Kirk W. Elifson

Rolling Beyond Raves: Ecstasy Use Outside the Rave Setting

In this paper, we explore settings of ecstasy use other than those that are part of the rave scene. Little is known about its use in other settings. Data from young adult (18–25 years old) active ecstasy users were collected using surveys (N = 158) and qualitative in-depth interviews (N = 66). Recruitment involved targeted and theoretical sampling. Data analysis was guided by the constant comparison method, common in grounded theory. Our findings indicate that ecstasy use has extended to social settings beyond raves, including dance/music venues, bars in inner-city neighborhoods, neighborhood cruising sites, and private residences. Users may attend multiple settings, and it is common for use practices to be transmitted across settings. An understanding of emerging social settings of ecstasy use and the associated use patterns provides baseline information for the development of effective and appropriate prevention and intervention programs, including drug treatment, as well as for policy makers.

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.

Women and Drug Treatment Experiences: A Generational Comparison of Mothers and Daughters

Drug use and treatment frequently are investigated from an individual perspective. In this paper, we focus on the perceptions of drug treatment among women in 48 mother/adult daughter dyads. Two-thirds of the women were crack cocaine users and they all were part of a larger study on intergenerational drug use. The women were recruited using targeted sampling, followed by theoretical sampling. In the tradition of feminist research, data collection primarily involved open-ended interviews, following a life course perspective. Data analyses involved the constant comparison method of the grounded theory process. A popular assumption is that women enter drug treatment because they are ordered by the court to do so. Overall, the mothers emphasized internal factors as most salient. Another theme in the womens stories was the perceived barriers to entering drug treatment. A better understanding of the internal and external factors regarding drug treatment decisions will assist us in clarifying treatment readiness. The women also made suggestions for more holistic and women-focused drug treatment.

Sex, touch, and HIV risk among ecstasy users.

We examined HIV risk among heavy and nonheavy ecstasy users, focusing specifically on touch and sexual behavior as part of the ecstasy experience. Structured interviews were conducted with 268 young adult (age 18–25) ecstasy users in Atlanta, Georgia. Heavy ecstasy users were more likely to have been tested for HIV than nonheavy users (79 vs. 68%). However, they also were more likely to perceive no chance of contracting HIV (36 vs. 26%). Touch, both sensual and sexual, was a significant part of the ecstasy experience. In addition, ecstasy use seemed to increase the sexual desire, however, not the ability to achieve an orgasm. Heavy users reported more sexual risk-taking than their nonheavy using counterparts. Results suggest that the setting of ecstasy use also may influence involvement in risk behaviors. Future longitudinal studies are needed on the relationship between ecstasy use, touch, sexual arousal and ability, and risk behavior.

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.

Female crack users and their sexual relationships: The role of sex-for-crack exchanges

This study challenges the image of female crack users as exchangers, or women who exchange sex for crack. Between June 1997 and February 1999, quantitative interviews were conducted with 150 active female crack users, one half of whom also completed a qualitative interview. Data analysis involved contingency analysis, bivariate logistic regression analysis, and the constant comparison method. Exchangers (n = 65) were younger, and were more likely to have been homeless and to be single than were nonexchangers (n = 85). Exchangers also were more likely to report infidelity and less likely to communicate with their most recent steady partner about the partners relationship expectations. Sexual behaviors differed by partner type among the exchangers and nonexchangers. These findings provide a comprehensive picture of female crack users. Additionally, the findings indicate the importance of designing interventions that capture the complexities of the womens sexual relationships.

HIV seroprevalence and risk factors among clients of female and male prostitutes

OBJECTIVES To document the HIV and STD infection rates among clients of female (CFP) and clients of male prostitutes (CMP) and to identify the risk factors for HIV among CFP and CMP. METHODS Structured interviews were conducted with 82 CMP and 69 CFP in 1990 and 1991 in Atlanta, Georgia, U.S.A. Blood samples were tested for HIV, syphilis, and hepatitis B. RESULTS The HIV-positive rate was 36.6% among CMP and 2.9% among CFP. Syphilis seromarkers were found in 15.9% of CMP and 10.1% of CFP; hepatitis B seromarkers were identified in 58.0% of CMP and 24.6% of CFP. Key risk factors for HIV among CMP included serologic history of syphilis, serologic history of hepatitis B, receptive anal sex with a male prostitute, ever injecting drugs, ever using crack cocaine, and little education. CFP had no significant risk factors for HIV in the logistic analysis. CONCLUSIONS Several studies have focused on risk factors for HIV among female and male prostitutes; however, research on their clients has been limited. Although HIV infection rates among CFP are relatively low, their infection rate for syphilis and hepatitis warrants serious health education efforts. Even more critical are harm-reduction programs targeting CMP. Generic health and HIV risk reduction messages on heterosexual transmission might be insufficient.

Young Adult Ecstasy use Patterns: Quantities and Combinations:

The objectives of this paper are to describe ecstasy use patterns among young adult (18–25 years) users and to compare use patterns and self-reported effects according to the frequency (number of days used in the last 90 days) and intensity (typical number of pills taken per sitting) of ecstasy use. Computer-assisted structured interviews were conducted with 261 young adult active ecstasy users in Atlanta, Georgia. A typical dose of ecstasy intake was two pills, often followed by a booster dose. In addition, binging on ecstasy was reported. Ecstasy was mentioned as the primary drug of choice by one fifth of respondents. Poly-drug use dominated, and a substantial proportion of the respondents reported symptoms of ecstasy dependence. Differences in sociodemographic characteristics, poly-drug use, and reported effects of ecstasy use were found according to frequency and intensity of ecstasy use. Findings from this paper are important for the development of effective prevention efforts, including drug treatment and policy.

Poly-Drug Use among Ecstasy Users: Separate, Synergistic, and Indiscriminate Patterns

The main objective of this paper is to explore poly-drug use among young adult ecstasy users. This phenomenon of using multiple substances within a specific time period is multi-faceted. In this paper, we focus on the various patterns of poly-drug use and the reasons for combining multiple drugs among ecstasy users. Using a mixed-methods design, we conducted interviews with young adults who used ecstasy and other licit and illicit drugs in the past 90 days. Based on the qualitative analyses, we define three distinct types of poly-drug experiences: separate, synergistic, and indiscriminate use. While separate and synergistic poly-drug use tended to be intentional, indiscriminate poly-drug use often was unintentional. These findings show the importance of recognizing poly-drug use as a common phenomenon. The findings presented here suggest areas for further research aimed at identifying risk and protective behaviors and risk reduction strategies.

Hug drug or thug drug? Ecstasy use and aggressive behavior.

While clinical studies have established a link between aggression and ecstasy (3,4-methylenedioxymeth-amphetamine [MDMA]), no research has attempted to explore how this link manifests itself in behavioral outcomes. In this research we examine the effects of ecstasy on aggressive and violent behavior in a sample of active users. Data were collected from 260 ecstasy users in Atlanta, Georgia. Data analysis included ordered logit regression to examine the likelihood of engaging in aggressive behavior, controlling for key predictors of aggression independent of ecstasy use. Our results indicate that those with a higher prevalence of lifetime ecstasy use exhibit higher levels of aggressive and violent behavior. However, the effect of lifetime ecstasy use differs by levels of low self-control as a measure of propensity for aggression. Those who exhibit low self-control are more affected by ecstasy use than those who do not in terms of aggression. Our findings add an important dimension to our current knowledge about the relationship between aggression and ecstasy.