Sung-Yeon Kang

Retention of cocaine abusers in outpatient psychotherapy.

Retention in outpatient psychotherapy of 148 crack and cocaine abusers was examined. The clients were predominantly Black (63%) and Hispanic (21%), predominantly male (87%), and the majority (66%) had completed no more than 12 years of high school. Clients entered treatment in a low-cost treatment center in New York City between June 1987 and November 1988. Forty-two percent (62) of the subjects were seen for one or two research interviews only, and did not return to begin therapy. Of the 86 persons who came to at least one therapy session, 30% (26) dropped out before the third session, 28% (24) dropped out between the third and fifth sessions, and 42% (36) were retained for six or more sessions. Short-term and longer-term retentions were analyzed separately, using a battery including sociodemographic variables, treatment history, psychiatric symptomatology, number of arrests, and drug use variables. None of the variables considered was significantly related to short-term retention. There were large although not significant differences in longer term retention by therapist. Longer-term retention was associated significantly with being White (contrasted with being Black) and being young. Nonsignificant but large associations were found between longer-term retention and having few arrests, being Hispanic (contrasted with being Black), and having low SCL-90 scores. Results are compared with previous findings about retention in drug and alcohol treatment. It is suggested that future research on retention in treatment focus less on client variables and more on therapist and program variables.

Integrating Qualitative and Quantitative Methods: Comparing HIV-Related Risk Behaviors Among Puerto Rican Drug Users in Puerto Rico and New York

A dual site project was conducted to assess determinants of injection and sex-related risk behaviors among Puerto Rican drug users. The project focused on injection drug users and crack smokers, and was conducted in East Harlem, NY and Bayamón, PR in 1996–2000. Qualitative methods included ethnographic mapping, focus groups, in-depth interviews, and observations. A survey component (East Harlem, n = 800; Bayamón, n = 400) was also conducted. Procedures to ensure integration of methodologies and comparability of data were developed. This paper describes the qualitative and survey methods used, and presents the comparative HIV risk behaviors. The integration of the two methodologies served multiple functions: each component identified issues to be addressed in the other, enhanced cross-site comparability of data, and assisted in interpretation of findings. The survey data showed high levels of risk behaviors in both communities, with significantly higher levels of risk reported in Bayamón. Conducting studies of similar ethnic groups in different communities provides opportunities to examine diverse sources of influence on risk behaviors. The integration of qualitative and quantitative methods can enhance comparability and understanding of findings, particularly when there are differences in behaviors between communities.

Migration and HIV Risk Behaviors: Puerto Rican Drug Injectors in New York City and Puerto Rico

OBJECTIVESnWe compared injection-related HIV risk behaviors of Puerto Rican current injection drug users (IDUs) living in New York City and in Puerto Rico who also had injected in the other location with those who had not.nnnMETHODSnWe recruited Puerto Rican IDUs in New York City (n = 561) and in Puerto Rico (n = 312). Of the former, 39% were newcomers, having previously injected in Puerto Rico; of the latter, 14% were returnees, having previously injected in New York. We compared risk behaviors within each sample between those with and without experience injecting in the other location.nnnRESULTSnNewcomers reported higher levels of risk behaviors than other New York IDUs. Newcomer status (adjusted odds ratio [OR] = 1.62) and homelessness (adjusted OR = 2.52) were significant predictors of shooting gallery use; newcomer status also predicted paraphernalia sharing (adjusted OR = 1.67). Returnee status was not related to these variables.nnnCONCLUSIONSnIntervention services are needed that target mobile populations who are coming from an environment of high-risk behavior to one of low-risk behavior.

Condom use among criminally-involved adolescents

Condom use was studied for 421 sexually active, minority male adolescents who were currently in jail in New York City. Over three-quarters of the youths were users of alcohol and marijuana and about one-quarter were users of cocaine or crack, but drug injectors were rare. In the six months before arrest they had multiple sexual partners and about one-third had engaged in anal intercourse. Inconsistent condom use was the norm, with 17% reporting that they never used condoms and only 15% reporting that they used condoms every time for insertive sex. In multivariate analysis, more frequent condom use was independently predicted by gay/bisexual preference, greater acceptability and accessibility of condoms, partners receptivity to use, self-initiation of use, and self-efficacy of avoiding AIDS. Condoms were used less frequently with steady than with causual partners, and rarely for anal or oral sex. AIDS prevention curricula addressing these factors should be delivered to high risk adolescents while they are temporarily accessible in jail.

Correlates of Drug Injection Behaviors among Methadone Outpatients

Intravenous drug use, which has been recognized as the second most common risk behavior associated with AIDS, was studied among methadone outpatients who were enrolled in a methadone program at a hospital-based clinic in New York City. Intercorrelations among the following variables were observed: sociodemographic, psychological, drug use patterns, and criminal history. Then a stepwise discriminant analysis was employed to examine factors differentiating the high risk clients from the lower risk clients in terms of needle use/sharing in the 30 days prior to the interview. The subjects (N = 152) were heterosexual (95%), non-White (63%), had no more than 12 years of education (72%), were not full-time employed (65%), and had been arrested at least once (79%). The median age at the time of entering the methadone treatment was 33 and the median length of stay in the treatment was 17.5 months (mean = 44.7 months), with an average 52 mg of methadone dosage. Results indicated that risk behavior in terms of current needle use/sharing occurred in about 16% of a sample of clients in the methadone maintenance. A shorter length of stay in treatment was the strongest predictor of high risk, followed by early arrest history, ethnicity, depression, and employment status.

Residential status and HIV risk behaviors among Puerto Rican drug injectors in New York and Puerto Rico.

This article investigates the association between residential status and human immunodeficiency virus (HIV) risk behaviors among island and New York Puerto Rican injection drug users (IDUs). We assigned 561 subjects from New York City and 312 from Puerto Rico to five residential status categories: living in parents home, living in own home, living in others home, living in temporary housing (hotel, single-room occupancy [SRO] hotels), and homeless (living in streets/shelters). Dependent variables included injection- and sex-related risk behaviors (sharing syringes, sharing other injection paraphernalia, shooting gallery use, and having paid sex). Chi square, t tests, and multivariate logistic analysis tests were performed separately by site. About one-quarter of the sample in each site was homeless. Island Puerto Ricans were more likely to live with their parents (44% vs. 12%, p <. 001), and more New York IDUs lived in their own home (30% vs. 14%, p <. 001). In New York, gallery use and paid sex were associated with living in others home, living in parents home, and being homeless. Sharing paraphernalia was related to living in others home, living in temporary housing, and being homeless. In Puerto Rico, having paid sex was associated with homelessness. High-risk behaviors were more likely among homeless IDUs in both sites. Programs to provide housing and target outreach and other prevention programs for homeless IDUs would be helpful in reducing HIV risk.

Measuring Cocaine Use by Hair Analysis among Criminally-Involved Youth

The study examined the utility of hair analysis for determining the prevalence of cocaine use in a high-risk population. Personal interviews and scalp hair specimens were obtained from 121 male youths who had been in jail in New York City and were followed-up in the community after their release. Using the standard cutoff, 51% of the hair specimens were classified positive for cocaine at a mean concentration of 87.6 nanograms per 10 milligrams of hair. Using the detection limit of the test, 67% were positive for cocaine. Only 23% of the youths reported any use of cocaine or crack during the previous 3 months and only 36% reported any lifetime use, indicating a substantial rate of underreporting. Associations were found between cocaine in hair and several behavioral variables: number of prior arrests (p=.08, trend), rearrest after release from jail (p<.05), not continuing education (p<.01), and no legal employment (p<.01). Hair analysis is a promising new epidemiological tool for obtaining more valid measures of illicit drug use in difficult-to-study populations.

Impact of expanding syringe access in New York on sources of syringes for injection drug users in Harlem and the Bronx, NYC, USA

Abstract Beginning in January 2001, it became legal for pharmacies, health care facilities and certain health care providers in New York State (NYS) to sell or provide syringes (10 maximum) without prescription. Cross-sectional survey data from three research projects recruiting active injection drug users (IDUs) in Harlem and the South Bronx ( n =682) were analysed by calendar quarter, from January 2001 through September 2002, to assist in an evaluation of the impact of the program, the Expanded Syringe Access Demonstration Program (ESAP). The outcome variable examined was having used a pharmacy as the source of the last injection syringe. The percent of IDUs who knew that it was legal to buy a syringe from a pharmacy increased over time (25–54%, P

A Longitudinal Study of Syringe Acquisition by Puerto Rican Injection Drug Users in New York and Puerto Rico: Implications for Syringe Exchange and Distribution Programs

Increasing access to sterile syringes and new drug preparation materials is an effective means of reducing HIV transmission among injection drug users (IDUs), and a fundamental component of harm reduction ideology. The purpose of this study is to examine changes during a three-year period in syringe acquisition by street-recruited Puerto Rican IDUs characterized by frequent drug injection and high HIV seroprevalence. At baseline (1998–1999) and 36-month follow-up, 103 IDUs recruited in East Harlem, New York (NY), and 135 from Bayamón, Puerto Rico (PR) were surveyed about syringe sources and HIV risk behaviors in the prior 30 days. A majority of participants in both sites were male (NY 78.6%, PR 84.4%), were born in Puerto Rico (NY 59.2%, PR 87.4%), and had not completed high school (NY 56.3%, PR 51.9%). Compared to PR IDUs at follow-up, NY IDUs injected less (3.4 vs. 7.0 times/day, p <. 001), and re-used syringes less (3.1 vs. 8.0 times, p <. 001). Between baseline and follow-up, in NY the proportion of syringes from syringe exchange programs (SEPs) increased from 54.2% to 72.9% (p =. 001); syringes from pharmacies did not increase significantly (0.2% to 2.5%, p =. 095). In PR, the proportions of syringes from major sources did not change significantly: private sellers (50.9% to 50.9%, p =. 996); pharmacies (18.6% to 19.0%, p =. 867); SEP (12.8% to 14.4%, p =. 585). The study indicates that NY SEPs became more dominant, while NY pharmacies remained a minor source even though a law enacted in 2001 legalized syringe purchases without prescription. Private sellers in PR remained the dominant and most expensive source. The only source of free syringes, the SEP, permitted more syringes to be exchanged but the increase was not statistically significant. Implications for syringe exchange and distribution programs are discussed.

HIV Risk and Prevention Among Hispanic Immigrants in New York: The Salience of Diversity

The importance of identifying differences in HIV risk between Hispanic subgroups is the focus of this article. Data are drawn from two New York–based HIV-related studies: among Puerto Rican drug users and among new immigrants from Central America, the Dominican Republic, and Mexico. Results indicated that intercultural individuals (i.e., those involved in both Puerto Rican and mainland cultures) were less risky in terms of injection- and sex-related risk behaviors and that geographic and other contextual factors, along with cultural norms, influence risk behaviors for immigrants. Both studies indicate the need to differentiate subgroup factors affecting HIV risk and prevention behaviors to develop appropriate and effective community-based interventions. The studys limitations are noted.