Helen Navaline

High-Risk Behaviors for HIV: A Comparison Between Crack-Abusing and Opioid-Abusing African-American Women

High rates of unprotected sexual behaviors and the exchange of sex for crack have been reported among female crack cocaine users. This subpopulation of drug users is at significant risk for contracting and transmitting HIV and AIDS. To date, there has been no research comparing crack- and opioid-abusing women, particularly regarding their involvement in high-risk behaviors and other key background indicators for different subgroups of drug-abusing women. Sixty-one crack-abusing African-American women who recently entered an intensive outpatient treatment program were compared to 64 matched women whose primary drug of abuse was heroin. The opioid subgroup represented both those who were involved in methadone maintenance and those who were out of treatment. Higher rates of high-risk sexual behaviors were reported by the crack subgroup, including prostitution, number of sexual partners, and infrequency of condom use. As expected, i.v. drug use and high-risk behaviors associated with needle use were much higher among the opioid subgroup. Other significant differences were found between the two groups across key indicators. Individuals in the crack subgroup were younger, cared for more children, were less employable, were less likely to be married, and had more extensive lifetime substance abuse. Quantitative and qualitative background and clinical data are also presented. The nature of crack versus heroin abuse is also discussed, particularly in relation to high-risk sexual behaviors. Finally, the impact of the findings on developing appropriate treatment interventions for both groups is addressed.

HIV prevention among injection drug users: the need for integrated models.

Opportunistic infections (OIs) were first recognized among injection drug users (IDUs) in New York City in 1981. By the mid-1980s, OIs had become associated with HIV infection, and attention began to focus on efforts to prevent HIV transmission among IDUs. Since then, a range of prevention strategies has been implemented and evaluated in an attempt to reduce the spread of HIV infection among drug users. These prevention strategies include (1) HIV testing and counseling and educational and behavioural interventions delivered through community outreach; (2) condom, bleach, and needle distribution and syringe access and exchange programs: (3) substance abuse treatment; and, more recently, (4) prevention interventions targeting HIV-positive IDUs. Data from evaluations of these strategies over the past 20 years have provided substantial evidence of effectiveness and have helped to inform network-based and structural interventions. Despite the cumulative empirical evidence, however, research findings have yet to be widely, disseminated, adopted, and implemented in a sustained and integrated fashion. The reasons for this are unclear, but point to a need for improved communications with program developers and community planners to facilitate the implementation and evaluation of integrated intervention strategies, and for collaborative research to help understand policy, legal, economic, and local barriers to implementation.

HIV vaccine trials: will intravenous drug users enroll?

OBJECTIVES The purpose of this study was to assess the willingness of intravenous drug users to participate in a preventive human immunodeficiency virus (HIV) vaccine efficacy trial. METHODS Of the 347 intravenous drug users in methadone treatment who were approached for participation, 257 completed a battery of self-administered questionnaires assessing risk behaviors, interest in vaccine trials, and other vaccine-related information. Data from 16 known seropositives and 1 inconsistent responder were dropped from analyses (n = 240). RESULTS Fifty-two percent of the subjects expressed a willingness to be one of the first individuals to participate in a preventive HIV vaccine efficacy trial. Subjects who had recently shared needles or works and subjects who trusted the government to ensure vaccine safety were both twice as likely to report interest in participation. Twenty-two percent of subjects reported that they would increase needle sharing if vaccinated. Thirty percent did not know what a vaccine was. CONCLUSIONS These findings suggest that some in-treatment intravenous drug users would volunteer for a preventive HIV vaccine efficacy trial. Education and counseling will be required to ensure that subjects fully understand the trials purposes, methods, risks and benefits.

Long-term changes in psychological symptomatology associated with HIV serostatus among male injecting drug users.

ObjectiveTo examine long-term changes in psychological symptomatology from 6 to 24 months after notification of HIV serostatus among male injecting drug users (IDU). DesignSelf-report and interview data were collected at 6-month intervals as part of a longitudinal study monitoring HIV infection and risk-associated behaviors among IDU. SettingA community-based methadone-maintenance clinic. ParticipantsNinety-seven male IDU (81 HIV-seronegative, 16 HIV-seropositive), including both methadone-maintained and out-of-treatment IDU. Main outcome measuresAnalyses of long-term changes in psychological symptomatology associated with HIV serostatus among male IDU. ResultsAnalyses of long-term changes in psychological symptomatology between groups revealed no significantly greater levels of overall psychological distress or significant elevations on subscales of the Symptom Checklist-90 for HIV-seropositive compared with HIV-seronegative male IDU. Also, no significantly higher scores on the Beck Depression Inventory or the psychiatric composite score of the Addiction Severity Index were observed between groups. ConclusionsOur results suggest that HIV-seropositive male IDU do not express greater levels of psychological symptomatology from 6 to 24 months following notification of seropositivity compared with HIV-seronegative male IDU. Several explanations for these findings are considered. Future work should examine why male IDU do not report significant and long-term elevations in symptoms post-notification of HIV seropositivity. Also, studies of changes in psychological symptomatology as a function of HIV serostatus among female IDU need to be conducted to assess implications for treatment interventions among this underserved population.

Will preventive HIV vaccine efficacy trials be possible with female injection drug users

This article examines whether preventive HIV vaccines trials will be viable among female injection drug users (IDUs). Of the 137 women who completed baseline serologic and behavioral assessments, 121 (88%) were seronegative; all enrolled in Project Jumpstart in Philadelphia (PA, U.S.A.), a vaccine preparedness initiative cosponsored by NIAID and NIDA. Subjects were seen every 3 months for risk and vaccine opinion assessment, risk reduction counseling, and HIV antibody testing. The baseline prevalence rate of HIV infection was 12% (16 of 137) with an annual incidence rate of 3.5% (4 of 114) during the first year. Of the 121 baseline seronegative women, 28% shared needles and 52% engaged in unprotected intercourse. Sixty percent of the baseline seronegative women reported being willing to be one of the first people to try an HIV vaccine. According to logistic regression, needle sharers were 12.8 times more likely, women who engaged in sex for drugs or money 6.6 times more likely, out-of-treatment women 3.5 times more likely, and those who believed that vaccines can prevent disease acquisition 3 times more likely to report willingness to try an HIV vaccine than their respective counterparts. At 1-year postbaseline assessment, 98% of the women had behavioral data collected and 95% had serologic specimens collected. Given that seroconversions occur and that these women engage in risk behaviors, report willingness to try an HIV vaccine, and can be retained for longitudinal assessment, they appear to be suitable participants for preventive HIV vaccine efficacy trials. Nonetheless, work is required to insure that these women make informed and knowledgeable decisions regarding trial enrollment.

The Role of Drug Abuse Treatment in the Prevention of HIV Infection

The acquired immunodeficiency syndrome (AIDS) epidemic has had a profound impact on the community of injection drug users (IDUs) in the United States. The human immunodeficiency virus (HIV) is believed to have been introduced into this risk group in the mid-1970s,1,2 and within two decades estimates suggest that over 300,000 IDUs had become infected. During this time over 100,000 IDUs are believed to have died of AIDS-related causes. Injection drug use has become the leading cause of infection among newly diagnosed AIDS cases.3

Attitudes toward mandatory human immunodeficiency virus testing and contact tracing. A survey of intravenous drug users in treatment.

Legal initiatives and treatment policies regarding mandatory human immunodeficiency virus testing and contact tracing often are considered without the input of those groups most affected by the proposed legislation. A survey of attitudes toward the testing and tracing issues was conducted on one such group--intravenous drug users in treatment. Interview and self-report questionnaire data were collected on 196 methadone-maintained patients from two Philadelphia clinics. Data indicate that although most methadone patients supported mandatory testing, their support appears to be influenced by past testing experience. That is, significantly more untested than tested individuals were opposed to the policy. Regarding contact tracing, data indicate that most patients with seronegative results supported tracing, but of the three patients with seropositive results who were surveyed, two were opposed to it. However, most seropositive and seronegative patients reported a willingness to comply with tracing if it were to become law.

Service Needs of Injection Drug Users

A number of recent investigations have focused on the treatment needs of injection drug users (IDUs); especially with regard to gender and ethnic/ racial differences. The results of those studies indicate that female IDUs represent a large portion of the addicted population, and have particular treatment needs that differ from their male counterparts. In addition, those treatment needs often vary among ethnic and racial groups. In order to elucidate the service needs of IDUs, data is presented from a recent study that compares the gender and racial differences in characteristics and service utilization of subjects in methadone treatment. The results of that study parallel other research, and indicate that gender and racial differences are important factors to consider in the development of effective treatment programs.