William N. Elwood

Powerlessness and HIV prevention among people who trade sex for drugs ('strawberries')

Researchers and members of the drug culture have employed the term strawberries to describe African American women who trade sex for drugs. Data from six US cities participating in a community-based drug research project were analysed to examine the determinants of trading sex for drugs. As shown by our data, some African American women match the street description commonly attributed to strawberries. However, our results also show that trading sexual favours for drugs is not limited to African American women, nor solely to women. Rather, trading sex for drugs is an economic behaviour that occurs among women and men of any race/ethnicity who use crack cocaine. Trading sex for drugs is closely related to conditions of poverty and homelessness, conditions that especially affect many crack smokers. The discussion urges educators and researchers to be alert for strawberry behaviours exhibited by drug-users of any racial/ethnic background or gender.

An assessment of the risks of syphilis and HIV infection among a sample of not-in-treatment drug users in Houston, Texas

The research presented in this paper details the results of an assessment of the risk factors associated with having a positive syphilis or HIV serology. The study was conducted using a sample of not-in-treatment drug users volunteering to participate in an HIV risk reduction intervention. The sample was composed of individuals who had injected drugs within 30 days or smoked crack cocaine 48 hours prior to participation in the study. Study participants were approximately 75% male and 66% African-American. All participants provided a blood sample to be tested for HIV and syphilis. Analysis of risk was conducted using univariate and multivariate statistical methods. Multivariate analysis of blood results showed that women, African-Americans, and those having a positive blood test for HIV were at higher odds of having a positive syphilis test. Analysis also showed that being a gay or bisexual male, having a history of drug injection, having less than a high-school education, having a history of trading sex for money, being African-American, and having a positive blood test for syphilis significantly increased the odds of a positive HIV test. Implications for HIV and STD prevention are discussed.

Escape from risk: a qualitative exploration of relapse to unprotected anal sex among men who have sex with men.

Abstract Since the advent of the HIV/AIDS epidemic, gay men have reduced their sexual behaviors that put them at risk. Despite these changes, recent studies have found that some men who have sex with men (MSM) who regularly practice safer sex behaviors, periodically engage in risky anal sex. Many of these MSM realize that their “lapses” place them at risk for HIV infection; nevertheless, they engage in unprotected sex. In response to these findings, some behavioral scientists have questioned the ability of existing models of condom use to completely account for all types of HIV sexual risk and risk avoidance behaviors, especially episodic unprotected anal sex by men who otherwise use condoms. A cognitive escape model proposed by McKir-nan, Ostrow, and Hope (1996) is an explanation that may be able to account for periodic “lapses” in condom use by MSM who usually comply with safer sex standards. This manuscript applies that model to textual data from a sample of 41 MSM who have sex in bathhouses. In depth, semi-structured interviews provided the data for the study. We found that MSM in this study recognize strong normative expectations for using condoms during anal sex, and usually comply with these expectations. Participants also report that constant awareness of HIV and the AIDS epidemic and the need to constantly comply with standards of safer sex produce stress. The men noted that they frequented certain settings, including bars and bathhouses, and used alcohol and illicit drugs because these provided the stimuli that facilitated a cognitive disengagement from the norms of safer sex. Among the MSM interviewed who reported unprotected sex, a cognitive escape model appears able to account for their lapses from safer sex standards. Limitations of the study and recommendations for further exploration are discussed.

Sticky Business: Patterns of Procurement and Misuse of Prescription Cough Syrup in Houston

Abstract Reports of recreational codeine cough syrup use have increased in Houston and in the state of Texas. Occasional and polydrug users increasingly have consumed codeine cough syrup (with or without alcohol or other drugs) over the past three years, accounting for a

Embalming fluid-soaked marijuana : New high or new guise for PCP ?

40 increase in the price of an eight-ounce bottle on the underground economy. News stories regarding syrup abuse and reports of deaths by codeine overdoses suggested the need to explore this emerging drug trend. The investigator conducted a literature search of scientific journals and news media, interviews with community authorities, and guided interviews with 25 adults who reported using codeine cough syrup in the 30 days preceding their interviews. Participants were recruited through snowball sampling; interview transcripts were coded and content analyzed. Polydrug users reported a penchant for codeine syrup because it carries fewer legal consequences, is perceived as “safer” than illegal drugs, and is either free or inexpensive for users with Medicaid or private insurance. Participants reported methods for procuring syrup from physicians and hospital emergency rooms which they consumed or traded for money, goods, or services. Consumption patterns for chronic and occasional users are described. Reported side effects include a drowsy relaxed high, fatigue, loss of coordination, constipation, and urinary retention.

Perceived compliance with AZT dosing among a sample of African-American drug users.

A growing trend of smoking marijuana soaked in what is purported to be embalming fluid has been reported in the literature since the mid-1980s. This article describes several cases of intoxication, gives regional epidemiological data on this phenomenon, and includes current nomenclature. The authors also analyze a sample of fluid said to be embalming fluid and discover PCP (phencyclidine) and multiple congeners and by-products of PCP manufacture. The implications of this finding are discussed, and the hypothesis that most embalming fluid-soaked marijuana likely contains PCP is considered.

Determinants of condom use among African Americans who smoke crack cocaine

The purpose of this report was to present findings from a pilot study conducted to explore the associations between sociodemographic, drug use, and health belief factors and perceived compliance with zidovudine (AZT) among African-American drug users. Data were collected in Washington, DC, USA from individuals who were African-American; were recent or current drug injectors or crack smokers; were HIV-seropositive, and were receiving treatment for HIV infection. Participants were recruited through local organizations that provide services to HIV-infected persons. Participants were interviewed using a questionnaire that solicited sociodemographic, lifetime and current drug use, current sexual behaviours, health status, HIV and drug treatment history, and health belief data. Analyses were limited to individuals currently using an illicit substance and who had received AZT during their medical treatment. Parametric (Pearsons r) and non-parametric (Spearmans rho) statistics were used to assess correlations between perceived compliance with AZT dosing and independent variables. As the study was intended to be both descriptive and exploratory, the level of statistical significance was set at 0.10, rather than the customary 0.05. Antiretroviral medications recognized and recalled by participants are presented. The most commonly recalled medication was AZT. Slightly less than one-third of participants reported being completely compliant with an AZT regimen. Perceived compliance was found to be negatively associated with 5 variables: age, homelessness, number of injections in the previous 30 days, trading sex for drugs, and the perception that AIDS is no longer a serious disease since the development of new antiretroviral medications. Intensity of feelings of joy, fear, and the belief that taking more anti-HIV medications would result in better health were found to be positively correlated. Bivariate associations between perceived compliance and sociodemographic, drug use, sexual behaviour, and health belief variables suggest further avenues of study and potential points for intervention to increase compliance with antiretroviral medications among racial/ethnic minority drug users receiving treatment for HIV infection.

A Cluster Analysis of Not-in-Treatment Drug Users at Risk for HIV Infection

This paper presents findings from an elicitation study that focused on the sexual risks and condom use behaviour of African American crack smokers. Of interest were the attitudes, beliefs, and barriers that affect the adoption and maintenance of condoms as an HIV prophylactic. Thick descriptive data were collected from 64 heterosexual African Americans who smoke crack cocaine. Data were content analysed for descriptions of condom use attitudes, normative beliefs, and barriers or facilitators of condom use. Participants described few positive condom use outcome expectations, while detailing several negative expectations. Normative beliefs were found to be weakly related to condom use with casual partners. However, descriptions of sexual relationships with intimate partners indicated that the normative expectations of the partner strongly influenced condom use. Participants described few contextual barriers to condom use, although situational barriers, including crack addiction, were identified.

Introduction of HIV into drug injector networks outside AIDS epicentres

The purpose of the analysis described here was to classify not-in-treatment drug users participating in the National Institute on Drug Abuse (NIDA)-sponsored Cooperative Agreement study into several homogeneous HIV risk groups using cluster analysis. Data for this analysis (N=17,778) were collected at 19 study sites in the United States and Puerto Rico. Measures selected for the cluster analysis were limited to (a) current drug use and HIV risk behaviors, (b) mutually exclusive behaviors, (c) behaviors directly related to HIV risk, and (d) behaviors that were not statistically rare. Eight homogeneous HIV risk clusters were produced. Crack cocaine use was the most distinguishing feature of three clusters. Another three clusters were distinguishable by drug injection and needle use practices. Two additional clusters could not be grouped with either the crack- or the injection-dominant clusters. Prostitution was the most distinguishing risk behavior of one of these clusters, and extremely high drug injection frequencies and relative rates of risky needle use characterized the other. Composition of the clusters varied significantly by gender, race/ethnicity, educational attainment, and drug use characteristics. In addition, perceptions and behaviors initiated to reduce the chances of becoming infected with HIV varied by cluster. Subjects in the crack-predominant clusters reported low perceptions of the chances of getting AIDS. Perceptions of the chances of becoming infected with HIV among subjects in the injection-predominant clusters were strongly related to injection frequency. Seroprevalence was also related to cluster. Higher rates of HIV infection were evident among the injection-predominant clusters, and higher rates were related to frequency of injection and the rate of risky needle use. Among the crack-predominant clusters, the relationship between drug use and sexual behaviors and HIV infection was less clear.

Fostering a drug-free workplace.

Injection drug users (IDUs) continue to be at risk for HIV infection despite high levels of knowledge about how human immunodeficiency virus/ acquired immunodeficiency syndrome (HIV/AIDS) is transmitted. Yet, among notin-treatment injection drug users, the chances of becoming infected with HIV vary substantially. Information regarding the factors that facilitate the introduction of HIV into networks of drug injectors in low HIV seroprevalence cities is urgently needed. This study examines the factors related to HIV seroprevalence in a large ( n =9492), multi-site sample of IDUs recruited in 11 low seroprevalence cities. Univariate and multivariate associations between drug injection and sexual behaviours and travel to an AIDS epicentre were examined. Results show that, next to male-to-male sexual contact, having sex at least twice in an AIDS epicentre was the strongest predictor of HIV infection. Also associated with higher odds of being HIV-positive were racial/ethnic characteristics, daily drug injection, and injecting drugs in an AIDS epicentre. These results confirm that travelling to an AIDS epicentre and having sex or injecting drugs play a large role in the introduction of HIV into drug injector networks in low seroprevalence cities.