Steven Huettner

Social contextual factors associated with entry into opiate agonist treatment among injection drug users

We tested hypotheses that social living arrangement and drug use in ones network are independently associated with entry into opiate agonist treatment modalities. Injection drug users (IDUs) attending the Baltimore Needle Exchange Program who received a referral for drug abuse treatment were studied. Baseline interviews, HIV testing, and the Addiction Severity Index (ASI) were administered. Agency records were used to confirm entry into a treatment program offering opiate agonist maintenance therapy within 30 days of the baseline interview. Logistic regression was used to identify predictors of treatment entry. To date, of 245 IDUs, 39% entered such a program. Multivariate logistic regression models controlling for age and intervention status revealed that compared to individuals who lived alone, in a controlled, or nonstable environment (e.g., streets, abandoned house, transitional housing program, or boarding house), individuals who lived with a sexual partner were 3 times more likely to enter treatment (adjusted Odds Ratio [aOR] = 3.04; p = 0.013) and those who lived with family or friends were almost 3 times more likely to enter treatment (aOR = 2.72; p = 0.016). In the bivariate analyses, a marginal association was observed between being responsible for children or others and entry into treatment (p = 0.066); however, this association was not significant in the multivariate model. Findings from this study suggest that supportive living environments may facilitate entry into treatment and may be helpful in devising appropriate and targeted interventions to encourage drug treatment entry.

Decline in self-reported high-risk injection-related behaviors among HIV-seropositive participants in the Baltimore needle exchange program

This study was conducted to determine whether enrollment in a needle exchange program (NEP) was associated with reduction(s) in high-risk injection practices among HIV-seropositive drug users. Between August 1994 and August 1997 HIV-seropositive individuals who underwent baseline and 6-month follow-up visits in the Baltimore NEP evaluation were studied. Chi-square statistics and paired t tests were used to compare reported injection-related behaviors between visits. One hundred and twelve HIV-seropositive NEP participants completed baseline and follow-up visits. Between visits self-reported lending of used syringes to others decreased (34.0% vs. 15.5%, p = .001), borrowing syringes from others decreased (23.2% vs. 11.1%, p = .002), and reported participation in drug treatment increased (8.0% vs. 18.8%, p = .01). A decrease in the mean number of injections per syringe was reported, 11.4 vs. 4.7 (p < .001). These data suggest that NEP attendance can contribute to significant reductions in risky drug-use behaviors in HIV-seropositive drug users.

The Relationship Between Lifetime Abuse and Suicidal Ideation in a Sample of Injection Drug Users

Abstract This study examined the relationship between lifetime abuse and suicidal ideation in a sample of 245 injection drug users (IDUs) who attended the Baltimore Needle Exchange Program and received a referral for opiate agonist therapy. Data were obtained from baseline interviews and HIV antibody tests. The sample mean age was 42.2 (SD = 8.1); 77% were African American; 69% were male. Overall, 27% reported thoughts of suicide in the last six months, and lifetime emotional, physical and sexual abuse was reported by 17%, 12% and 10%, respectively. In bivariate analyses, recent suicidal ideation was associated with emotional (odds ratio [OR] = 3.2; p = 0.001), physical (OR = 2.5; p = 0.026), and sexual abuse (OR = 5.0; p < 0.001). In multiple logistic regression models controlling for HIV status and Center for Epidemiological Studies Depression (CES-D) score, individuals who experienced emotional abuse were more than twice as likely to report recent suicidal ideation (adjusted odds ratio [AOR] = 2.6; p = 0.011); those who experienced sexual abuse were four times more likely to report suicidal ideation (AOR = 4.0; p = 0.004). These findings suggest that emotional and sexual abuse might be risk factors for suicidality among IDUs and also might suggest that suicide prevention should be an integral part of drug treatment for treatment-seeking IDUs.

Characteristics of Injection Drug Users Who Utilize Tuberculosis Services at Sites of the Baltimore City Needle Exchange Program

ObjectiveTo describe characteristics of needle-exchange program (NEP) participants who utilized tuberculosis services from an NEP site.MethodsBetween June 1998 and May 1999, tuberculosis services were advertised and offered to Baltimore, Maryland, NEP participants. Demographic and tuberculosis-specific data were collected on participants who self-selected into services. Analyses were based on being tuberculin skin tested, returning for a skin test reading, and testing tuberculin positive.ResultsAmong 691 contacts with NEP participants, this service performed 296 tuberculin tests, with an 84% return rate for skin test reading. Participants were 32% female, 87% African American, and 11% employed. Higher frequency of NEP visits was positively associated with requesting tuberculosis services and returning for skin test reading. Among those who returned for skin test reading, longer smoking duration and problems getting food in the past year due to a lack of money were associated with a positive test.ConclusionsUtilization of a tuberculosis service and high return rates can be achieved among NEP participants without formal recruitment strategies. Frequent exchange appears to facilitate return visits for NEP-based tuberculosis screening, which may imply accessibility for frequent exchangers. More extensive health services at sites of the Baltimore NEP appear to be warranted, with particular attention paid to effectiveness for frequent exchangers.

Pharmacy Access to Sterile Syringes for Injection Drug Users: Attitudes of Participants in a Syringe Exchange Program

OBJECTIVE To examine attitudes of participants of a van-based syringe exchange program (SEP) toward the hypothetical prospect of pharmacy-based syringe access. DESIGN One-time, cross-sectional survey. SETTING Baltimore, Maryland. PARTICIPANTS 206 injection drug users who participate in the Baltimore SEP. INTERVENTIONS Face-to-face interviews. MAIN OUTCOME MEASURES Location preferred for obtaining syringes, drug and syringe use, past experience with pharmacies, and willingness to pay. RESULTS The sample was 67% men, 95% African American, and 95% unemployed; mean age was 39.8 years. A total of 19% of respondents had bought syringes at a pharmacy during the prior six months. Some 37% reported having been turned down when asking for syringes at a pharmacy, most commonly due to lack of identification to prove diabetic status (50%). If legal restrictions were lifted, 92% of respondents would obtain syringes from pharmacies, and would be willing to pay a mean price of

The Impact of Opiate Agonist Maintenance Therapy on Drug Use Within Social Networks of Injecting Drug Users

0.80 (median =

Understanding variability in adolescent women's sexually transmitted infection-related perceptions and behaviors associated with main sex partners.

1.00) per syringe. Women were more likely than men to report the intention to switch from van-based SEP to pharmacy (57% versus 38%, p = .045). CONCLUSION If current legal restrictions were lifted, pharmacies would be a viable syringe source appealing particularly to women, suggesting gender-specific access issues that should be addressed. The per-syringe price that study participants would be willing to pay exceeds typical retail prices, suggesting that pharmacists could charge enough per syringe to recoup operational costs.

Factors Associated with HIV Seroprevalence among Participants Enrolling at a Needle Exchange Program

This study examined whether participation in opiate drug treatment is associated with changes in drug use and injecting drug use within the social networks of injecting drug users. Participants were 245 injecting drug users who attended the Baltimore Needle Exchange Program during 2002-2004 and requested treatment and received a referral for opiate agonist treatment as part of an intervention to improve treatment outcomes. Data included interviews at baseline, 3, 6, 12, and 18 months and drug treatment program agency records. The mean age of participants was 42.2 years; 77% were African American, 69% were male, and 48% entered treatment. Final generalized estimating equations (GEE) models indicated that participants that entered opiate drug treatment exhibited approximately a 20% decrease in the proportional odds of having friends that used drugs (p = 0.04). Additionally, participants that entered opiate drug treatment exhibited a 26% decrease in the proportional odds of having friends that injected drugs (p = 0.01). These findings contribute evidence to further understand the dynamics between opiate drug treatment, changes in social network risk, and treatment outcomes, as well as suggest an important role for peer-based interventions to support entry and retention in opiate drug treatment.

Care-Seeking Behavior After Notification Among Young Women With Recurrent Sexually Transmitted Infections After Pelvic Inflammatory Disease

Background It is not well understood whether characteristics of adolescent main partnerships differ categorically from one relationship to the next or whether observed differences in sexually transmitted infection (STI)–related perceptions and sexual behaviors between main partnerships results from a failure to capture variability within adolescent main partnerships. The objective of this study was to examine the extent to which female adolescents’ STI-related feelings, perceptions, and sexual behavior associated with main sex partners varied over the course of their relationship. Methods A cohort of adolescent women aged 16 to 19 years at baseline, recruited from health clinics or community venues, completed daily diaries on a Smartphone continuously for 18 months. Participants reported daily on their partner-specific feelings of closeness, trust, commitment, perceived risk for acquiring a sexually transmitted disease (PRSTD), perception of partner concurrency (PPC), and condom use for their main sexual partners. Results Relationships from 49 participants were used to examine variability over time in STI-related feelings, perceptions, and behavior. Overall, relationships were characterized by high levels of trust, closeness, and commitment and low levels of PPC, PRSTD, and condom use. However, for all but PRSTD, there was more variation (>50%) within than between relationships for each of these measures, although variability of PRSTD was high (47.1%). Residual variability for all perceptions and behaviors remained significant after controlling for trends over time. Conclusions Diary data illustrate wide day-to-day fluctuations in feelings of intimacy, PPCs, PRSTDs, and condom use indicating that these are dynamic attributes of adolescent romantic relationships.

P2-S8.12 Feasibility of using cell phones for daily data collection within adolescent cohort studies

The purpose of this study was to identify HIV risk factors associated with participants who were HIV seropositive at Needle Exchange Program (NEP) entry. A sample of injection drug users (IDUs) who enrolled in an NEP between 1994–1997 were recruited into a prospective study and tested for HIV antibodies. Demographic and recent drug use characteristics were collected. Logistic regression models were constructed to identify factors associated with HIV-seropositive status at NEP entry. Of 811 evaluation participants, 87% were African American, 67% were male, and 30% were HIV seropositive. The multivariate model indicated that daily cocaine injection (Adjusted OR (AOR)=1.98), daily speedball injection (AOR=2.36), daily heroin injection (AOR=0.55), cohabitation with someone (AOR=0.7), and employment (AOR=0.4) were all significantly associated with HIV seroprevalence at NEP entry (p<0.05). These findings indicate that HIV-seropositive individuals entering NEP practice particularly risky behaviors and are more likely to need help in order to minimize the harm of drugs and HIV infection than their HIV-seronegative counterparts.