Richard Needle

Validity of self-reported drug use among injection drug users and crack cocaine users recruited through street outreach

This paper examines the validity of self-reported drug use as a measure of behavior change for the evaluation of drug use prevention and HIV risk reduction programs. The results of urinalysis are used to evaluate responses from 154 subjects from 4 cities to questions about drug use in the past 48 hours in the National Institute on Drug Abuses (NIDA) Risk Behavior Assessment (RBA). This instrument is currently being used in 21 studies throughout the United States. Unlike criminal justice or employment settings where there is a tendency to underreport drug use, participants in this research study acted more like a treatment seeking population and were slightly more likely to report drug use than to be tested positive. Urinalysis and self-reports agreed for 86.3% of the subjects who reported use of some form of cocaine (Kappa = .658) and 84.9% of the heroin users (Kappa = .631). The percentage of subjects reporting drug use and testing negative was somewhat higher than the percentage reporting no use and testing positive for both cocaine (7.8% vs. 5.8%) and heroin (9.7% vs. 5.2%). The results suggest that self-reported drug use in not-in-treatment, noninstitutionalized populations is accurate enough for measuring changes in risk behavior practices. Urinalysis may not be necessary if respondents are asked about their drug use in a nonthreatening manner, and if they are assured of the confidentiality of their results.

A meta-analysis of the effect of HIV prevention interventions on the sex behaviors of drug users in the United States

Summary: We examined the effectiveness of 33 U.S.‐based HIV intervention studies in reducing the sexual risk behaviors of drug users by reducing unprotected sex or increasing the use of male condoms. The studies, identified as of June 1998, through the HIV/AIDS Prevention Research Synthesis project, were published in 1988 or later, measured behavioral or biologic outcomes, used experimental designs or certain quasiexperimental designs, and reported sufficient data for calculating an effect size for sexual risk reduction. Of the 33 studies, 94% recruited injection drug users; 21% recruited crack users. The mean age of participants was 36 years. Almost all studies were randomized (94%), provided another HIV intervention to the comparison groups (91%), and evaluated behavioral interventions (91%). On average, interventions were conducted in 5 sessions (total, 10 hours) during 4.5 months. Interventions compared with no interventions were strong and significant (k = 3; odds ratio [OR], 0.60; 95% confidence interval [CI], 0.43‐0.85). Interventions compared with other HIV interventions showed a modest additional benefit (k = 30; OR, 0.91; 95% CI, 0.81‐1.03). When we extrapolated our result (an OR of 0.60) to a population with a 72% prevalence of risk behavior, the proportion of drug users who reduced their risk behaviors was 12.6% greater in the intervention groups than in the comparison groups. Our meta‐analysis shows that interventions can lead to sexual risk reduction among drug users and justifies providing interventions to drug users. Developing interventions with stronger effects to further reduce sexual risk behaviors among drug users must remain a high priority.

Reliability and Validity of Adolescent Self-Reported Drug Use in a Family-Based Study: A Methodological Report

Given the sensitive topic of drug abuse and the private nature of the family, researchers must overcome a number of methodological obstacles when studying drug abuse and the family. The purpose of this study was to determine whether adolescents would provide honest and accurate answers to drug use questions in the context of their homes with their families participating in the same survey. Although there is no direct objective validation of the self-report measures used in this study, evidence from the analysis of the survey data suggests that adolescent self-reports are, in most cases, reliable and valid, and that the setting in which respondents complete questionnaires does not, in general, result in systematic reporting bias.

Rapid Assessment of the HIV/AIDS Crisis in Racial and Ethnic Minority Communities: An Approach for Timely Community Interventions

OBJECTIVES The US Department of Health and Human Services, in collaboration with the Congressional Black Caucus, created a new initiative to address the disproportionate ongoing HIV/AIDS crisis in racial/ethnic minority populations. METHODS This initiative included deploying technical assistance teams through the Office of HIV/AIDS Policy. The teams introduced rapid assessment and response methodologies and trained minority communities in their use. RESULTS The first 3 eligible cities (Detroit, Miami, and Philadelphia) focused assessments in small geographic areas, using multiple methodologies to obtain data. CONCLUSIONS Data from the first 3 eligible cities provided critical information about changing the dynamics of the HIV/AIDS epidemic at the local level, including program and policy changes and infrastructure redeployment targeted at the most serious social and environmental conditions.

A Methodological Model for Rapid Assessment, Response, and Evaluation: The RARE Program in Public Health

Rapid assessment projects are expanding in the arenas of public health policy, planning, and program development in both developing and developed nations. This article reviews the methodological advances that have changed rapid assessment from a primarily “quick and dirty” approach for data collection into a public health tool for time-sensitive development of changes in intervention strategies, community-based organizational structure, program evaluation, and policy decisions. The methodological design of the Rapid Assessment, Response, and Evaluation Project, adopted by the Office of HIV/AIDS Policy (U.S. Department of Health and Human Services) in 1999, is presented as a model for using revised rapid assessment approaches within the context of public health policy development.

Familial, Interpersonal, and Intrapersonal Correlates of Drug Use: A Longitudinal Comparison of Adolescents in Treatment, Drug-Using Adolescents Not in Treatment, and Non-Drug-Using Adolescents

This study examined familial, interpersonal, and intrapersonal factors associated with adolescent drug use from both developmental and etiological perspectives. Retrospective case-control and prospective longitudinal designs were used. A multivariate analysis of variance with repeated measures design was conducted to examine changes over time and differences between groups of adolescents in treatment for alcohol and drug problems, drug-using adolescents not in treatment, and non-drug-using adolescents, on 16 measures of familial, interpersonal, and intrapersonal variables. Significant differences were found between adolescents using drugs (clinical or nonclinical) and those not using drugs and alcohol. No differences were found in any of the variables between clinical adolescents and those using drugs but not in treatment.

Rapid assessment of drug-related HIV risk among men who have sex with men in three South African cities

The current assessment was undertaken to examine the link between drug use and sexual risk behavior among men who have sex with men (MSM) in locations known to have high prevalence rates of drug use and sexual risk behavior in Cape Town, Durban and Pretoria, South Africa. Street intercepts and purposive snowball sampling were used to recruit drug-using MSM. A rapid assessment was undertaken which included observation, mapping, key informant interviews and focus group interviews with MSM. Drug using key informants were tested for HIV. The use of drugs like crack cocaine, cannabis and methamphetamine to specifically facilitate sexual encounters was evident. Drugs led to inconsistent condom use and other high-risk sexual activities despite HIV risk knowledge being high. Many injecting drug-using MSM shared needles and reused equipment. Among MSM who agreed to HIV testing, one-third tested positive. Views about drug and HIV treatment and preventive services and their efficacy were mixed. Various barriers to accessing services were highlighted including homosexual stigmatization and availability of drugs in treatment facilities. Recommendations include addressing the gap between HIV-risk knowledge and practice, extending VCT services for MSM, increasing the visibility of drug abuse services within communities, addressing concerns about drug availability in treatment centers as well as reintegration issues and the need for after-care services, reducing stigmatization in drug and HIV services for MSM and finally, strengthening the link between drug treatment services and HIV prevention by integrating HIV/drug-related risks into HIV prevention efforts and HIV risks into drug use prevention efforts.

Marital Disruption and Psychological Well-Being A Panel Study

This study offers prospective data on the psychological well-being of men and women before and after a marital separation, in comparison with a control group who remained married during the same period. Data were gathered as part of the Minnesota Family Health Study on a primarily middle-class White sample. Primary variables were current psychological well-being, self-esteem, mastery, substance use, and family income. Findings were quite different for men and women. Prior to separation, men in the disrupted group had lower psychological well-being scores than the continuously married group had, but showed no declines in any of the measures in the follow-up period. Separated women scored lower than did women from continuing marriages on psychological well-being prior to the separation, and they declined further afterwards. Separated women also increased their use of alcohol and other substances, and experienced a decline in family income. Findings are discussed in terms of the social causation hypothesis and the social selection hypothesis for understanding the relationship between divorce and mental health in adults.

Sex, drugs, and HIV : Rapid assessment of HIV risk behaviors among street-based drug using sex workers in Durban, South Africa

South Africa is experiencing significant changes in patterns of illicit drug use, including increasing injection and non-injection drug use, and the use of drugs by persons engaged in sex work, both of which could further expand the HIV/AIDS epidemic. In 2005, a rapid ethnographic assessment was conducted in Durban, South Africa, to learn more about patterns of drug use and HIV risk behaviors among drug-using, street-based sex workers. Field teams recruited 52 current injection and non-injection drug users for key informant interviews and focus groups, and they conducted mapping and observation in identified high-risk neighborhoods. Key informants were offered free, voluntary counseling and HIV rapid testing. The results of the assessment indicate that in this population, drugs play an organizing role in patterns of daily activities, with sex work closely linked to the buying, selling, and using of drugs. Participants reported using multiple drugs including crack cocaine, heroin, Ecstasy and Mandrax, and their choices were based on their expectations about the functional role and behavioral and pharmacological properties of the drugs. The organization of sex work and patterns of drug use differ by gender, with males exercising more control over daily routines and drug and sexual transactions than females. Activities of female sex workers are subject to considerable control by individual pimps, many of whom also function as landlords and drug dealers. A strong hold over the overlapping economies of drugs and sex work by a few individuals extends to control of the physical and social settings in which sex is exchanged and drugs are sold and used as well as the terms under which sex work is carried out. The potential for accelerated HIV spread is considerable given the evidence of overlapping drug-using and sexual risk behaviors and the mixing patterns across drug and sexual risk networks.

Rapid assessment of drug use and sexual HIV risk patterns among vulnerable drug- using populations in Cape Town, Durban and Pretoria, South Africa

This exploratory study examines the links between drug use and high-risk sexual practices and HIV in vulnerable drug-using populations in South Africa, including commercial sex workers (CSWs), men who have sex with men (MSM), injecting drug users (IDUs) and non-injecting drug users who are not CSWs or MSM (NIDUs). A rapid assessment ethnographic study was undertaken using observation, mapping, key informant interviews and focus groups in known ‘hotspots’ for drug use and sexual risk in Cape Town, Durban and Pretoria. Key informant (KI) and focus group interviews involved drug users and service providers. Purposeful snowball sampling and street intercepts were used to recruit drug users. Outcome measures included drug-related sexual HIV risk behaviour, and risk behaviour related to injection drug use, as well as issues related to service use. HIV testing of drug-using KIs was conducted using the SmartCheck Rapid HIV-1 Antibody Test. Non-injection drug use (mainly cannabis, methaqualone, crack cocaine and crystal methamphetamine) and injection drug use (mainly heroin) was occurring in these cities. Drug users report selling sex for money to buy drugs, and CSWs used drugs before, during and after sex. Most (70%) of the drug-using KIs offered HIV testing accepted and 28% were positive, with rates highest among CSWs and MSM. IDUs reported engaging in needle sharing and needle disposal practices that put them and others at risk for contracting HIV. There was a widespread lack of awareness about where to access HIV treatment and preventive services, and numerous barriers to accessing appropriate HIV and drug-intervention services were reported. Multiple risk behaviours of vulnerable populations and lack of access to HIV prevention services could accelerate the diffusion of HIV. Targeted interventions could play an important role in limiting the spread of HIV in and through these under-reached and vulnerable populations.