James E. Rivers

HIV-1 RNA load in needles/syringes from shooting galleries in Miami: a preliminary laboratory report

We quantified HIV-1 RNA load in rinses from needles/syringes (N/S) obtained at shooting galleries in Miami and also analyzed the rinses for antibodies for viral proteins. In rinses from 36 N/S that contained visible blood, 14 (39%) had detectable amounts of HIV-1 RNA. Numbers of copies of HIV-1 RNA ranged from the detection limit (400 copies/ml) to 268,000 copies/ml. We also detected antibodies to HIV-1 polypeptides in 34/36 (94%) of rinses from visibly contaminated N/S using Western blots specific for the HIV-1 proteins. No antibodies were detected in laboratory rinses from six visibly clean needles. The presence of HIV-1 RNA in N/S is an important indication of the risk created by N/S sharing as well as by shared paraphernalia and wash waters by injecting drug users.

Drug use and HIV risks among migrant workers on the DelMarVa Peninsula.

Because high rates of drug use have been documented in the migrant farm worker population, the National Institute on Drug Abuse funded the Migrant Health Study to examine HIV risk behaviors among drug-using farm workers and their sexual partners. Many of these individuals were home-based in South Florida and migrated during the work season to various points along the Eastern Migratory Stream. The focus of this paper is a description of the characteristics and behaviors of the 151 respondents contacted on the DelMarVa Peninsula during 1994 and 1995. The data indicate that drug use was widespread in this population, a significant proportion were at risk for HIV infection, and 6% were HIV positive. As a result of these findings, public health agencies on the peninsula have instituted HIV education programs in those clinics utilized by both local and transient agricultural workers.

Access to health and human services for drug users : An urban/rural community systems perspective

Publicly funded drug-user treatment programs in both urban and rural areas are under unprecedented pressure to adapt to multiple perspectives of their mission, reduced governmental funding, diminished entitlement program resources for clients, managed care reforms, and continuing unmet need for services. This article describe an ongoing health services research study that is investigating how these and related health and human service programs currently serve and cross-refer chronic drug users and how they perceive and are reacting to systemic pressures. Interim analysis on intra-agency diversity and managed care perceptions are reported.

Consequences and Costs of Closing a Publicly Funded Methadone Maintenance Clinic

Objective. We examine volunteering to support the relief effort after the bombing of the Murrah Federal Building. We address two issues: (1) how widespread was volunteering and what forms did it take, and (2) does Wilson and Musick’s (1997a) “integrated theory of volunteer work” help to explain variation in volunteering in this disaster situation? Methods. We use data from the 1996 Oklahoma City Survey (OKC Survey). The 1996 OKC Survey is based on a random sample of the adult population of Oklahoma City and was administered 10 months after the bombing. Results. Nearly 75 percent of the sample respondents volunteered to support the relief effort in at least one way; giving money and donating nonprofessional goods or services were the two most prevalent volunteer activities. Socioeconomic status, knowing someone killed or injured in the bombing, belonging to voluntary organizations before the bombing, and being affiliated with a religious denomination were predictors of volunteering, depending on the type of volunteer activity considered. Conclusions. The magnitude of volunteering after the Murrah Building bombing was in line with volunteer efforts after other disasters. The integrated theory of volunteer work is a useful framework for studying volunteering after disasters.

Juvenile Assessment Centers: Strengths, Weaknesses, and Potential:

Increases in recent years in both violent crime and substance use among United States youth necessitate the development of more efficient and clinically effective approaches to intervention with juvenile offenders. One such approach calls for development and implementation of Juvenile Assessment Centers (JACs) to centralize the screening of juveniles who have been placed in some form of police custody and better coordinate justice and human service system activities. This article presents a summary of data from interviews and surveys conducted at five JACs in three states. It discusses the findings in the context of an “ideal model” specifically designed to better address substance use among justice-involved juveniles.

Health services for chronic drug users in an era of managed care

This chapter reports findings on two studies that culminated in the development of a multilevel intervention to improve access to health care among chronic drug users. The first two studies began with an investigation of the health care delivery system serving chronic drug users in Miami-Dade County, Florida from the perspectives of both consumers and providers. These studies documented the health care needs and use patterns of chronic drug users as well as the practices and perspectives of the providers who served them. Findings indicated that (1) chronic drug users demonstrated greater health care needs than nondrug users; (2) chronic drug users were less likely to receive appropriate health care services; and (3) the gap between services needed and services actually provided can be ameliorated. By participating in our multilevel intervention, both health care providers and health care consumers changed attitudes and behaviors resulting in the provision of appropriate, accessible, and acceptable health care.

The Hillsborough County, Florida, Juvenile Assessment Center: A Prototype

Juvenile Assessment Centers (JACs) or community assessment centers are essentially screening and classification programs that assess the nature and extent of risks to and from arrested juveniles. This article presents a brief account of the Hillsborough County (Tampa, Florida) JAC, a model for JACs that is currently being implemented throughout Florida and is suggested as a prototype for communities throughout the nation. Identifying, assessing, referring, and ensuring that services for juveniles are delivered and received is extremely important given current levels and recent increases in both violent crime and drug use among U.S. youth.

Accessibility of health and human services for the HIV-infected

Most research on services for the HIV/AIDS population has focused on primary medical care or on service brokering by advocacy groups. Little research data exist on the extent to which services of programs that do not specialize in HIV/AIDS clients are available to these individuals who often have multiple and multi-dimensional problems. The reported research examines selected data from a sample of 236 medical, behavioral health and social service programs in Miami-Dade County, Florida. A constructed measure of ‘involvement’ in services for HIV/AIDS clients, pertinent provider program and client characteristics are examined in the context of geo-distributed data on reported AIDS cases and census data. In logistic regression analyses, two aspects of race/– the population in the zip code area served by the program, and the clients or patients seen in the program – were significant in predicting program under-response, defined as level of response relative to cumulative reported AIDS cases from the programs zip code area. The analysis is briefly discussed regarding its relevance and methodological generalizability for HIV/AIDS and related public health policy and applied purposes.