A gender comparison of HIV and drug use across the rural-urban continuum

Despite the central role of women drug users in escalating AIDS statistics, there is still a limited number of studies that examine the roles of gender and drug use type in HIV seroprevalence. This lacuna in the research literature has led to significant gaps in researchers' understanding of how and to what extent women may differ in their drug-using and HIV risk behaviors compared to their better-studied male counterparts. This study, derived from a sample of 3,555 out-of-treatment drug users residing in three South Florida urban and rural communities, attempts to compare the drug usage and needle and sexual risk behaviors of male and female drug users that put them at risk for HIV infection. The overall seropositivity rate for women drug users was 26.5% compared to 19.5% for their male counterparts. Results of multivariate analyses indicate that females compared to males were 1.4 times more likely to be HIV seropositive. Risk behaviors associated with this elevated seropositivity include living arrangements, homeless status, drug use, sexual trading behaviors, and history of STDs. Furthermore, there was a strong linear relationship between drug use type and HIV seroprevalence among women drug users. Compared to those who were neither crack smokers nor injectors of illicit drugs, those who were crack smokers only were 2 times more likely to be HIV seropositive, while those who were both crack smokers and injectors were 5 times more likely to be HIV seropositive, and those who were injectors only were 6 times more likely to be HIV seropositive. These findings indicate that among women, drug abuse and its associated risk behaviors, increase the vulnerability of this population for HIV and thus render them an extremely important priority population on which to focus HIV prevention and public health efforts and programs.     

吸毒人群对艾滋病防治的接纳现状与影响因素

近年来我国已经把吸毒人群作为艾滋病防治的重要干预对象之一,然而现状不容乐观,吸毒人群传播艾滋病的风险远未得到有效控制。探讨影响吸毒人群对艾滋病防治措施的认同和接纳的因素,以便为完善艾滋病防治措施提供新的思路。研究表明,吸毒人群的认知水平、社会支持、政策保障、人生态度等因素对其接纳艾滋病防治措施有影响。只有将吸毒人群视为弱势群体予以增权和关爱,以"合作"的社会政策导向和"平等"的社会工作价值介入,从其需求入手开展务实多样的防治措施,才有可能真正改变吸毒人群的观念与行为,从而获得艾滋病防治的良效。     

HIV diffusion patterns and mobility: Gender differences among drug users

Researchers have recently expanded the scope of study of transmission patterns of AIDS to incorporate spatial and geographical questions. United States diffusion patterns of this disease appear to indicate that it may emanate from urban area epicenters to areas of low and moderate prevalence. The travel patterns of injecting drug users (IDUs) and the extent to which they engage in high risk drug and sexual activities was examined as an explanation of diffusion of the HIV virus from one community to another. The study population of 49,621 was comprised of subjects recruited from approximately 60 sites nationwide from 1988–1991. While the data are limited in some ways, they partially support a diffusion explanation of HIV transmission for males and females. The analysis demonstrates that low prevalence cities were significantly more likely to have been the destinations of both men and women who engaged in high risk drug and sexual activities. In addition, HIV seropositive drug users who engaged in high risk drug and sexual behaviors in destination cities were more likely than seronegatives to travel to high or low seroprevalence areas than to moderate prevalence areas. The findings suggest a need for effective HIV prevention educational messages about the risks of traveling and participating in high risk activities.     

The prevalence and incidence of HIV among injection drug users: A five year panel study

Six hundred and one injection drug users (IDUs) who attended drug treatment programs in Miami, Florida, were enrolled in a panel study to determine the prevalence and incidence of human immunodeficiency virus (HIV) and associated risk factors. A structured questionnaire which elicited injection and sexual behaviors was administered and blood was obtained by venipduncture. All participants were reassessed at six month intervals for 5 years. The baseline prevalence of HIV was 16.3%. African–Americans had a prevalence of HIV (37.1%) that was significantly higher than that of non-Hispanic whites (7.6%); the prevalence of HIV among Hispanics was 27.2%. Persons who were more than thirty years of age were more likely to test HIV positive (17.8%) than were younger participants (9.7%). The annual incidence per 1000 person-years of exposure for the 503 initially seronegative participants was consistently low for each year of the study. The 5 year incidence was 4.1 per 1000 person years; 7.5 for men and 1.7 for women, 7.5 for African–Americans and 3.8 for non-Hispanic whites. No Hispanic participants seroconverted. Multivariate logistic techniques were used to identify the independent risk factors for HIV prevalence. Earlier injection, ethnicity, and income were independently associated with HIV serostatus. A history of a sexually transmitted disease was marginally associated with HIV prevalence. Low incidence probably is a function of the reduction of risk behavior that occurred over the course of the study and the stage of the epidemic.     

Gender comparisons of injection drug use practices in shooting galleries

Previous research studies and anecdotal evidence portray shooting galleries as locales that place injection drug users at great risk for HIV infection, drug use and violence. Collectively, these studies highlight the need to intervene with injectors who frequent shooting galleries. However, few researchers have studied an often-forgotten risk group – women injecting drug users who frequent shooting galleries – and compared their risk behaviors to their male counterparts. To address this gap in the research literature and to evaluate the functionality of the shooting gallery as a setting for HIV prevention, we collected data on risk practices from 201 injectors (101 men and 100 women) who were recruited from eight shooting galleries in Miami, Florida. Results indicate that, compared with men, women injectors engaged in a similar variety and frequency of injection risk behaviors and had more shooting companions. While only minor gender differences were apparent, relatively few injectors – male or female – adhered to current recommendations for needle hygiene practices. Needle hygiene practices existed equally among injectors of both sexes, however very few adhered to current recommendations. Furthermore, contrary to common images of shooting galleries, use of other drugs was infrequently reported, episodes of violence or victimization were uncommon, and sexual contact almost never occurred. Operators of shooting galleries, both men and women, indicated their willingness to participate in HIV prevention efforts. Implications of these findings for HIV intervention indicate that (1) there is a great need to intervene with both men and women IDUs who frequent shooting galleries and that (2) shooting galleries can be an optimal setting for HIV prevention.     

HIV seroprevalence and risk behaviors among clients attending tuberculosis clinics in Miami-Dade County,Florida, 1989–1996

Miami-Dade County is a major HIV epicenter and a port of entry for immigrants from nations with high endemic rates of tuberculosis (TB). We analyzed data from an unlinked (blinded) serosurvey of clients attending four Miami TB clinics to elucidate the dynamic HIV seroprevalence patterns in relation to demographics and risk behaviors. Data were analyzed from 3,107 consecutive TB patients at four TB treatment clinics over eight years. Overall HIV seroprevalence was 23.6% with a significantly higher infection rate for men (26.6%) compared to women (17.3%) (p < 0.0001). In rank order, the HIV infection rates were 30.3% for black non-Hispanics, 24.7% for white non-Hispanics and 14.2% for Hispanics. U.S.-born clients had significantly higher HIV rates compared with foreign-born clients (32.4% vs. 18.5%, p < 0.0001). HIV rates declined over six years from (32.5% to 15.9%, p < 0.0001) with significant trends observed for men and women; and for blacks, whites and Hispanics. Seroprevalence was 15.7% for clients identifying heterosexual contact as their only risk. Highly significant increases in seroprevalence above this heterosexual-contact-only `baseline', were found for clients disclosing the following high-risk behaviors: male-to-male sex, drug injection, smoking crack cocaine, receiving or giving money/drugs for sex, and sexual contact with a drug injector or HIV-infected partner. While highly significant elevations in HIV seroprevalence were associated with each of these definitive risk behaviors, even the baseline HIV infection rate of 15.7% in heterosexual-contact-only clients was markedly higher than that of the general population. These findings underscore the need to obtain routine HIV serology on all TB patients.     

Drug dependency and HIV testing among state prisoners

HIV and drug use are higher among prisoners than the general US population. This study examines drug dependency/use and differences between prisoners who volunteered for HIV testing and those who did not in a less densely populated state. It was hypothesized that prisoners who volunteered for an HIV test were engaged in more drug use and other risky behaviors than those who did not. Survey data were collected from 600 randomly selected inmates (567 males and 33 females) from 15 state prisons. Subjects were male (95%), white (63%), never married (43%), and 44% volunteered for an HIV test since entering prison. Ninety-two percent of inmates met DSM criteria for drug dependence in their lifetime. Those who volunteered for HIV testing were 2.6 times more likely to ever have used PCP; 1.5 times more likely to ever have used cocaine; 1.4 times more likely to ever have had a problem with drugs; 1.3 times more likely to have used opiates, and 1.6 times more likely to report having been sexually or physically abused. Implications for interventions are discussed.     

Modelling the spread of HIV/AIDS in China: the role of sexual transmission

The study presented here is an exploration of the implications of patterns of sexual behaviour for the spread of HIV in China, using a bio-behavioural macrosimulation model. To reflect the uncertainty surrounding key parameters, analyses of varied scenarios are used to show a range of possible outcomes consistent with variations in selected biological and behavioural inputs. The latter are estimated from a nationwide survey of sexual behaviour recently conducted in China, a country with an emerging HIV/AIDS epidemic, where it is feared that HIV/AIDS will spread to the general population via heterosexual transmission. The results highlight the primacy of the levels and distribution of sexual activity in the population. They offer some guidelines for understanding and interpreting the potential implications of current and prospective changes in sexual behaviour for the spread of HIV/AIDS in the world's largest population, and also highlight the need to collect better data on sexual behaviour for the estimation of key model inputs.     

Left behind: intergenerational transmission of human capital in the midst of HIV/AIDS

This paper provides evidence on how adverse health conditions affect the transfer of human capital from one generation to the next. We explore the differential exposure to HIV/AIDS epidemic in sub-Saharan Africa as a substantial health shock to both household and community environment. We utilize the recent rounds of the Demographic and Health Surveys for 11 countries in sub-Saharan Africa. First, we find that an additional year of maternal education leads to a 0.37-year increase in children’s years of schooling in the developing economies in sub-Saharan Africa. Second, our results show that mother’s HIV status has substantial detrimental effects on inheritability of human capital. We find that the association between infected mothers’ and their children’s human capital is 30 % less than the general population. Finally, focusing only on noninfected mothers and their children, we show that HIV prevalence in the community also impairs the intergenerational human capital transfers even if mother is HIV negative. The findings of this paper are particularly distressing for these already poor, HIV-torn countries as in the future they will have even lower overall level of human capital due to the epidemic.     

HIV and population dynamics: A general model and maximum-likelihood standards for East Africa

In high-prevalence populations, the HIV epidemic undermines the validity of past empirical models and related demographic techniques. A parsimonious model of HIV and population dynamics is presented here and fit to 46,000 observations, gathered from 11 East African populations. The fitted model simulates HIV and population dynamics with standard demographic inputs and only two additional parameters for the onset and scale of the epidemic. The underestimation of the general prevalence of HIV in samples of pregnant women and the fertility impact of HIV are examples of the dynamic interactions that demographic models must reproduce and are shown here to increase over time even with constant prevalence levels. As a result, the impact of HIV on population growth appears to have been underestimated by current population projections that ignore this dynamic.     

AIDS in China

Most recent official statistics indicate that there was a cumulative total of 133 AIDS cases in mainland China through the end of October 1996 and 5157 people infected with HIV. Official statistics also indicate continuing increases in recent years in the number of people with AIDS and people infected with HIV, and that the incidence of infection is growing in China. HIV has been found to have been transmitted in China through IV drug use, sexual activities, from mother to child, and through transfusions and the use of blood products. Important risk factors for the spread of HIV in China include high population density, a considerable transient population, drug use, prostitution, blood transfusion, the improper sterilization of medical instruments in rural areas, changes in people's sexual attitudes and behaviors, and lack of information on safe sex. The Chinese government reports having taken considerable steps to check the spread of HIV/AIDS and supports communication and education as an essential tool in the fight against the epidemic. Life expectancies in China's provinces and municipalities are listed.     

Refusal Bias in the Estimation of HIV Prevalence

In 2007, UNAIDS corrected estimates of global HIV prevalence downward from 40 million to 33 million based on a methodological shift from sentinel surveillance to population-based surveys. Since then, population-based surveys are considered the gold standard for estimating HIV prevalence. However, prevalence rates based on representative surveys may be biased because of nonresponse. This article investigates one potential source of nonresponse bias: refusal to participate in the HIV test. We use the identity of randomly assigned interviewers to identify the participation effect and estimate HIV prevalence rates corrected for unobservable characteristics with a Heckman selection model. The analysis is based on a survey of 1,992 individuals in urban Namibia, which included an HIV test. We find that the bias resulting from refusal is not significant for the overall sample. However, a detailed analysis using kernel density estimates shows that the bias is substantial for the younger and the poorer population. Nonparticipants in these subsamples are estimated to be three times more likely to be HIV-positive than participants. The difference is particularly pronounced for women. Prevalence rates that ignore this selection effect may be seriously biased for specific target groups, leading to misallocation of resources for prevention and treatment.     

A Case for Developing Community Drug Indicators

The EU Action Plan on Drugs (2005?C2008) calls for member states of the European Union to provide information on five key epidemiological indicators. These are: general population surveys, prevalence and patterns of problem drug use, drug related infectious diseases, drug related deaths and mortality of drug users, and demand for drug treatment. The goal is to improve the comparability of data across the Member States, which is a central task of the EMCDDA (European Monitoring Centre for Drugs and Drug Addiction). Ireland has made progress on a national level in meeting this obligation. Currently the core information systems used to monitor the drugs problem in Ireland and to inform policy making are in the health and law enforcement areas including treatment, mortality and crime data. The dominance of such objective indicators and treatment outcome measures has contributed to obscuring the view of communities experiencing drugs problems on a day to day basis. The data are summations of the individual experience of drug problems and contribute little to understanding the broader question of how drug problem effect communities. This article draws on a community drugs study to review the contribution of traditional indicators of drug problems and consider some of the limitations of this data. It then presents an analysis of community data to identify possible community indicators of drug problems.     

Are young people in the Philippines taking chances with HIV / AIDS?

The numbers of AIDS cases and HIV infections detected in the Philippines have risen slowly but steadily since the first AIDS case in the country was diagnosed in 1984. By the end of 1995, 234 AIDS cases and 470 HIV infections had been reported to the country's Department of Health. However, given the limited extent to which people have been tested for HIV infection, there are most likely many more cases than reported. The HIV/AIDS epidemic is spreading within the Filipino population. The country's substantial commercial sex trade, reports suggesting that many unmarried young men have sexual intercourse with girlfriends and acquaintances, and IV drug use among a small number of young people are factors which contribute to the potential for a serious HIV/AIDS epidemic in the Philippines. Findings from the 1994 national Young Adult Fertility and Sexuality Study, a household survey covering 10,879 men and women aged 15-24 years in 959 different communities, are presented. Almost all respondents had heard of AIDS, but there was some degree of ignorance and misinformation on the modes of HIV transmission. 13% of all single men reported having had only one sex partner, 10% reported two or more partners, and 3% reported five or more. 98% of sexually active men had heard of condoms, 58% knew that condom use can protect against HIV infection, 23% reported ever having used one, and 4% reported using a condom during the most recent act of sexual intercourse.     

Attitudes and Stereotypes Regarding Older Women and HIV Risk

Persons aged 50 years and over will soon disproportionately represent the future of the HIV/AIDS epidemic. It is estimated that by 2015 older adults will represent 50% of persons living with HIV in the United States. Despite the HIV/AIDS growing population among older adults, attitudes, beliefs, and stereotypes toward older adults that exist in general society have affected HIV prevention, education, and care. Specifically, ageist attitudes about the sexuality of older adults in general and older women in particular, low clinical HIV suspicion among healthcare providers, lack of knowledge about risk among older women, and differentials in power related to negotiating sexual practices all lead to heightened concerns for the prevention, identification, and treatment of HIV disease in mature women. This article examines common attitudes, beliefs, and stereotypes that exist within general society as well as health and social service providers that place older women at a disadvantage when it comes to HIV prevention, education, and treatment.     

Estimating the Incidence of Hidden,Untreated Opiate Use

Illegal drug use is a hidden phenomenon, making it extremely difficult to obtain accurate estimates of untreated use. Yet it is this very estimate of incidence that is required by policy makers and service providers who are responsible for allocating increasingly scarce resources in times of worldwide recession. Using Irish data on more than 6,000 cases of clients presenting for first treatment, a Gamma incubation period distribution describing progression to first opiate treatment is fitted. An analytical solution of the back calculation method and a linear Volterra integral equation are used to project back and estimate the hidden, untreated population of opiate users.     

Sero‐Discordant Couples in Five African Countries: Implications for Prevention Strategies

Most analyses of the determinants of HIV infection are performed at the individual level. The recent Demographic and Health Surveys, which include results from HIV tests, allow the study of HIV infection at the level of the cohabiting couple. This article exploits this feature of the data for Burkina Faso, Cameroon, Ghana, Kenya, and Tanzania. The analysis yields two findings about the dynamics of the HIV/AIDS epidemic that have important implications for policy. First, at least two‐thirds of the infected couples are sero‐discordant, that is, only one of the two partners is infected. This implies scope for prevention efforts among infected couples. Second, among 30–40 percent of the infected couples only the woman is infected. This is at odds with levels of self‐reported extramarital sex by women and with the common perception that unfaithful men are the main link between high‐risk groups and the general population. These findings are confirmed by tests of robustness. These results indicate that extramarital sexual activity among women in union is a substantial source of vulnerability to HIV that should be, as much as male extramarital activity, targeted by prevention efforts.     

The politics of invisibility: homophobia and low-income HIV-positive women who have sex with women

HIV-positive women who have sex with women (WSW) have been overlooked by government researchers, health care providers and the AIDS service community. In addition to stigmas against homosexuality and HIV in larger society, low-income, African-American and Latina HIV-positive WSWs face culturally-based stigmas and are disproportionately affected by poverty, drug addiction, homelessness, sex work and abuse. Through an analysis of sixteen intensive interviews with low-income HIV-positive WSWs of color, I critically examine the physical, emotional and psychological needs of this population and their methods of coping with HIV. I also examine the participants' percepHIV-positive women who have sex with women (WSW) have been overlooked by government researchers, health care providers and the AIDS service community. In addition to stigmas against homosexuality and HIV in larger society, low-income, African-American and Latina HIV-positive WSWs face culturally-based stigmas and are disproportionately affected by poverty, drug addiction, homelessness, sex work and abuse. Through an analysis of sixteen intensive interviews with low-income HIV-positive WSWs of color, I critically examine the physical, emotional and psychological needs of this population and their methods of coping with HIV. I also examine the participants' percepHIV-positive women who have sex with women (WSW) have been overlooked by government researchers, health care providers and the AIDS service community. In addition to stigmas against homosexuality and HIV in larger society, low-income, African-American and Latina HIV-positive WSWs face culturally-based stigmas and are disproportionately affected by poverty, drug addiction, homelessness, sex work and abuse. Through an analysis of sixteen intensive interviews with low-income HIV-positive WSWs of color, I critically examine the physical, emotional and psychological needs of this population and their methods of coping with HIV. I also examine the participants' perceptions of available support networks and patterns of disclosure in order to raise awareness of their struggle against HIV and homophobia and to assist in empowering the low-income HIV-positive WSW community.     

Educational efforts in the implementation of rural family planning programs in East Pakistan

The pilot family planning studies reported in this paper were conducted in a rural area adjacent to the city of Dacca in East Pakistan. It reports the preliminary findings of action-research in the implementation of educational efforts to reach rural villagers of a developing country.Preliminary analyses of the records identify two significant educational problems: (1) most of the villagers (85-90 percent of the couples) who initially accepted contraceptives do not truly adopt and become continuing users and (2) the continuing users (10-15 percent of the initial users) are generally characterized by large families. (Later data show an even lower percentage of continuing users.)The field activities in the development of various educational approaches to family planning are described. Three separate geographic areas (from 15,000 to 20,000 population) were each approached in a different way, varying in the number and educational qualifications of the workers and in the degree of involvement of village leadership. Preliminary analyses of field records indicate that these variations of approach apparently have little effect on the percentage of the population willing to accept contraceptive supplies.It is the opinion of the writers that more intensive educational efforts are necessary at the village level to develop social support for continuing use of contraception and to gain adoption of contraception by younger married couples primarily for spacing of births.The impact of introduction of the IUCD in populations where condoms and foam tablets have been available for one to two years has also been reported. Preliminary findings indicate that the IUCD encourages adoption by previous non-users and may increase the over-all percentage of contraceptive users.