Henry H. Cagle

Needle exchange and injection drug use frequency: A randomized clinical trial

Despite a lack of evidence that needle exchange programs (NEPs) cause an increase in injection drug use, there are still concerns over fostering increased injection behavior with NEPs. The design was a randomized controlled trial conducted from May 1997 to June 2000 comparing injection drug users (IDUs) who are randomly assigned to have access to an NEP versus training in how to purchase needles and syringes (NS) at pharmacies. Of 653 IDUs recruited into the study, 600 were randomized: 426 were followed-up at 6 months, and 369 were followed-up at 12 months. Four hundred ninety were followed up at least once. There was no difference in the number of injections over time between the NEP and the Pharmacy Sales arms of the study or in the percentage of positive urine test results over time between the NEP and the Pharmacy Sales arms of the study for morphine and amphetamine. The decrease in the presence of cocaine was marginally greater between the arms of the study. The results do not support the hypothesis of NEPs causing an increase in injection drug use. This clinical trial provides the strongest evidence to date that needle exchanges do not produce this negative effect.

Gonorrhea Among Drug Users: An Alaskan Versus a National Sample

The study described here investigates the replicability of gender-specific risk profiles for gonorrhea based on an Alaskan sample compared to a U.S. national sample of drug users at risk for HIV infection. The Alaska sample (interviewed at a field station in Anchorage, Alaska; N=1,049) and the national sample (interviewed at 18 sites other than Alaska; N=17,619) consisted of cocaine smokers and injection drug users not in drug treatment. A history of gonorrhea infection was self-reported and coded as ever or never. The Anchorage and national risk profile for men included the following factors: (a) history of intranasal or parenteral cocaine use, (b) being black versus nonblack, (c) being older, (d) income from illegal activity, and (e) history of amphetamine use. The Anchorage and national risk profiles for women included the following factors: (a) trading sex for money, (b) being Native American versus non-Native American, and (c) trading sex for drugs. The Anchorage model for women included perceived homelessness as a factor, but it was not retained in the national model. The extent of the replicability of these models illustrates the generalizability of Alaskan findings to other U.S. drug-using populations. The authors also discuss the implications of these findings for disease prevention.

Sex partners of native American drug users

This study describes patterns of sexual behavior and condom use in a sample of Native American drug-using men and women (N = 114). Data are self-reports of sexual behavior in the last 30 days, including descriptions of the most recent sex partners up to five. These data provided information on 157 sex partner pairs, of which at least one partner was a drug user. Native American women (55%) were more likely than Native American men (23%) to report never using condoms for vaginal and anal sex in the last 30 days. Compared with other ethnic pair combinations, sex partner pairs composed of Native American women and white men (n = 18) were the least likely to use condoms (6% of pairs) and the most likely to report an injection drug user (IDU) sex partner (33% of pairs). These results suggest a potential vector of HIV and other sexually transmitted disease (STD) transmission between white male IDUs and Native American women and highlight the need for further qualitative and quantitative research to examine the factors underlying this pattern of sexual risk behavior.

Reading Abilities of Drug Users in Anchorage, Alaska

Evaluated the reading abilities of 122 male and fifty-nine female intravenous and other drug users in Anchorage, Alaska. Reading abilities were assessed through the Reading subtest of the Wide Range Achievement Test-Revised and the short Form of the Woodcock Reading Mastery Test-Revised. Results indicated that men and Black subjects reported the highest levels of schooling completed. However, no differences were revealed across gender and ethnicity in actual reading levels. Among all subjects, the average reading ability was between 8.5 and 8.7 grade level. These scores place the average subject reading at a level lower than approximately 76 percent of the general population. Implications are provided for development of educational materials accessible for this population.

The role of employment cycles and incentives in the recruitment of drug users

This study evaluates the role of monetary incentives in the recruitment of crack-cocaine and injection drug users into an AIDS prevention program in Anchorage, Alaska. The study also looks at how seasonality impacted recruitment of this population. Data from interviews with 1,427 out-of-treatment drug users were aggregated to monthly levels. Forty-seven months of data were used in the analysis. Independent variables included monthly income, source of income, employment status, self-reported homelessness, incentive paid at intake, potential incentive at follow-up, and data on the local unemployment rate. A dummy coded variable for seasonality also was included. Regression analysis was used to develop a model using number of individuals recruited each month as the dependent variable. Only one variable, the incentive paid at intake, was significant at p < .05. A strong interaction effect was found between the amount of the incentive paid at intake and seasonality. The chapter concludes that the use of monetary incentives has a positive effect on the recruitment of hidden populations.

Assessing Community-Based AIDS Helpline Service Provision in Alaska

AIDS helplines provide an important public health service in disseminating information on HIV/AIDS, sexual risk behaviors, testing information, and situations that do not confer the risk of HIV acquisition. The Alaskan AIDS Assistance Association (AAAA) maintained a telephone helpline for the state of Alaska. This paper evaluated data collection efforts at this community-based organization. Data concerning the demographics of callers and topics and patterns of helpline utilization for the years 1991, 1992, 1995, and 1996 were investigated. Differences were found in topics of inquiry with respect to caller gender and time of day in which the call was logged, using correspondence analysis. Men were more likely to request information on HIV testing and safe-sex practices. Women were more likely to request information on other topics such as household transmission of HIV and information on transmission of HIV to children in settings such as childcare centers and schools. Knowledge of caller demographics and concerns has been used by AAAA to improve helpline services and volunteer training. Revelations concerning missing data have resulted in changes to data collection procedures.