being able to speak honestly with SSP staff about their drug use without fear of stigmatization. The suspension of the KCHD SSP fundamentally changed the public health landscape for PWID, ushering in a new era of increased risks for acquiring bloodborne infections and overdose. PWID described more frequently injecting with used syringes and engaging in a range of high-risk injection practices after the SSP was suspended. PWID also discussed having decreased access to naloxone and being less likely to get routinely tested for HIV following the KCHD SSP suspension.

CONCLUSIONS

This research demonstrates that the suspension of a SSP in rural West Virginia increased risks for HIV/HCV acquisition and overdose among PWID. The suspension of the SSP led to community-wide decreases in access to sterile injection equipment and naloxone among PWID. The suspension of the KCHD SSP should be viewed as a call to action for sustaining evidence-based interventions in the face of sociopolitical forces that attempt to subvert public health.

The influence of a peer-based HIV prevention intervention on conversation about HIV prevention among people who inject drugs in Baltimore, Maryland

STEP into Action assessed the efficacy of a peer-based HIV prevention intervention in reducing HIV risk behaviors among people who inject drugs (PWIDs) in Baltimore. This analysis examined the effect of the intervention on the change in frequency of conversation about HIV prevention topics over time. 114 participants were randomized into an experimental and 113 into a control group. Data was collected prospectively at 6, 12, and 18 months. The experimental group talked more frequently about HIV prevention topics compared to the control group at 6-month visit. At 18 months relative risk ratios (RRR) remained statistically significant for conversation about the danger of needle sharing (RRR = 3.21) and condom use (RRR = 2.81). The intervention resulted in an increased conversation about HIV prevention among PWIDs, but the sustainability past 6 months remained a challenge; suggesting that interventions should be designed to constantly reinforce communication about HIV prevention among PWIDs.

Consequences of a restrictive syringe exchange policy on utilisation patterns of a syringe exchange program in Baltimore, Maryland: Implications for HIV risk

INTRODUCTION AND AIMS

Syringe distribution policies continue to be debated in many jurisdictions throughout the USA. The Baltimore Needle and Syringe Exchange Program (NSP) operated under a 1-for-1 syringe exchange policy from its inception in 1994 through 1999, when it implemented a restrictive policy (2000-2004) that dictated less than 1-for-1 exchange for non-program syringes.

DESIGN AND METHODS

Data were derived from the Baltimore NSP, which prospectively collected data on all client visits. We examined the impact of this restrictive policy on program-level output measures (i.e. distributed : returned syringe ratio, client volume) before, during and after the restrictive exchange policy. Through multiple logistic regression, we examined correlates of less than 1-for-1 exchange ratios at the client level before and during the restrictive exchange policy periods.

RESULTS

During the restrictive policy period, the average annual program-level ratio of total syringes distributed : returned dropped from 0.99 to 0.88, with a low point of 0.85 in 2000. There were substantial decreases in the average number of syringes distributed, syringes returned, the total number of clients and new clients enrolling during the restrictive compared to the preceding period. During the restrictive period, 33 508 more syringes were returned to the needle exchange than were distributed. In the presence of other variables, correlates of less than 1-for-1 exchange ratio were being white, female and less than 30 years old.

DISCUSSION AND CONCLUSIONS

With fewer clean syringes in circulation, restrictive policies could increase the risk of exposure to HIV among Injection Drug Users (IDUs) and the broader community. The study provides evidence to the potentially harmful effects of such policies.

Effects of an HIV peer prevention intervention on sexual and injecting risk behaviors among injecting drug users and their risk partners in Thai Nguyen, Vietnam: a randomized controlled trial

Globally, 30% of new HIV infections outside sub-Saharan Africa involve injecting drug users (IDU) and in many countries, including Vietnam, HIV epidemics are concentrated among IDU. We conducted a randomized controlled trial in Thai Nguyen, Vietnam, to evaluate whether a peer oriented behavioral intervention could reduce injecting and sexual HIV risk behaviors among IDU and their network members. 419 HIV-negative index IDU aged 18 years or older and 516 injecting and sexual network members were enrolled. Each index participant was randomly assigned to receive a series of six small group peer educator-training sessions and three booster sessions in addition to HIV testing and counseling (HTC) (intervention; n = 210) or HTC only (control; n = 209). Follow-up, including HTC, was conducted at 3, 6, 9 and 12 months post-intervention. The proportion of unprotected sex dropped significantly from 49% to 27% (SE (difference) = 3%, p < 0.01) between baseline and the 3-month visit among all index-network member pairs. However, at 12 months, post-intervention, intervention participants had a 14% greater decline in unprotected sex relative to control participants (Wald test = 10.8, df = 4, p = 0.03). This intervention effect is explained by trial participants assigned to the control arm who missed at least one standardized HTC session during follow-up and subsequently reported increased unprotected sex. The proportion of observed needle/syringe sharing dropped significantly between baseline and the 3-month visit (14% vs. 3%, SE (difference) = 2%, p < 0.01) and persisted until 12 months, but there was no difference across trial arms (Wald test = 3.74, df = 3, p = 0.44).

Initiation to drug injection among street youth: a gender-based analysis

OBJECTIVE(S)

To estimate the incidence rate of initiation into drug injection and to identify predictors of initiation into drug injection separately among street girls and boys.

DESIGN

Data from two consecutive prospective street youth cohort studies (1995-2001 and 2001-2005) were used to conduct these analyses, stratified by gender.

METHODS

Data were collected using semi-annual interviewer-administered questionnaires. Variables from the following domains were considered in Cox regression models: socio-demographic characteristics, early and current substance abuse, marginalization, childhood traumatic sexual events and injection exposure.

RESULTS

Of the 946 youth who had never injected drugs at study entry, 86.4% completed at least two questionnaires representing 243 girls and 574 boys. Incidence rates of injection of 7.0 and 5.9 per 100 person-years were observed among these girls and boys respectively. Among girls, cocaine or crack use (adjusted hazard ratio (AHR)=1.97), heroin use (AHR=2.86), homelessness (AHR=2.49) and hanging out regularly with people who inject (AHR=4.46) all independently increased risk of first injection. Among boys, age decreased risk of initiating injection (AHR=0.90/year), while cocaine or crack use (AHR=2.14), heroin use (AHR=3.56), homelessness before age 16 (AHR=1.68), incest or rape before age 14 (AHR=1.98) and hanging out regularly with people who inject (AHR=1.66) all independently increased this risk.

CONCLUSIONS

Our findings suggest similar rates of initiation among girls and boys; however, factors associated with initiation vary by gender. This might lead to the design of more effective programs to prevent initiation into drug injection.

Psychosocial interventions for reducing injection and sexual risk behaviour for preventing HIV in drug users

BACKGROUND

Drug users (including both injection drug users and crack cocaine users), are at high levels of risk for contracting HIV. Therefore it is important to reduce the injection and/or sexual risk behaviours of these groups both for the benefit of themselves and for society as a whole.

OBJECTIVES

To assess the efficacy of multi-session psychosocial interventions in comparison with standard education and minimal intervention controls for the reduction of injection and sexual risk behaviour.

SEARCH STRATEGY

Electronic searches were conducted of a number of bibliographic databases (including Cochrane Library, CINAHL, MEDLINE, PsycINFO). In addition, other methods of locating papers were employed including contacting various authors working in the field of HIV risk reduction and examining reference lists of applicable papers identified in the electronic search.

SELECTION CRITERIA

The inclusion criteria consisted of randomised and quazi-randomised trials assessing the efficacy of psychosocial interventions in the reduction of injection and sexual risk behaviour for people who misused opiates, cocaine, or a combination of these drugs.

DATA COLLECTION AND ANALYSIS

Two authors independently assessed the eligibility of studies identified by the search strategy, quality assessed these studies and extracted the data. A total of 35 trials met the eligibility criteria of the review providing data on 11,867 participants.

MAIN RESULTS

There were minimal differences identified between multi-session psychosocial interventions and standard educational interventions for both injection and sexual risk behaviour. Although it should be noted there were large pre-post changes for both groups suggesting both were effective in reducing risk behaviours. In addition, there was some evidence of benefit for multi-session psychosocial interventions when compared with minimal controls. Subgroup analyses suggest that people in formal treatment are likely to respond to multi-session psychosocial interventions. It also appears single-gender groups may be associated with greater benefit.

AUTHORS' CONCLUSIONS

There is limited support for the widespread use of formal multi-session psychosocial interventions for reducing injection and sexual risk behaviour. Brief standard education interventions appear to be a more cost-effective option. Further research is required to assess if there are particular groups of drug users more likely to respond to such interventions.

Harm reduction policies in Argentina: a critical view

The concept of 'harm' underpinning current drug harm reduction policies is most often limited to viral infections and other health consequences for drug users. This paper analyses harm reduction policies in Argentina, with the purpose of challenging and extending this narrow conception of harm to encompass all harms inflicted on drug users, in a context of criminalization of drug use and poverty. Faced with a steep rise in poverty, rapid changes in drug use practices, the quality and prices of drugs, and patterns of morbidity and mortality, Argentina has implemented harm reduction policies specifically for drug users who mostly live in the Greater Buenos Aires impoverished areas. These changes, as well as the Latin American tradition of social and health policies that focus on the collective, subjective, and political-economic aspects of harm, highlight some tensions between the individualistic, public health model structured in the North and its application in Argentina.

Reflections on 25 Years of HIV and AIDS Research among Drug Abusers

Booth: Since early in the HIV epidemic, street outreach workers, often indigenous to the target population, have served both to recruit drug injectors for interventions and to conduct interventions. The typically unstructured nature of outreach interventions present challenges in determining the nature of services actually delivered. It is recommended that both qualitative and quantitative methods be utilized to monitor intervention service delivery. Des Jarlais: The threat of AIDS has led to profound behavioral changes among drug users. These changes need to be seen primarily not as responses to public health interventions, but in terms of the competencies of drug users themselves. A Drug User Competency Model of HIV Prevention would include: 1. Competency in understanding HIV transmission, 2. Competency in reducing HIV risk behavior, and 3. The competency of altruism. Friedman: Twenty years of work on HIV among drug users highlight that we need to incorporate large-scale social dynamics in research and interventions, understand drug users' sexual behavior and networks, and view drug users as multifaceted human beings, not just “walking addictions.” Crucially, drug users can be highly competent at many things, so non-users can learn from their ideas and their practices. Drug users can be partners and sometimes leaders, not just “disabled addicts.”

HIV prevention for injecting drug users: the first 25 years and counting

During the last three decades, both the injection of illicit psychoactive drugs and HIV infection among injecting drug users (IDUs) have spread throughout industrialized and developing countries. Extremely rapid transmission of HIV has occurred in IDU populations with incidence rates of 10 to 50/100 person-years. In sharp contrast, there are many examples of very effective HIV risk reduction for IDUs, both in preventing initial epidemics and in bringing existing epidemics under control. IDUs are capable of learning basic information about HIV/AIDS and modifying their behavior to protect both themselves and their peers. Effective HIV prevention for IDUs requires programs that treat IDUs with dignity and respect, provide accurate information and the means for behavior change-access to sterile injection equipment, condoms, and drug abuse treatment. Programs that provide these services need to be implemented on a public health scale for IDU populations at risk for HIV infection.

HIV-related communication and perceived norms: an analysis of the connection among injection drug users

Although research has consistently shown a link between perceived norms and HIV risk behaviors, research examining interpersonal variables that may contribute to perceived norms is sparse. Verbal communication is an important mechanism for establishing, altering, and maintaining norms. In this study we assess the association between HIV-related communication and perceived norms. Baseline data from 684 drug injectors enrolled in the STEP into Action (STEP) study were analyzed. Multivariate results revealed that injection drug users (IDUs) who talked to their drug partners about HIV were less likely to perceive that they engaged in risky injection behavior (beta = -1.53, SE = 0.29, p < .001). Also, exchanging sex for money or drugs (beta = 15.83, SE = 7.02, p = .024), going to a shooting gallery (beta = 17.03, SE = 6.79, p = .013), and having an IDU sex partner (beta = 15.34, SE = 6.58, p = .020) were associated with belief that peers' practiced risky drug behaviors. These findings may be used to develop peer education HIV prevention interventions for drug users.

Injection drug users' strategies to manage perceptions of personal risk: how do IDUs see HIV as having affected them?

The U.S. public health community is in its 3rd decade of seeking to prevent and treat HIV/AIDS. Injection drug users (IDUs) are central to targeted HIV prevention interventions as approximately one third of new U.S. infections are attributable to injection drug use (Santibanez et al.,Journal of Urban Health, 83[1], 86-100, 2006). Targeted behavior change efforts are often explicitly built upon the risk perception of targeted individuals. In this article, we consider the efficacy of behavior change based on IDUs' perceptions of elevated risk. Our qualitative analysis of 28 interviews with HIV negative IDUs in inner city Baltimore suggests that participants did not see themselves as personally affected by HIV. Rather, respondents constructed accounts in which they differentiated themselves from the type of people who are so affected, thereby creating a less stigmatizing identity. We argue that effective HIV prevention should explicitly acknowledge and address the stigmatized IDU identity, rather than assuming readiness for behavior change.

Estudo de comportamento associado à infecção pelo HIV e HCV em detentas de um presídio de São Paulo, Brasil

Observa-se aumento do número de casos de AIDS e hepatite C entre mulheres, incluindo aquelas confinadas no sistema prisional. Este trabalho propôs estudar aspectos relacionados ao comportamento sexual e associados ao risco de transmissão do HIV e da hepatite C em detentas numa penitenciária de São Paulo, Brasil. É um estudo transversal realizado em 2000, aplicando questionários de comportamento e obtendo diagnósticos sorológicos para HIV e HCV. A medida de associação escolhida foi OR para análises bi e multivariada (regressão logística). Participaram do estudo 290 detentas. A prevalência observada para HIV e HCV foi de 13,9% e 16,2%, respectivamente. Associações estatisticamente significantes (p < 0,05) para HIV positivo foram observadas para as variáveis: parceiros com AIDS OR = 6,9 (2,7-35,2); usuários de drogas ingetáveis (UDI) OR = 3,3 (1,6-14,7); parceiro fixo OR=3,7 (1,5-8,3) e para HCV positivo com UDI OR = 13,7 (4,4-42,7); parceiro UDI OR = 4,9 (1,9-12,2); prisão anterior OR = 2,8 (1,2-6,5) ajustadas por: parceiros com AIDS, UDI, parceiro UDI, uso de drogas e prisão anterior. Concluiu-se que o risco parenteral foi associado com infecções pelo HIV e HCV, e o sexual, pelo HIV. Recomendam-se programas de prevenção adequados e continuados no ambiente carcerário.

The dynamics of injection drug users' personal networks and HIV risk behaviors

AIMS

While studies of the social networks of injection drug users (IDUs) have provided insight into how the structures of interpersonal relationships among IDUs affect HIV risk behaviors, the majority of these studies have been cross-sectional. The present study examined the dynamics of IDUs' social networks and HIV risk behaviors over time.

DESIGN

Using data from a longitudinal HIV-intervention study conducted in Baltimore, MD, this study assessed changes in the composition of the personal networks of 409 IDUs. We used a multi-nomial logistic regression analysis to assess the association between changes in network composition and simultaneous changes in levels of injection HIV risk behaviors. Using the regression parameters generated by the multi-nomial model, we estimated the predicted probability of being in each of four HIV risk behavior change groups.

FINDINGS

Compared to the base case, individuals who reported an entirely new set of drug-using network contacts at follow-up were more than three times as likely to be in the increasing risk group. In contrast, reporting all new non-drug-using contacts at follow-up increased the likelihood of being in the stable low-risk group by almost 50% and decreased the probability of being in the consistently high-risk group by more than 70%.

CONCLUSIONS

The findings from this study show that, over and above IDUs' baseline characteristics, changes in their personal networks are associated with changes in individuals' risky injection behaviors. They also suggest that interventions aimed at reducing HIV risk among IDUs might benefit from increasing IDUs' social contacts with individuals who are not drug users.

Behavior change and health-related interventions for heterosexual risk reduction among drug users

Prevention of heterosexual transmission of HIV between and from drug users is important for controlling the local and global HIV heterosexual epidemic. Sex risk reduction interventions and health-related interventions are important for reducing the sex risk behaviors of drug users. Sex risk reduction interventions address individual-level, peer-level, and structural-level determinants of risk reduction. Health-related interventions include HIV counseling and testing, prevention and treatment of sexually transmitted diseases, and delivery of highly active antiretroviral therapy. It is important to adapt effective interventions implemented in resource-rich countries to the realities of the resource-constrained settings and to address relevant contextual factors.

Sexual risk reduction in a cohort of injecting drug users in Bangkok, Thailand

OBJECTIVE

Interventions to reduce sexual risk behavior among injecting drug users (IDUs) have generally had very modest effects, but almost all such interventions have been conducted within short time frames. This study assessed whether long-term participation in interventions to reduce sexual risk behavior was associated with reduced sexual risk behavior.

METHODS

A total of 806 IDUs participated in the Bangkok HIV Vaccine Trial Preparatory Cohort Study from 1995-1998 and remained in the study for at least 4 follow-up visits (approximately 16 months). Participants received HIV counseling and testing every 4 months and free condoms were provided. Structured interviews including questions on sexual behavior were administered every 4 months.

RESULTS

Approximately 40% of participants reported engaging in unprotected sex (vaginal intercourse without always using a condom) with a regular partner at each study visit, without any decline over time in this behavior. There were declines in the proportions of participants reporting unprotected sex with casual partners and with paid partners (men only) over time, but the declines were confined to the early period of the study. Unprotected sex with casual partners was associated with amphetamine use. Condom use increased substantially among participants who seroconverted for HIV during the study.

CONCLUSIONS

Interventions to reduce sexual risk behavior among HIV-seronegative IDUs over extended periods were no more likely to be effective than shorter interventions. New programs are needed to reduce sexual risk behavior among amphetamine users and among IDUs who are currently seronegative but are engaging in injection risk behaviors and in unprotected sex with regular partners.

Egocentric HIV risk networks among Puerto Rican crack users in New York and in Puerto Rico: impact on sex risk behaviors over time

This study examined risk network characteristics of Puerto Rican crack users and the relationship between the network and HIV-related sex risk behavior over time. The participants (N = 383 in New York; N = 165 in Puerto Rico), recruited through street outreach, were interviewed at both baseline and 6-month follow-up. The majority of crack users (88%, New York; 92%, Puerto Rico) in the sample named one or more personal risk network members. As compared with New York participants, crack users in Puerto Rico reported larger risk networks and were more likely to engage in sex risk behaviors with strangers or acquaintances. In multivariate analyses, a significant variable in predicting sex risk behaviors at follow-up in both sites was the baseline measure of the dependent variable. Significant network variables were: having any known crack use member less than 6 months and having acquaintance/stranger in network in New York; communicating with network members about using condoms in Puerto Rico. More attention to sex risk behaviors are needed in HIV/AIDS prevention and education programs.

Factors associated with peer HIV prevention outreach in drug-using communities

Peer education is a critical approach to HIV prevention. The current study evaluated 156 peer outreach educators 6 months after their 10-session training. Specifically, we examined factors associated with talking to network members about HIV-related topics as well as distributing risk reduction materials. Overall, current drug users were less likely to report engaging in HIV-related conversations in the prior month but were more likely to provide bleach to drug-using network members. Older participants (aged 41 and older) were more likely to report HIV prevention conversations, and women were marginally more likely to report providing condoms to network members. HIV-seropositive participants were significantly more likely to report talking to sex partners and family members about HIV. These data suggest that demographic characteristics, drug use, and HIV status are associated with HIV prevention conversations among network members. These characteristics should be considered when designing peer outreach HIV prevention programs.

Injection drug use and crack cocaine smoking: independent and dual risk behaviors for HIV infection

PURPOSE

Previous studies have examined the practices of injecting drugs or smoking crack cocaine as high-risk, but independent, factors for HIV transmission. To explore the independent and dual risks of injection practices and crack smoking, this study examined HIV seroprevalence rates among distinct drug user groups, based on patterns of daily administration.

METHODS

A sample of 3,555 drug users and neighborhood controls in urban Miami, FL and rural Belle Glade and Immokalee, FL were partitioned into four mutually-exclusive groups: 1) injection drug users (IDUs); 2) crack-cocaine smokers; 3) dual users who both smoked crack and injected drugs; and 4) non-drug-user controls.

RESULTS

HIV seroprevalence rates were 45.1% for IDUs, 30.5% for dual users, 20.1% for crack smokers and 7.3% for controls. Multivariate logistic regression analysis found that when compared with controls odds ratios for HIV seropositivity were 9.81 for IDUs, 5.27 for dual users, and 2.24 for crack smokers.

CONCLUSIONS

These findings provide evidence of: 1) behavioral and structural co-factors that influence HIV exposure patterns among drug users; and 2) the substantially higher risk of HIV infection among IDUs compared with other drug users. Intervention strategies must be tailored for the specific drug use subpopulations to optimize efficacy.

HIV/AIDS epidemics in Vietnam: evolution and responses

The goal of this study was to describe the evolution of the HIV epidemic in Vietnam and its responses. Surveillance was conducted in 8 provinces in 1994, expanded to 12 in 1995, 20 in 1996, and 30 in 2001. Sentinel populations were sexually transmitted disease (STD) patients, female sex workers (FSWs), injection drug users (IDUs), tuberculosis (TB) patients, antenatal women, and military conscripts. Vietnam is in the concentrated epidemic stage. HIV prevalence had increased significantly in all surveillance population groups in the 1990s. HIV prevalence in the south is higher than in other regions of the country. The national HIV prevalence increased from 10.1% in 1996 to 32% in 2002 among IDUs, from 0.6% in 1994 to 6.6% in 2002 among FSWs, from 0.4% in 1994 to 2.4% in 2002 among STD patients, from 0.03% in 1994 to 0.34% in 2002 among pregnant women, from 0% in 1994 to 0.7% in 2002 among army military recruits, and from 0.5% in 1994 to 3.6% in 2002 among TB patients. The government has a strong commitment to control the epidemic and has implemented many activities for HIV prevention and control. Vietnam's HIV epidemic is predominantly among IDUs. Current intervention activities have not been sufficient to reduce HIV transmission. Vietnam needs to strengthen responses by scaling up the best practices in the most affected population groups by implementing internationally recognised effective interventions appropriately.

Social network correlates of self-reported non-fatal overdose

The leading cause of death among heroin users is drug overdose. The present study examined the relationship between history of self-reported drug overdoses and social network characteristics among cocaine and opiate users. Data were from cross-sectional surveys administered from March 2001 through February 2003 as part of follow-up of an experimental network oriented HIV prevention intervention. A total of 838 participants with histories of cocaine and opiate use completed the survey. Several social network variables were found to be significantly associated with drug overdose in the prior 2 years, including larger number of network members who were injection drug users and a larger number of conflictual ties among the network members. Even after controlling for age, gender, frequency of injection drug and alcohol use, and health status, network variables continued to have a strong association with history of recent overdose. These data suggest that large drug networks should be targeted for drug overdose prevention interventions.

Condom use for preventing HIV infection/AIDS in sub-Saharan Africa: a comparative multilevel analysis of Uganda and Tanzania

This study explored the relationships between individual-, household-, and community-level variables and condom use to prevent HIV infection in women and men in Uganda and Tanzania using multilevel modeling. Using data from the Demographic and Health Surveys for Uganda (1995) and Tanzania (1996) as well as data collected by the MEASURE Evaluation Project at the Carolina Population Center for Tanzania (1996 and 1999), the study found higher condom use among men than women. There was also heterogeneity in condom use among different clusters for both women and men. More specifically, women and men living in clusters with higher indicators of development were more likely to use condoms to prevent HIV infection. In addition, condom use was much more prevalent in areas where health care services were nearby (0-5 km). In addition, condom use was more common among women (but not men) who lived in clusters where HIV/AIDS testing, counseling, and treatment were provided. The results further revealed that education improved condom use; however, the effect of education was considerably reduced in the models that included HIV/AIDS knowledge and cluster-level variables. The positive effect of household wealth on condom use also diminished after controlling for the effects of the knowledge and cluster-level factors. Knowledge about HIV and perceiving oneself to be at risk for contracting HIV infection improved condom use.

Drug use patterns over time among HIV-seropositive and HIV-seronegative women: the HER study experience

BACKGROUND

Drug use, particularly among women, is a public health issue given its health effects and its impact on HIV transmission. Becoming HIV seropositive could lead to differing patterns of drug use over time. HIV infection may decrease drug use due to an increased access to health services. Alternatively, increased drug use may occur due to depression associated with being HIV infected, leading to despair, hopelessness, and a lack of motivation to become drug free.

METHODS

We evaluated the potential association between HIV serostatus and drug use among a cohort of 1310 women who were part of a multicenter collaborative study on the natural history of HIV infection. Eight hundred seventy-one HIV-seropositive women and 439 HIV-seronegative women were enrolled at four sites (New York, Providence, Baltimore, and Detroit). We defined drug use as any heroin or cocaine use reported at the baseline visit (enrollment).

RESULTS

Drug use was found to decrease during earlier visits (months 1-24) and remained stable at 20% thereafter (months 30-84). No significant differences in change of drug use were noted by HIV serostatus, using generalized estimating equation-based logistic regression analyses.

CONCLUSIONS

HIV-seropositive status did not affect drug use patterns over time within our population of high-risk women.

Secondary syringe exchange among injection drug users

Syringe-exchange programs (SEPs) have proven to prevent the spread of bloodborne pathogens, primarily human immunodeficiency virus (HIV), among injection drug users (IDUs). In the United States, only about 7% of IDUs have access to and use SEPs. Some IDUs engage in secondary syringe exchange (SSE), meaning that one IDU (a "provider") obtains syringes at an SEP to distribute to other IDUs ("recipients"). This formative qualitative research was conducted to understand why and how IDUs engage in SSE to aid in the development of a large-scale peer HIV prevention intervention. Interviews with 47 IDUs in Oakland and Richmond, California, indicated that SSE was embedded in existing social networks, which provided natural opportunities for peer education. SSE providers reported a desire to help other IDUs as their primary motivation, while recipients reported convenience as their primary reason for using SSE. Building SSE into SEP structures can facilitate an effective provision of risk reduction supplies and information to IDUs who do not access SEPs directly.

HIV, ethnicity and travel: HIV infection in Vietnamese Australians associated with injecting drug use

BACKGROUND

The movement of people with their constructed identities including ethnicity has always been one of the determinants of the human immunodeficiency virus (HIV) pandemic. An example of the contributions of travel and ethnicity to experiences of HIV can be seen in the Vietnamese community in Australia.

OBJECTIVES

This paper seeks to describe the contributions of ethnicity and travel to the Australian HIV epidemic with particular reference to the evolving epidemic within the Vietnamese Australian community.

STUDY DESIGN

We reviewed the available data on the HIV epidemic in Australia with reference to overseas acquisition, ethnicity, the epidemic in the Vietnamese community and the determinants of the current patterns of transmission within this community.

RESULTS

Available data suggests that 20-25% of HIV infections notified in Australia are acquired overseas. This proportion is higher in some specific categories such as heterosexually acquired infections. Notification rates are no higher in Vietnamese Australians than in the general Australian population apart from infections associated with injecting drug use (IDU) notified in the state of Victoria. The reasons for this increased rate of notification include increased vulnerability to blood borne virus infection in Australia and the additional, unique risk of frequent travel to Vietnam, a country where IDU carries a high risk of HIV infection.

CONCLUSIONS

Australia has succeeded in stabilising the HIV epidemic partly through successful interventions to limit the spread of infection among IDUs. There is now early evidence that HIV transmission may be increasing amongst Vietnamese Australian IDUs. Timely responses that help Vietnamese Australian IDUs reduce their accumulation of risk are likely to be important in determining the level of harm associated with IDU throughout Australia.

Adaptation and validation of a questionnaire about risk behaviors for AIDS among drug users

Objectives: To initiate the process of validation of an instrument based on an American self-reported questionnaire named RAB (Risk Assessment Battery) -- called CRA in its Brazilian version --, which covers aspects related to drug use, HIV testing, sexual behavior and concern with the transmission of the virus. The questionnaire was back-translated and its concurrent validity was tested, as well as the utility of an Overall Risk Score (ORS) for the transmission of the HIV virus or of subscores for Drug Use (SDU) or Sexual Risk (SSR). Methods: Case vignettes of ten typical cases had their questionnaire scores compared with the impression of independent referees. Results: There were systematic differences in the comparison with the specific referees for each area, suggesting that only the ORS has clinical validity, specifically regarding the exposure to risk of infection/reinfection by HIV. Conclusion: The questionnaire in its current use and format is not adequate to express impairment already caused by exposure to the virus. The specific subscores were not clinically valid to express such risk, and the instrument needs the addition of a more comprehensive section about intravenous drug use to be used in future studies.

Risk factors of HIV infection and needle sharing among injecting drug users in Ho Chi Minh City, Vietnam

OBJECTIVE

We sought to identify risk factors for needle sharing and HIV infection among injecting drug users (IDUs) in Ho Chi Minh City (HCMC), Vietnam.

METHODS

Three cross-sectional surveys among IDUs, both on the street (in 11 urban districts) and in the rehabilitation center for IDUs in HCMC, were carried out in April of 1995, 1997, and 1998. Outreach workers interviewed IDUs about socio-demographic characteristics, drug use and sexual practices, and HIV knowledge and perceptions. The IDUs were also tested for seropositivity to HIV. Independent predictors for HIV positivity and needle sharing were determined by univariate and multivariate logistic regression for the study sample within the rehabilitation center in 1997 and for that on the street in 1998.

RESULTS

The HIV prevalence in 1998 among IDUs was 44% for those on the street and 38.5% for those in the rehabilitation center. Independent predictors for HIV infection in IDUs were being injected by drug dealers (for the 1997 sample), injecting on the street, and sharing the drug pots (for the 1998 sample). The reported rate of needle sharing was low and decreased significantly from 20% in 1995 to 12% in 1998 for the sample of IDUs at the street. In the multivariate analysis, predictors for needle sharing for both study samples were injecting on the street, injecting at shooting galleries, and having shared needles in the past. Adequate and easy access to sterile needles and syringes, and a supportive environment of behavior change, especially in street and shooting gallery could reduce risks of virus transmission in the Vietnamese IDU community.

Factors associated with frequent and infrequent HIV testing

Drug user treatment clients with 5 or more HIV tests (frequent testees N=43) and 0-2 HIV tests (infrequent testees-N = 56) were compared on demographic characteristics, risk behaviors, perceived risk of HIV infection to self, involvement with family members, and psychological functioning. Extreme groups of HIV testees did not differ on any variables other than an index of perceived vulnerability to HIV infection (e.g., " You think that you really could get AIDS"). That measure of felt vulnerability was not correlated significantly with needle or sexual risk behaviors, family involvement, psychological functioning or other measures of perceived risk. It was reasoned that, in a community in which both dangers and protective behaviors are widely understood, frequent testees experience a generalized and heightened concern unrelated to specific behaviors or characteristics.

Consistent condom use in the heterosexual relationships of young adults who live in a high-HIV-risk neighbourhood and do not use "hard drugs"

This study was set up to determine the predictors of condom use in the heterosexual non-commercial sexual relationships of young adults who neither inject drugs nor use cocaine, heroin or crack, in a neighbourhood with widespread drug-use-connected HIV. The analytic sample is 279 young adults, aged 18-24, who have never injected drugs and who have not used heroin, cocaine or crack in the last year. They were recruited in the Bushwick neighbourhood of New York City, July 1997 to September 1999. A face-to-face interview included items about their sociodemographic background, substance use and sexual networks. Sexual relationship and self-reported consistent (100%) condom use over the prior year with the partner in a given relationship was examined. Subjects had 337 heterosexual non-commercial relationships. Consistent condom use was reported in 32% of these relationships. In multiple logistic regression, consistent condom use was more likely in relationships that are not 'very close' (odds ratio = 3.92; 95% confidence interval = 2.08, 7.52); in the relationships of subjects whose peer norms support condom use (OR = 1.94; 95% CI = 1.43, 2.69), who are not problem drinkers (OR = 8.70; 95% CI = 2.22, 58.8), and (perhaps as a result of measurement issues) who are men (OR = 1.95; 95% CI = 1.04, 3.68). In conclusion, consistent condom use remains uncommon among youth in this high-risk neighbourhood. It is thus important to keep HIV from entering the sexual networks of youth in communities like this through programmes aimed at drug injectors and their sexual partners. Programmes to increase condom use among young adults should focus on strengthening norms that promote safer sex to protect oneself and others. In addition, assistance should be provided to youth who are problem drinkers.

Point Defiance: a case study of the United States' first public needle exchange in Tacoma, Washington

The first publicly funded needle exchange program in the United States began in Tacoma, Washington, in August 1988. The exchange's history is characterized by a series of firsts: the first American publicly funded exchange; the first pharmacy exchange; the first American needle delivery program; and the first state Supreme Court ruling not only supporting the existence of a needle exchange program but superseding existing drug paraphernalia laws. It is also unique because it began outside of the public health system and was not compromised by political feasibility. This article documents the events and personalities which led to the exchange's establishment and its expansion over time; the program's local, state and legal challenges and advocates; its portrayal in the local and national media; the research that documented its successes; and its important contribution to the fight for drug users' unencumbered access to sterile needles.

Modelo teórico de exposição a risco para transmissão do vírus HIV em usuários de drogas

Descrevendo inicialmente as dificuldades na abordagem da Aids e da transmissão do HIV atualmente - em particular com usuários de drogas -, o autor ilustra alguns modelos teóricos relativos ao uso e abuso de substâncias e à exposição ao HIV. Descreve as teorias de aprendizado social como a base para a compreensão dos comportamentos associados ao uso de drogas, ressaltando a importância do meio como fator de risco. O modelo clássico de Crenças em Saúde é também ilustrado, ressaltando-se que esta é a base para o desenvolvimento de programas preventivos associados à Aids. Finalmente, baseando-se nos modelos descritos, o autor propõe um modelo original sobre a exposição ao HIV em usuários de drogas, no qual elementos relativos à informação, à escolaridade, ao gênero e à idade direcionam e interferem nas atitudes associadas ao uso de drogas e à percepção do risco envolvido, gerando um efeito em cascata que culmina no aumento da contaminação nesses indivíduos.

Estudo sobre as características de usuários de drogas injetáveis que buscam atendimento em Porto Alegre, RS

Introdução: O estudo descreve uma amostra de usuários de droga injetável (UDI) que buscam atendimento na cidade de Porto Alegre, a fim de conhecer melhor os métodos de exposição ao vírus HIV, gerando hipóteses para estudos futuros e diretrizes para programas preventivos. Métodos: Foram entrevistados 142 UDI, utilizando uma entrevista estruturada para levantamento de fatores de risco. Foram analisadas características demográficas e das relações sexuais, utilizando-se como desfechos de interesse o status sorológico e as características do uso de drogas, tais como freqüência e tipo de droga utilizada. Resultados: 97% dos indivíduos havia injetado cocaína (8,6 dias do mês, 9,3 vezes por dia) e usado álcool e maconha no mês prévio à entrevista; apenas 44 apresentavam testes HIV (54,5% soropositivos). Quase 90% haviam recebido aconselhamento para HIV, porém a mudança de condutas aconteceu somente numa parcela dos casos, sem informação adequada sobre limpeza de seringas; 53% dos indivíduos relataram compartilhamento de equipamento prévio à coleta de dados, utilizando 16,2 vezes a mesma seringa. Os entrevistados eram sexualmente ativos e predominantemente heterossexuais, com uma média de sete relações por mês; 44% não usou camisinha nas relações sexuais e 48% afirmou ter utilizado pelo menos álcool antes ou durante as relações. Conclusões: Os achados sugerem que o aconselhamento é importante para modificar hábitos dos UDI mas não contempla necessidades de usuários recreacionais. A limpeza de seringas é infreqüente, talvez produto da pouca informação sobre práticas de risco. Os UDI são sexualmente ativos, heterossexuais e na maioria têm poucos parceiros, o que pode justificar o baixo uso de preservativos nessa amostra. É possível que o uso freqüente de drogas antes ou durante as relações contribua para tal fato.

Risk behaviour change and HIV infection among injection drug users in Montreal

OBJECTIVE

To investigate the independent association between changes in risk behaviour and HIV seroconversion risk among Montreal injection drug users (IDU).

DESIGN

A longitudinal study of risk behaviour change and the maintenance of low-risk practices. At baseline and semi-annually, subjects were tested for HIV, and questionnaires on risk behaviour were completed.

RESULTS

A total of 833 IDU were recruited from January 1992 to June 1998, and completed a minimum of three visits. Large fluctuations in risk behaviour were observed, and the risk of HIV infection appeared to be dependent upon the consistency of risk behaviour practised. IDU who consistently engaged in risky behaviour were at high risk of HIV infection. IDU who attempted to practise low-risk behaviour but experienced relapses to risky behaviour were also at considerable risk of infection. IDU who managed to maintain low-risk practices were at minimal risk. Using Cox regression analysis, the hazard ratio (HR) of HIV seroconversion among IDU who consistently and inconsistently shared needles with an HIV-positive partner was 8.17 (95% CI 3.59-18.59) and 2.63 (95% CI 1.33-5.17), respectively, relative to non-needle sharers. Corresponding HIV incidence rates were 30.42 per 100 person-years (py) among consistent sharers, 13.78 per 100 py among inconsistent sharers and 2.51 per 100 py among non-sharers.

CONCLUSION

Although some HIV risk reduction was evident, behaviour change seems to be effective only in IDU who adopt and maintain low-risk practices. Additional strategies may be needed to assist IDU in the maintenance of low-risk practices.

Characteristics and utilization patterns of needle-exchange attendees in Chicago: 1994-1998

The objectives of this study were to describe characteristics and utilization patterns of participants attending a needle-exchange program (NEP) in Chicago, Illinois. Since 1994, demographics of NEP attendees and program utilization data were collected systematically at 22 sites operated by the Chicago Recovery Alliance (CRA). Descriptive statistics were used to assess time trends, site variations, and characteristics of attendees in day sites versus evening sites. A total of 11,855 injection drug users (IDUs) visited the NEP at least once from 1994 to 1998. Median age was 41 years, and 74% were male. Overall race distribution was African-American 50%, Caucasian 38%, Puerto Rican 10%, other 2%. Over time, there was a proportional decrease in African-American users (55.4% to 39.9%, P < .001), a significant increase in Puerto Rican users (1.4% to 14.1%, P < .001), and a stable proportion of Caucasian users (42%). Each year, 15-20% of all clients were first-time attenders. Overall, participants attending evening versus day sites were younger (median age 39 years vs. 42 years, P < .001) and more ethnically diverse. Over a 4-year period, this NEP reached a diverse population of IDUs and recruited a stable proportion of first-time users. Compared to daytime NEP venues, evening NEP sites attracted younger clients and those who were more diverse ethnically. To maximize coverage of sterile syringes, NEPs should strive for diversification in terms of hours of operation and location.

Women Injection Drug Users Who Have Sex with Women Exhibit Increased HIV Infection and Risk Behaviors

This article is a comprehensive review of published research on HIV seroprevalence and HIV-related risk behaviors among women injection drug users (IDUs) who have sex with women (WSW). At least 14 studies since the late 1980s converge into a consistent pattern: compared to other IDUs, WSW IDUs report higher levels of HIV-related risk behaviors and in many cases exhibit higher rates of HIV seroconversion or seroprevalence. Data from these and additional studies also indicate that large numbers of women IDUs are WSWs. Since information regarding WSW IDUs are widely collected but infrequently analyzed and reported, we suggest promising research and analysis strategies for exploring the meaning behind this pattern of increased vulnerability to HIV. Finally, we assert that enough is currently known to warrant significant investment in targeted prevention and intervention programs to address the critical HIV-related needs of lesbian, bisexual, and other WSW IDUs.

Structural barriers and facilitators in HIV prevention: a review of international research

OBJECTIVES

This article provides an overview of a growing body of international research focusing on the structural and environmental factors that shape the spread of the HIV/AIDS epidemic, and create barriers and facilitators in relation to HIV-prevention programs. OVERVIEW OF STRUCTURAL-FACTORS LITERATURE: Most of the research on structural and environmental factors can be grouped into a small number of analytically distinct but interconnected categories: economic (under)development and poverty; mobility, including migration, seasonal work, and social disruption due to war and political instability; and gender inequalities. An additional focus in research on structural and environmental factors has been on the effects of particular governmental and intergovernmental policies in increasing or diminishing HIV vulnerability and transmission.

INTERVENTIONS

A smaller subset of the research on structural factors describes and/or evaluates specific interventions in detail. Approaches that have received significant attention include targeted interventions developed for heterosexual women, female commercial sex workers, male truck drivers, and men who have sex with men.

CONCLUSIONS

The structural and environmental factors literature offers important insights and reveals a number of productive intervention strategies that might be explored in both resource-rich and -poor settings. However, new methodologies are required to document and evaluate the effects of the structural interventions, which by their very nature involve large-scale elements that cannot be easily controlled by experimental or quasi-experimental research designs. Innovative, interdisciplinary approaches are needed that can move beyond the limited successes of traditional behavioral interventions and explicitly attempt to achieve broader social and structural change.

Human rights is a US problem, too: the case of women and HIV

Overall, US AIDS incidence and mortality have shown significant declines since 1996, probably because of new antiviral therapies. For women, however, these benefits have been much less pronounced than for men. At the heart of women's HIV risk is gender-based discrimination, which keeps women, and especially women of color, poor and dependent. Although human rights issues are often linked with AIDS issues abroad, in the US they receive insufficient attention in our response to women's HIV risk. Advocacy from public health professionals is needed to overcome the longstanding paternalistic attitudes of federal agencies toward women and to change the paradigm of women's HIV/AIDS prevention and care. Examples of unjust and punitive social policies that may affect women's HIV risk include the 1996 welfare policy legislation, drug treatment policies for women, and women's access to medical research and technology. The overriding public health response to AIDS consists of behavioral interventions aimed at the individual. But this approach will not successfully address the issues of women with AIDS until efforts are made to eliminate society's unjust and unhealthy laws, policies, and practicles.

Evaluation of the exposure effects of a theory-based street outreach HIV intervention on African-American drug users

The Street Outreach to Drug Abusers-Community AIDS Prevention (SODA-CAP) Project implemented and evaluated an HIV-prevention intervention aimed at current drug users. The intervention was developed using social cognitive theory and the transtheoretical model of change. The outreach team assessed individuals' stages of change for the target behaviors and they were given stage-appropriate role-model stories. The program effects were evaluated using a quasi-experimental design with a repeated, cross-sectional sampling method in which community surveys were administered at baseline, 12 and 22 months. Multivariate statistical models were developed for four outcomes (condom use with main and other partners, treatment entry, and stopping all drug and alcohol use). Exposure to intervention was a significant predictor for condom use with other partners and for stopping drug and alcohol use.

Methamphetamine use and sexual and injection risk behaviors among out-of-treatment injection drug users

Our primary objective was to examine the relationship between methamphetamine use and sexual risk-taking behaviors--number of sexual partners, frequency of sexual behaviors with regular and casual partners, trading money or drugs for sex, and condom use--among male and female out-of-treatment injection drug users (OTIDUs). As a risk group for human immunodeficiency virus (HIV) transmission, we also investigated injection behaviors by methamphetamine use. Data were collected from 1392 OTIDUs within the California counties of Fresno, Sacramento, and San Diego. Excluded from this cross-sectional survey were male OTIDUs engaging in sex with only or mostly men since 1978. In bivariate analyses, we found that male OTIDUs with a history of methamphetamine use had more sex partners and participated in more acts of anal insertive intercourse with casual partners and vaginal intercourse with regular and casual partners than male OTIDUs never using methamphetamines. In addition, a greater percentage of male OTIDUs using methamphetamines reported trading sex for money or drugs. Methamphetamine-using female OTIDUs participated in more acts of vaginal intercourse with regular male sex partners than female OTIDUs never using methamphetamines. By multivariate logistic regression, we found methamphetamine use related to consistent condom use among male OTIDUs and among male sex partners of female OTIDUs. Discriminant function analyses revealed that sexual risk taking could be differentiated by methamphetamine use among male OTIDUs. Methamphetamine use also correlated with using shared needles or syringes among male and female OTIDUs and was related to not always disinfecting used needles or syringes with bleach. Our findings suggest that methamphetamines may contribute to heterosexual HIV transmission.

Longitudinal changes in sexual risk behavior among HIV+ and HIV- male injecting drug users

Injecting drug users (IDUs) play a prominent role in the transmission of human immunodeficiency virus (HIV), particularly in urban areas such as New York City, where they comprise nearly half of all adult acquired immunodeficiency syndrome (AIDS) cases. Intervention studies have demonstrated that IDUs are responsive to safer sex messages, but sexual behavior appears to be more resistant to change than drug use behavior. This multidisciplinary study (without an intervention component) assesses changes in sexual risk behavior as a function of time, HIV status, and disease progression in a cohort of HIV+ and HIV- male IDUs (N = 144) for 4 years.

RESULTS

For HIV+ and HIV- men, there were increases in abstinence and monogamy, with decreases in the frequency of unprotected vaginal/anal sex and sexual risk index scores. With the exception of monogamy, HIV+ men reported lower levels of risk. Although there was also a decline in substance use, this accounted for only some of the decline in sexual risk behavior. Among the HIV+ men, a CD4 level below 200 was associated with more abstinence and monogamy. HIV-related medical symptoms were associated with increased abstinence, less unprotected sex, and lower sexual risk index scores. Lower neuropsychological memory test scores were associated with increased abstinence and lower sexual risk index scores. Neurological impairment and depression were not associated with sexual risk behavior.

CONCLUSION

IDU men in New York City have modified their sexual behavior toward safer practices. Lower levels of risk are found among HIV+ men, particularly those with more progressed HIV illness. Nevertheless, a substantial amount of sexual risk behavior remained in this cohort, indicating the continued need for education and intervention.

Infecção pelo HIV entre usuários de drogas injetáveis: análise dos fatores de risco no Município do Rio de Janeiro, Brasil

O trabalho visa a determinar os fatores de risco para a infecção pelo HIV (Human Immunodeficiency Virus - vírus da aids) entre usuários de drogas injetáveis (UDI), no Município do Rio de Janeiro. Os entrevistados foram recrutados em centros de tratamento para usuários de drogas e nas "cenas de uso" ("ruas"). Foram utilizados três questionários: um destinado a colher informações mais gerais acerca dos UDI, adaptado de estudo anterior da Organização Mundial da Saúde (OMS); um segundo voltado para a pesquisa de informações suplementares sobre conhecimentos, comportamentos e atitudes em relação à aids; além de um terceiro instrumento destinado a avaliar níveis de disfunção psicológica. O estudo consistiu de 110 entrevistados que voluntariamente realizaram testes laboratoriais para a presença do HIV, além de outros agentes infecciosos de transmissão sangüínea (HBV, HCV, HDV, HGV/GBV-C, HTLV-I/II). A soroprevalência para o HIV-1 foi de 28,7%. Utilizando-se um modelo de regressão logística múltipla (Estatística de Hosmer-Lemeshow, c² = 1,89; p=0,98), foram identificados como fatores de risco para a infecção pelo HIV: "local de moradia de baixa renda" (OR=5,57; IC 95%: [1,39 - 22,27]), "fonte de renda irregular" (OR=3,26; IC 95%: [1,01 - 10,51]), "menor idade de início quando do consumo de drogas injetáveis" (OR=2,50; IC: 90%: [0,99 - 6,28]), "local de recrutamento nos centros de tratamento para uso de drogas" (vs. recrutamento nas "ruas") (OR=7,91; IC 95%: [2,03 - 30,87]) e "maior freqüência de compartilhamento do material de injeção nos 6 meses anteriores à entrevista" (OR=4,41; IC 95%: [1,33 - 14,64]).

Sexual risk behavior changes among HIV+ and HIV-female injecting drug users over 4 years

This paper examines the sexual risk behavior of female injecting drug users who participated in a 4 year longitudinal study. Both HIV+ and HIV- women showed increases in monogamy, decreases in the frequency of unprotected vaginal/anal sex, and decreases in a risk index score throughout the study. HIV+ women had fewer occasions of unprotected sex than HIV-. However, a substantial proportion of the sample continued to engage in unprotected sex. Among the HIV+ women, depressed mood was significantly related to abstinence and to fewer occasions of unprotected sex, but CD4, medical symptoms, neurological impairment, and memory test performance were not associated with sexual risk behavior.