Journal of substance abuse最新文献

Purpose: The study sought to understand the HIV testing patterns of low-income drug users. Methods: Sixty-seven low-income drug users were recruited from street outreach venues in three San Francisco Bay Area counties. Participants were interviewed using an open-ended questionnaire eliciting information on HIV testing histories, sexual behavior, and drug use. Transcripts from interviews were coded and analyzed using methods consistent with the grounded theory approach of qualitative research. Results: Participants identified four themes related to HIV testing: (1) anticipating positive results, (2) belief in a 10-year window period during which the virus is undetectable, (3) regular HIV testing as part of self-care, and (4) the HIV test as a means of control. These themes did not relate to personal risk behavior but rather to the community experience of HIV in small, dense populations of low-income drug users with high rates of HIV infection. Implications: Participants used HIV testing like regular mammograms or blood pressure checks, as if it were a screening procedure for a chronic illness. This is a reasonable response given the context of HIV within their communities. HIV testing in this population should not be limited.

Purpose: We tested the hypotheses that sexual risk would relate to gay/bisexual men's patterns of combining alcohol or drugs with sex, their motivation to use drugs to cognitively “escape” awareness of HIV risk, and their use of bars as social and sexual settings. Methods: We conducted extensive interviews among African–American (n=139) and White (n=112) gay and bisexual men who were attending a behavioral intervention for safer sex results. Those who frequently combined drugs with sex reported higher rates of sexual risk and Hepatitis B infection than did men who infrequently combined substances with sex, or who combined only alcohol with sex. Sexual risk was pronounced among more frequent drug users who also reported strong expectancies that alcohol or drugs facilitate sex and cognitively escape from awareness of HIV risk. Frequenting bars per se was not an important factor in sexual risk. Implications: Men who use alcohol or drugs to enhance sexuality and escape self-awareness of HIV risk have a significantly diminished capacity to avoid sexual risk.

Purpose: This cross-sectional study investigated the predictors for and patterns of health care utilization among young adult injection drug users (IDUs). Methods: The subjects were 206 IDUs, ages 18–29, who were street-recruited from Harlem, New York. Participants were interviewed about their drug use, health conditions, and use of services such as health care, needle exchange programs (NEPs), and drug treatment in the preceding 6 months. Data were analyzed using logistic regression. Results: Health insurance was associated with use of health care both among NEP users [AOR (adjusted odds ratio) 10.66] and non-NEP users (AOR 2.45). Use of health care was independently associated with drug treatment (AOR 2.58), being gay/bisexual (AOR 3.86), and negatively associated with injecting cocaine (AOR 0.56). Half the participants (49%) had used health care in the previous 6 months; 48% were uninsured. Many participants who did not use health services reported a condition that would have warranted medical care. Implications: Health insurance was strongly associated with use of health care, particularly among those who attend NEPs. Young adult IDUs may benefit from increased efforts to help them arrange and maintain health insurance coverage, potentially at NEPs. NEPs may be connecting young IDUs with health insurance to medical care through referrals.

Purpose: The purpose of this preliminary study was to document self-reported tattooing and body piercing behavior among a sample of 860 adolescent detainees. Additionally, the study examined the relationship of alcohol and drug use to tattooing and body piercing — an often overlooked HIV risk behavior. Method:Adolescents (N = 860) participating in a substance use and HIV risk reduction intervention were upon entrance to Youth Development Campus (YDC). Results: Twenty-nine percent of the sample (N=245) had at least one tattoo, and more than half (69%) had at least one body piercing. Fifteen percent had two or more tattoos, while 28% had three or more piercings. Although a small percentage of the youth reported knowingly sharing needles for tattoos or piercings (2% and 1.5%, respectively), 21% had tattoos that had been administered unprofessionally and 20% had unprofessionally administered piercings. Marijuana and alcohol were the highest reported substances used in this sample, 62% and 54%, respectively. Alcohol, marijuana, antidepressants, and sedatives were significant correlates of having tattoos. Alcohol was found to be a marginally significant (P=.052) correlate of body piercing. Conclusion: The popularity of tattooing and piercing and the risk involved with these activities make them an HIV risk behavior worthy of address. Risk reduction messages to youth should consistently address these behaviors and focus on them as they relate to substance use.

Purpose: This study examined gender and age as potential moderators of the association between marijuana use and human immunodeficiency virus (HIV) risk among 272 adolescent offenders. Methods Analyses were based on biological and self-report measures of both marijuana use and HIV risk. Results: Results revealed that the association between marijuana use and HIV risk was moderated by age but not gender across both biological and self-report measures. Specifically, marijuana use was associated with a higher occurrence of HIV risk among younger but not older adolescent offenders. Implications: These findings provide meaningful information that can be used to guide future research as well as interventions with adolescent offenders.

Accumulating findings suggest a relationship between partner violence and HIV risk among women, however, this issue has yet to be adequately researched among men. This study examines the relationship between perpetrating intimate partner violence and HIV risk behavior among a sample of men in methadone maintenance treatment programs (MMTPs). Data were collected on 273 sexually active men, who were recruited from four inner-city MMTP clinics. More than a third of the sample reported perpetrating intimate physical abuse and 15% reported severe physical abuse in the past 12 months. Results from multiple logistic regression analyses indicate that after adjusting for demographic, poverty, and drug-use factors, men who abused an intimate partner were almost 4 times more likely to have more than one intimate partner, almost 3 times more likely to have unprotected anal sex, and 2.6 times more likely to have sex with a drug-injecting sexual partner than their counterparts. This study showed that men who perpetrated partner violence were at higher risk for HIV transmission. HIV prevention interventions need to consider the complex relationship between partner violence and HIV risk.

Purpose: To measure prevalence, incidence, and correlates of chlamydia and gonorrhea among injection drug users (IDUs). Methods: Participants (n=2129; 63% male, 52% white, ages 18–30 years) in five US cities were tested for chlamydia and gonorrhea by urine LCR assay and completed a standardized questionnaire about demographics and recent sexual behavior. Logistic regression identified correlates of prevalent infection; incidence rates were calculated from 6-month follow-up data. Results: Chlamydia prevalence was 5.2% and did not differ by gender. Gonorrhea prevalence was 0.2% among men and 2.0% among women, P<.001. Among men, younger age [OR (95% CI): 0.89 (0.83–0.96)], age at sexual debut [0.91 (0.83–0.99)], and African American race [2.92 (1.53–5.59)] were associated with chlamydia. Among women, age at sexual debut [1.16 (1.02–1.31)] and commercial sex [1.96 (1.03–3.74)] were associated with chlamydia, and with gonorrhea [1.27 (1.04–1.56)] and [5.17 (1.66–16.11)], respectively. At 6 months, the cumulative incidence of chlamydia was 1.7% among men and 4.4% among women, P=.03; no men and 1.3% of women tested positive for gonorrhea, P=.01. Implications: Prevalence and correlates of chlamydia and gonorrhea were similar to other samples, suggesting that screening criteria need not be modified for IDU populations. The number of behavioral correlates identified was limited; perhaps unmeasured sexual-network-level factors play a role in determining sexually transmitted disease (STD) prevalence.

Purpose: The Columbia University HIV Mental Health Training Project, created to improve the mental health workforce's AIDS preparedness in New York and neighboring states, sought to compare the perceived HIV-related needs and capacities of mental health care providers in settings where clients with substance use disorders predominated versus those where clients with substance use disorders were the minority of the agencies' caseload. Methods: The first consecutive 67 mental health care agencies that requested HIV/AIDS training between March 2000 and January 2001 completed a written needs assessment describing their HIV-related services and training needs. Results: Agencies with higher substance abuse caseloads were significantly more likely than others to have large HIV/AIDS caseloads, to be currently providing condoms to clients, and to rate staff comfort with sexual identity issues as well as drug-related issues as good. Overall, agencies that had received previous training in specific topic areas (e.g., HIV risk assessment) were significantly more likely than others to provide those services. Even so, in all settings, significant gaps in service provision were found. Implications: Two decades into the AIDS epidemic, mental health care agencies, especially those treating smaller caseloads of patients with substance use disorders, may not be providing sufficient services to meet their clients' HIV-related needs.

Objective: We sought to identify risk factors for needle sharing and HIV infection among injecting drug users (IDUs) in Ho Chi Minh City (HCMC), Viet Nam. Methods: Three cross-sectional surveys among IDUs, both on the street (in 11 urban districts) and in the rehabilitation center for IDUs in HCMC, were carried out in April of 1995, 1997, and 1998. Outreach workers interviewed IDUs about socio-demographic characteristics, drug use and sexual practices, and HIV knowledge and perceptions. The IDUs were also tested for seropositivity to HIV. Independent predictors for HIV positivity and needle sharing were determined by univariate and multivariate logistic regression for the study sample within the rehabilitation center in 1997 and for that on the street in 1998. Results: The HIV prevalence in 1998 among IDUs was 44% for those on the street and 38.5% for those in the rehabilitation center. Independent predictors for HIV infection in IDUs were being injected by drug dealers (for the 1997 sample), injecting on the street, and sharing the drug pots (for the 1998 sample). The reported rate of needle sharing was low and decreased significantly from 20% in 1995 to 12% in 1998 for the sample of IDUs at the street. In the multivariate analysis, predictors for needle sharing for both study samples were injecting on the street, injecting at shooting galleries, and having shared needles in the past. Adequate and easy access to sterile needles and syringes, and an supportive environment of behavior change, especially in street and shooting gallery could reduce risks of virus transmission in the Vietnamese IDU community.

Purpose: To evaluate the relationship of various psychosocial factors on HIV sexual risk behavior in a sample of 169 “inner city” male and female adolescents mandated into in court-ordered substance abuse treatment. Method: The Millon Adolescent Clinical Inventory (MACI) and measures of sexual behavior, condom attitudes and skills, HIV knowledge, and substance abuse were administered. Data were evaluated according to five HIV risk groups: abstinent (n=37); monogamous and practicing only protected sex (n=19); monogamous and practicing unprotected sex (n=45); multiple partners and practicing only protected sex (n=11); and multiple partners and having only unprotected sex (n=57). Results: Significant main effects were found for impulsive propensity, submissiveness, marijuana and alcohol use, condom attitudes, and intentions to engage in safer sex. Protective behavior was directly associated with submissiveness and inversely associated with impulsive personality profiles, with increased marijuana use emerging as a significant predictive factor in the choice for sexual activity vs. abstinence. More alcohol use was predictive of choosing multiple partners vs. monogamy. Implications: Factoring risk variation into the design of HIV psychosocial research may enhance the tailoring of effective prevention strategies.