Associations among correlates of schedule adherence to antiretroviral therapy (ART): a path analysis of a sample of crack cocaine using sexually active African-Americans with HIV infection

Adherence to HIV medication regimens is a function of multiple dimensions including psychological functioning, social support, adherence self-efficacy and optimism regarding treatment. Active substance use can also negatively affect adherence. An understanding of the nature of the associations among the correlates of adherence can better inform the design of interventions to improve adherence. This study developed an exploratory path model of schedule adherence using data from a sample 130 African-American HIV-positive crack cocaine users on highly active antiretroviral therapy (ART). This model was based on the Transactional Model of Stress and Coping developed by Lazarus and Folkman. Following the theory, the effects of psychological distress on schedule adherence were mediated by patients' relationship with their doctor and optimism towards antiretroviral treatment. Adherence was also associated with patients' self-efficacy regarding their medical regimen which, in turn, was associated with their social support.

A comparison of psychosocial barriers among welfare recipients: implications for drug treatment

Implementation of Temporary Assistance for Needy Families (TANF) presents welfare recipients with time-limited benefits and work requirements. However, it is estimated that over 140,000 welfare recipients meet the DSM-IV criteria for "drug dependence". In this study, samples of chronic drug using and non-drug using female TANF recipients were compared with regard to: current employment, psychological functioning, self-perceived employment skills, barriers to employment, and need for help in seeking employment. It was found that non-drug using study participants were significantly more likely to be employed and reported significantly higher self-perceived work skills than users. Chronic users reported significantly greater barriers to seeking employment.

Partner concordance in reports of joint risk behaviors

OBJECTIVE

To evaluate the accuracy of self reports on sexual and drug use behaviors.

METHODS

Data from a network study of HIV transmission among a sample of drug users and nonusers are used to compare reports of sexual and drug use behaviors by partners who engaged in those behaviors. Partner concordance (self-report agreement between two people) was used as an estimate of validity.

RESULTS

Results showed that persons are able to recall and report about 85% of their recent partners (15%-20% less for recent drug use partners). For relationships that were reported by both partners, a high degree of concordance existed about recent behaviors (83%-96%) and variable agreement about frequency (0.48 </= r </= 0.86). When the time between interviews was longer, then recall, behavioral concordance, and agreement about frequency were lower.

CONCLUSIONS

Underreporting of sex and drug partners may make HIV prevention and intervention efforts more difficult if risk partners cannot be identified. The ability to reach out to all affected partners is critical in the effort to contain any epidemic. Underreporting may also skew epidemiologic projections on which many policy decisions are made.

Labor force participation in a sample of substance users

This paper reviews the microeconomic theory underlying the work/leisure tradeoff and how this tradeoff may be manifested among substance users. The effects of drug use, demographic factors, and income factors on the probability of labor force participation are analyzed in a sample of 687 male and 327 female drug users. The decision not to seek employment appears to be associated primarily with non-job-related sources of income (including illegal sources).

Economics as a factor in models of behavioral motivation and change

This note first presents a summary of four main behavioral models that are used to explain behavioral motivation and change. Three models are based on psychosocial theory. They are: 1) the Theory of Reasoned Action, 2) the Theory of Planned Behavior, and 3) the Theory of Stages-of-Change. The fourth model is based on economic theory and is known as the Rational Addiction Model. Each model is analyzed for its strengths and weaknesses. The note concludes by arguing for the usefulness of integrating the economic and the psychosocial models to study drug use. Specific examples and suggestions are presented.

An analysis of unmet need for HIV services: The Houston Study

HIV/AIDS is indicative of general institutional neglect that disproportionately affects minorities, poor, and underserved populations. Among women and minorities, HIV infection is associated with preexisting economic distress. Moreover, socioeconomic resources, gender, and race/ethnicity may determine access to medical and nonmedical services that affect disease progression. An analysis of data collected for the Ryan White Care Act needs assessment in Houston, Texas, was performed to assess the effects of socioeconomic and demographic factors on unmet needs for existing medical, social, and counseling services, adjusting for the effects of illness and substance abuse. Results indicated that lower income and Hispanic ethnicity were associated with the unmet need for medical services. Higher income was positively associated and African American ethnicity was negatively associated with the unmet need for social services. Also, higher income and private insurance were negatively associated with counseling services. The authors suggest that these latter findings may result from program eligibility requirements and respondents' hierarchy of needs, respectively.

Therapeutic connection and client progress in drug abuse treatment

This article explores the effects of the therapeutic connection between the drug abuse treatment client and the treatment counselor on the client's progress in psychological functioning during the course of treatment. Two hypotheses of the relationships between therapeutic connection and psychological functioning are formulated. The first predicts that higher levels of connection will be associated with greater improvement in the client's level of psychological functioning. The second predicts that higher levels of functioning at intake will, in turn, be associated with greater connection to counselor. Results from a longitudinal study of 139 participants in a federally sponsored pilot drug abuse treatment program in Houston, Texas show statistically significant associations between both a client's initial level of psychological functioning and therapeutic connection to counselor and between this connection and subsequent improvement in functioning.

Determinants of HIV seroprevalence rates among sites participating in a community-based study of drug users

The National Institute on Drug Abuse's National Cooperative Agreement Project is a nationwide study of the injection and sexual behaviors of three populations of out-of-treatment drug users: injecting drug users (IDUs) who did not smoke crack cocaine, non-injecting crack smokers, and those engaging in both types of use. The goal of the analyses we present was identification of subsets of behavioral variables that would, within each type of drug use, distinguish sites by HIV seroprevalence level. Among non-crack-smoking IDUs high seroprevalence rates were associated with race and sex, the overall frequency of injection, the frequency of cocaine injection, and geographic location. Among noninjecting crack smokers, cities were distinguished by the frequency of exchanging sex for money, the number of sex partners, the local seroprevalence rate among IDUs, and location. Among subjects engaging in both types of use, seroprevalence rates among sites was distinguished by the frequency of exchanging sex for drugs and location.

The trajectory of client progress. A longitudinal pilot study

Successful nonchemical drug treatment is a transformative experience: client change is the goal of treatment. Two domains in which programs intend to facilitate change are emotional well-being and the therapeutic relationship. Little previous research has addressed the question of what changes clients in drug treatment actually undergo while in treatment. This article presents results from a pilot longitudinal study of clients in two short-term drug treatment programs in Houston, TX. Results showed measurable increases in self-esteem and connection to counselor and decreases in anxiety and depression over the course of treatment for clients who completed treatment. Program graduates and early withdrawals showed distinctly different patterns of progress as measured by emotional and relationship scales.