Joseph E. Schumacher

Substance use among HIV-infected patients engaged in primary care in the United States: findings from the Centers for AIDS Research Network of Integrated Clinical Systems cohort.

OBJECTIVESnThe purpose of this study was to better understand substance use behaviors and deleterious health consequences among individuals with HIV.nnnMETHODSnWe examined a multicenter cohort of HIV-infected patients (nu2009=u20093,413) receiving care in 4 US cities (Seattle, Birmingham, San Diego, Boston) between December 2005 and April 2010 in the Centers for AIDS Research Network of Integrated Clinical Systems (CNICS). We used generalized estimating equations to model specific substance use outcomes.nnnRESULTSnOverall, 24% of patients reported recent use of marijuana; 9% reported amphetamine use, 9% reported crack-cocaine use, 2% reported opiate use, 3.8% reported injection drug use, and 10.3% reported polydrug use. In adjusted multivariable models, those who reported unprotected anal sex had higher odds of marijuana, amphetamine, injection drug, and polydrug use. An increased number of distinct vaginal sexual partners was associated with polydrug and crack-cocaine use. Nonadherence to antiretroviral therapy was associated with the use of all substances other than marijuana.nnnCONCLUSIONSnThe co-occurrence of substance use, unprotected intercourse, and medication nonadherence could attenuate the public health benefits of test, treat, and link to care strategies. Prevention programs are needed that address these coprevalent conditions.

A situational picture of HIV/AIDS and injection drug use in Vinnitsya, Ukraine.

BackgroundNew and explosive HIV epidemics are being witnessed in certain countries of Eastern Europe, including Ukraine, as well as a rapid and dramatic increase in the supply, use, and negative public health consequences of illicit drugs. A majority of registered HIV cases in Ukraine occur among injection drug users (IDUs), large numbers of whom report HIV risk behaviors such as needle sharing. The purpose of this study was to apply the World Health Organizations Rapid Assessment and Response on Injection Drug Use (IDU-RAR) guide to create a situational picture in the Vinnitsya Oblast, Ukraine, a region with very scarce information about the HIV/AIDS and injection drug use (IDU) epidemics.MethodsThe IDU-RAR uses a combination of qualitative data collection techniques commonly employed in social science and evaluation research to quickly depict the extent and nature of the given health problem and propose locally relevant recommendations for improvement. The investigators focused their assessment on the contextual factors, drug use, and intervention and policy components of the IDU-RAR. A combination of network and block sampling techniques was used. Data collection methods included direct observation, review of existing data, structured and unstructured interviews, and focus group discussions. Key informants and locations were visited until no new information was being generated.ResultsThe number of registered HIV cases in Vinnitsya has increased from 3 (1987–1995) to 860 (1999–10/2004), 57 of whom have already died. Ten percent of annual admissions to the areas Regional Narcological Dispensary were for opiate disorders, and the number of registered IDUs rose by 20% from 1999 to 2000. The level of HIV/AIDS awareness is generally poor among the general population but high among high-risk populations. Both HIV/AIDS and injection drug use carry a strong stigma in the community, even among medical professionals. There was very little evidence of primary HIV/AIDS prevention efforts, and IDU prevention efforts focused on promotion of anti-drug messages in the schools.ConclusionGiven that Ukraine has sparse resources to be devoted to this problem, action recommendations should be prioritized, realistic, and initially targeted to persons in greatest need. The following action recommendations are prioritized by the following categories: First priority: Voluntary Counseling and Testing; Second Priority: Prevention and Education; and Third Priority: Harm Reduction and Treatment. They are provided in this sequence based on what response can realistically be implemented first with limited additional resources and can make the greatest immediate impact. The persons at greatest risk, HIV positive persons and IDUs, should be attended to first.

Methadone maintenance for HIV positive and HIV negative patients in Kyiv: acceptability and treatment response.

BACKGROUNDnWith up to 40% of opioid injectors infected with HIV, Ukraine has one of the most concentrated HIV epidemics in the world, mainly due to unsterile injection practices and a historical absence of effective prevention services. Harm reduction programs, including syringe exchange and a small buprenorphine treatment program, were introduced in 2004 and methadone maintenance was allowed in 2007. Despite an initial expansion, by 2009, only 3221 injectors were receiving methadone treatment. A growing body of research on methadone maintenance has found high retention rates with reduction in opioid use and HIV risk behaviors. We report on the acceptability and initial outcome of methadone treatment as a function of HIV status, an issue that has not yet been reported for injectors in Ukraine.nnnMETHODSnLongitudinal observational study of a 12-week course of methadone treatment in 25 HIV+ and 25 HIV- opioid addicted individuals recruited from a harm reduction program and the city AIDS Center. Drug use and HIV risk were assessed at baseline and weeks 4, 8, 12 and 20; all patients were offered continued methadone maintenance in the Kyiv city program at the end of 12 weeks.nnnRESULTSnFifty-four individuals were asked if they were interested in the study and 50, demographically similar to other samples of opioid addicted Ukrainians, agreed to participate. Two died of non-study related causes; the other 48 completed assessments at weeks 4, 8 and 12, and 47 completed followups at week 20. Significant reductions were seen in use of heroin (p<0.0001), other opiates/analgesics (p<0.0001), and HIV risk behaviors (drug, sex, total; all p<0.0001). All 48 patients chose to continue methadone after the 12-weeks of study medication ended. Unlike most opioid treatment studies, sexual risk was somewhat higher than injecting risk at study intake.nnnCONCLUSIONSnMethadone maintenance was well accepted by HIV+ and HIV- opioid dependent individuals and has the potential for significant public health impact if made more widely available with sustained access and support.

The Relation of Peer Assessment to Future Law Enforcement Performance

The association of peer assessment techniques and law enforcement job performance was investigated. Participants were trainees at a law enforcement academy who were subsequently employed in diverse law enforcement agencies. Results indicated that peer rankings were significantly correlated with academy instructor rankings, with job supervisor evaluations, and with two of four objective measures of job performance (retention and absenteeism). These results indicate that peer assessment techniques evidence concurrent and predictive validity. Potential applications of peer assessment in law enforcement settings are discussed.

Application of a Guttman intensity analysis to personality measurement

Guttman’s (Guttman & Suchman, 1947) statistical strategy for determining the zero or neutral point of an attitude scale is extended in this study to the area of personality measurement. The strategy assumes that the intensity with which pro and con feelings are held will plot as a U- or a J-shaped function of attitude content. We elected for focus in the present study a modification of Miller’s (1980) Behavioral Style Scale, a personality questionnaire designed to gauge the coping strategy adopted by the individual as he/she attempts to meet imminent threat. The modified Behavioral Style Scale failed to yield the U- or J-shaped function, suggesting complex measurement.

An International Look at the Death Penalty

ABSTRACT Much has been written on the history and use of the death penalty, but few discussions address capital punishment from a world-wide perspective. The purpose of this paper is to present a statistical and descriptive overview of the nature and use of capital punishment world-wide. The discussion of this topic covers prevalence rates of the death penalty, types of crimes punishable by death, methods used to perform executions, and the numbers of those who have died. Surveys have shown that the majority of the countries in the world retain execution as a form of punishment. It is revealed that within the last quarter of a century there has been no trend indicating a change in retention or abolition rates internationally. Even so, many nations have made significant alterations in death penalty statutes to reduce the number of capital crimes, humanize methods of execution, respect due process rights, and commute death sentences to life sentences.