Hugh Klein

Frequency and intensity of crack use as predictors of women’s involvement in HIV-related sexual risk behaviors

Recent trends in the progression of the AIDS epidemic in the United States indicate that womens rates of acquiring HIV are escalating more rapidly than are mens. Consequently, there has been both an increasing interest in and a need for research targeting substance-abusing womens involvement in HIV risk behaviors. In recent years, strong suggestive evidence has arisen to suggest that women who use crack cocaine are at an elevated risk for acquiring HIV, probably as a result of their involvement in high-risk sexual behaviors. The present study is based on a sample of 1723 women from 22 locales around the United States who used crack cocaine at least once during the previous 30 days but who reported never having injected drugs at any point in their lifetime. Women were divided into four groups based on their frequency and intensity of using crack. In subsequent analyses, this grouping was used to predict the extent to which female crack users engage in five sexual risk behavior measures (number of sexual partners, number of drug-injecting sexual partners, number of times having sexual relations while high on alcohol and/or other drugs, number of times trading sex for drugs and/or money, and proportion of all sexual acts involving the use of protection). The data revealed that the women who used crack with the greatest frequency and the greatest intensity were the most heavily involved in risky sexual behaviors. They differed quite sharply from their lower-intensity and/or lower-frequency crack-using counterparts in terms of their HIV risk behavior involvement and in terms of their actual HIV seroprevalence rates.

Self-Esteem and “At Risk” Women: Determinants and Relevance to Sexual and HIV-Related Risk Behaviors

ABSTRACT In this study, we describe the relationship between self-esteem and HIV-related risk behaviors, and explore what factors predict self-esteem levels of “at risk” women. Interviews were conducted with 250 (predominantly African American) women living in the Atlanta, Georgia metropolitan area between August 1997 and August 2000. A community identification process was used to identify potential study participants, with further expansion of the sample via targeted and theoretical sampling and ethnographic mapping procedures. Self-esteem was related to the number of times having oral sex, the number of times having sex with paying partners, the frequency of sexual risk-taking (all during the 90 days prior to interview), the number of different HIV risk behaviors practiced during the previous year, and condom use attitudes and self-efficacy. Greater involvement HIV risk behaviors was associated with lower self-esteem. Multivariate analyses revealed five significant predictors of womens self-esteem levels: race, religiosity, childhood experiences with emotional neglect, the number of money-related problems experienced, and the number of drug-related problems experienced. The findings indicate that self-esteem is highly relevant to “at risk” womens HIV risk behavior practices, and this has important implications for HIV intervention programs.

At Risk Women Who Think That They Have No Chance of Getting HIV: Self-Assessed Perceived Risks

ABSTRACT During the past two decades, a fair amount of inconclusive research has been conducted to examine the relationship between perceived risk of contracting HIV and actual HIV risk behavior practices. The present study examines HIV risk perceptions among a sample of 250 urban, economically-disadvantaged, primarily minority women. In particular, we focus on differences between those saying that they have no chance whatsoever of contracting HIV and those who indicated at least some possibility of becoming HIV-infected. Three research questions are addressed: (1) Are there differences between these groups attributable to their risk behavior practices? (2) To what extent do women who think that they are not at risk for HIV engage in risky behaviors that could expose them to HIV? (3) What are the most salient predictors of the womens perceived risk classification? Results showed that women perceiving themselves to have at least some HIV risk engaged in higher rates of risky behaviors than their counterparts who perceived themselves to have no possibility of contracting HIV. Despite this finding, more than one-half of the “no perceived risk of HIV” sample had engaged in at least one risky practice during the preceding year and more than one-quarter had engaged in at least two such behaviors. Age, childhood maltreatment experiences, self-esteem, number of HIV risk behaviors practiced, amount of illegal drug use reported, and number of times having sex were significant predictors of womens perception of having some HIV risk versus having no HIV risk.

Perceived Susceptibility to HIV among Women Differences According to Age

Older womens risk of acquiring HIV should not be discounted, because researchers have noted that older women may be at an increased risk of contracting HIV due to their heterosexual sexual practices and/or substance use behaviors. HIV prevention efforts must be directed at older adults who engage in high-risk sexual and drug behaviors, particularly those who may not perceive themselves to be at risk for HIV infection. This study is based on 183 women, mostly African American, divided into two age cohorts (ages 18 to 29, and ages 40 and older). The authors investigate factors associated with HIV risk perception in several domains, including individual, psychosocial, and sociodemographic characteristics as well as sexual and drug use behaviors. Multivariate analyses revealed differences in factors associated with younger and older womens HIV risk perceptions. Our findings indicate a need for HIV risk prevention programs to take age into consideration when developing intervention messages and strategies.

Using a Syndemics Theory Approach to Study HIV Risk Taking in a Population of Men Who Use the Internet to Find Partners for Unprotected Sex

This study examines the value of using syndemics theory as a model for understanding HIV risk taking in a population of men who are at great risk for acquiring and/or transmitting HIV. The principal aim is to provide an empirical test of the applicability of the theory to sexual risk behaviors in this particular research population. The study was based on a national random sample of 332 men who have sex with men, or MSM, who use the Internet to seek men with whom they can engage in unprotected sex. Data collection was conducted via telephone interviews between January 2008 and May 2009. As hypothesized in the syndemics theory model, attitudes toward condom use were central to understanding men’s involvement in risky sex. As hypothesized, these attitudes depended on various demographic, psychological/psychosocial functioning, and sex-related preference measures. Also as hypothesized, psychological and psychosocial functioning were found to be very important to the overall model, and as expected, these factors were shaped greatly by factors such as demographic characteristics and childhood maltreatment experiences. The structural equation assessing the fit of the overall model indicated solid support for the syndemics theory approach. Overall, syndemics theory seems to apply fairly well to understanding the complexity of the factors that underlie men’s risk-taking practices. The complicated interplay among factors such as attitudes toward condom use, childhood maltreatment experiences, psychological and psychosocial functioning, and substance use and abuse—all of which are central to a syndemics theory approach to studying risk—was demonstrated.

Perceived condom use self-efficacy among at-risk women.

The objectives of this study are to assess the confidence in their ability to use condoms among at-risk women and identify predictors for the womens condom use self-efficacy. Structured interviews were conducted with 250 adult women in Atlanta, Georgia, between August 1997 and August 2000. Overall, the women reported feeling moderately to moderately–strongly confident in their ability to use condoms consistently. Multivariate analysis showed women with higher condom use self-efficacy were significantly younger, experienced childhood neglect, had higher self-esteem, communicated better with their sex partner, and had fewer drug problems. Findings suggest the importance of addressing condom use self-efficacy in HIV risk reduction programs with a specific focus on women and the need to be attuned to tailored needs for specific subgroups such as older women or women who encountered childhood neglect.

Depression and HIV risk behavior practices among at risk women.

ABSTRACT In this study, we examined the relationship between depression and HIV-related risk behavior practices in a sample of 250 “at risk,” predominantly African American women living in the Atlanta, Georgia metropolitan area. Interviews were conducted between August 1997 and August 2000. Street outreach efforts were used to identify potential study participants, with further expansion of the sample via targeted sampling and ethnographic mapping procedures. Our conceptual model hypothesized a relationship between depression and HIV risk in which depression and condom-related attitudes were construed as intervening (or mediating) variables. A multivariate analysis was used to determine the relationship between depression and womens risk behaviors. The results showed that depression was a key-mediating variable, having its primary influence on womens risky practices through its impact upon their attitudes toward using condoms. Factors associated with depression, included religiosity, closeness of family relationships, financial problems, childhood maltreatment experiences, and drug-related problems. The implications of these findings for prevention and intervention efforts are: (1) heightening faith community involvement and religious participation to decrease depression; (2) working with women whose familial bonds are in need of strengthening to combat depression; (3) providing mental health and counseling services to women who were emotionally and/or sexually abused during their formative years seems to help these women to recover from unresolved issues that may be fueling depression; (4) assisting “at risk” women who need training in money management issues to minimize their risk for depression; and (5) helping women drug abusers to receive treatment for their drug problems to combat their depression and lower their HIV risk.

Predictors of sexual risk‐taking among new drug users

We studied predictors of HIV‐related sexual risk‐taking among individuals who initiated the use of heroin or metham‐phetamine during the past 5 years. Many studies have linked drug use to HIV risk, but most research has been based on samples of users with long‐established drug careers. We conducted face‐to‐face interviews with 153 adult new drug users in Atlanta, GA. Drug use was not a statistically significant predictor of sexual risk, but gender, age, race, homelessness status, childhood neglect, level of paranoia, and level of (dys)functionality in handling disagreements were associated with frequency of sexual risk‐taking. We discuss the need to incorporate new drug users in HIV/AIDS and other health‐related prevention and intervention programs.

SHOOTING GALLERY USERS AND HIV RISK

Recognizing that HIV transmission occurs within situated interactions between two or more people, prevention research has increasingly begun to focus on identifying the influence of situations and settings on the spread of HIV. Examination of the social geography of risk has emerged as a powerful tool for understanding where and among whom risky practices occur. In this regard, shooting galleries represent interactional territories where the normative expectations of participation within their spatial boundaries can both encourage and reinforce sex- and drug-related risky behavior. Indeed, research shows that those who inject in shooting galleries tend to be at a higher risk of transmitting HIV than those who inject elsewhere. Drawing upon data from a sample of 1,113 active injecting drug users, we examined the demographic and psychosocial factors that predict shooting gallery use. Next, we compared shooting gallery users with nonusers in terms of drug use, followed by an examination of differences in sex- and drug-related HIV risk behaviors. Then, we explored preventive practices that possibly differentiate those who use shooting galleries from those who do not. We end our analysis by discussing the implications of our results for HIV prevention and social policy.

Religiosity and HIV Risk Behavior Involvement Among "At Risk" Women

During the past decade, increased attention has been payed to the role that religious and faith-based organizations can play in enhancing health behaviors. Generally, researchers have found that religious and faith-based programs can have a positive impact upon enhancing peoples health and helping them to reduce risky health practices. Initial research into the impact that these programs can have on HIV-related knowledge and risk behaviors has also been promising, albeit quite limited. In this study, we examine the role that religiosity plays in womens involvement in HIV risk behaviors. Religiosity was found to be a strong predictor of womens involvement in HIV-related risky behaviors, with the greatest risk reported by women who were the least religious.