Risk behaviors and perceptions of AIDS among street injection drug users

Standardized survey interviews (n = 325) and guided in-depth interviews (n = 22) were conducted with injection drug users (IDUs) in Long Beach, California, to document drug usage and injection patterns, sexual practices, perceived risk of HIV infection, sources of health information, and knowledge and attitudes about AIDS. Most IDUs reported sharing needles (87.9%), and a large minority reported regular sterilization of needles/syringes (40.3%). Lower rates of needle sharing were reported among cocaine users than among heroin and speedball users. HIV seroprevalence was 5.7 percent (11/194). Sexually active female (60.7%) and male (20.5%) IDUs reported exchanging sex for money or drugs. Overall, 48.3 percent of IDUs reported having made changes in their injection practices and one-third reported modifying their sexual behavior in order to avoid HIV infection. Differences in drug use, sexual practices, and drug treatment history were found with regard to gender, ethnicity, age, and type of drug injected. Implications of findings for the development of AIDS risk-reduction programs are presented.     

Neighborhood history as a factor shaping syringe distribution networks among drug users at a U.S. syringe exchange

Throughout the U.S., high visibility drug markets are concentrated in neighborhoods with few economic opportunities, while drug buyers/users are widely dispersed. A study of Pittsburgh Syringe Exchange participants provides data on travel between and network linkages across neighborhoods with different levels of drug activity. There are distinct racial patterns to syringe distribution activity within networks and across neighborhoods. Pittsburgh's history suggests that these patterns emerge from historical patterns of social and economic development. Study data demonstrate the ability of IDUs to form long-term social ties across racial and geographic boundaries and use them to reduce the risk of HIV transmission.     

Reducing HIV/AIDS high-risk behavior among injection drug users: peers vs. education

This study examines the effects of peer groups and education on risk behavior for HIV among injection drug users (IDUs). The sample consisted of 682 participants in the Eastern Connecticut Health Outreach project, which compares traditional and peer-driven outreach interventions for IDUs. Participants are educated about safer injecting, subsequently administered a risk-reduction knowledge test, and given an extensive interview. Logistic regression shows that education alone is not a significant factor in reducing risky behavior in IDUs among the behaviors studied. A significant interaction was found between peer support for safer use and personal saliency of peer attitudes for both syringe and water sharing. Neither peer attitudes nor education affected cooker sharing. These results suggest that while education may be an important component in any intervention, it is not alone sufficient to reduce risky behavior. Our findings suggest that peer-directed interventions may be useful in reducing some forms of risk behavior among IDUs.     

Sexual decision making and safer sex behavior among young female injection drug users and female partners of IDUs

Data from interviews with 94 young women who were injection drug users (IDUs) or partners of IDUs were analyzed to examine associations between self-reported sexual decision making and condom use, contraceptive use, and relationship characteristics. Most women (73-85%) reported participating in decisions about condom use, contraception, and when to have sex. Adjusting for potential covariates, respondents who reported participating in decisions about condom use and when to have sex were 7 and 19 times, respectively, more likely than others to report recently using condoms. Respondents who reported participating in decisions about contraception were 20 times more likely than others to report recently using contraceptives. Longer sexual relationships were associated with decreased likelihood of condom or contraceptive use.     

Predictors of sexual risk-taking among new drug users

We studied predictors of HIV-related sexual risk-taking among individuals who initiated the use of heroin or methamphetamine during the past 5 years. Many studies have linked drug use to HIV risk and most research has been based on samples of users with long-established drug careers. We conducted face-to-face interviews with 153 adult new drug users in Atlanta, GA. Drug use was not a statistically significant predictor of sexual risk, but gender, age, race, homelessness status, childhood neglect, level of paranoia, and level of (dys)functionality in handling disagreements were associated with the frequency of sexual risk-taking. We discuss the need to incorporate new drug users in HIV/AIDS and other health-related prevention and intervention programs.     

Association between child sexual abuse and sexual revictimization in adulthood among women sex partners of injection drug users

Community-recruited women (n = 1490) were interviewed about their early and adult sexual victimization histories to determine whether there was an association between child sexual abuse and adult revictimization by sex partners and strangers/nonsex partners. Adolescent sexual abuse, lifetime sex-trading, drug treatment, and mental health treatment were examined as mediating variables. One-fourth of the women had been revictimized (i.e., experienced child sexual abuse and at least one instance of adult sexual victimization). Child sexual abuse was associated with both rape and other sexual victimization by a sex partner in adulthood, as well as adult rape by a stranger/nonsex partner. Drug and mental health treatments reduced abused women's chances of being raped by a sex partner; drug treatment also decreased the likelihood of other sexual victimization by a sex partner. Sex-trading increased abused women's likelihood of rape by a stranger or nonsex partner. Intervention--including drug treatment--can help women with child sexual abuse histories overcome some of the abuse-related sequelae that make them vulnerable to adult revictimization.     

Puerto Rican injection drug users: Prevention implications in Massachusetts and Puerto Rico

This study examines whether place of residence is a factor associated with reporting a positive HIV/AIDS, Hepatitis C (HCV), or Sexually Transmitted Disease (STD) status in a sample of 400 injection drug users (IDUs) residing on the Island of Puerto Rico (N=139) and in western Massachusetts (N=261). Logistic regression models revealed that IDUs residing in western Massachusetts were 66% less likely to be HIV positive compared to IDUs residing in Puerto Rico (p<.000) while IDUs residing in western Massachusetts were about 67% less likely to have a positive STD status than those residing in Puerto Rico (p<.000). Place of residence was not significantly associated with HCV status. Results indicate the need to develop prevention programs tailored to the unique socio-cultural context of Puerto Rican IDUs residing on the Island of Puerto Rico whose circumstances differ from those in the mainland US. To reduce drug use, HIV/AIDS, HCV, and STDs among Puerto Ricans in both locales, the Capacity Enhancement Model is proposed in order to develop more effective prevention programs.     

Modeling initiation into drug injection among street youth

This study aimed at examining the predictors of initiation into drug injection among street youth using social cognitive theory framework. A prospective cohort study based on semi-annual interviews was carried out. Psychosocial determinants referred to avoidance of initiation. Other potential predictors were: sociodemographic characteristics, relationships with injectors, parent's substance misuse, drug use patterns, homelessness, survival sex, sexual abuse. Independent predictors were identified using Cox proportional hazards regression models. Among the 352 participants, high control beliefs about avoidance of initiation was protective while younger age, daily alcohol consumption, heroin use, cocaine use, and survival sex all increased risk of initiation. Preventive strategies targeting street youth should both enhance youth's control beliefs and actual control over their substance use and improve their life conditions.     

A condom skill scale: assessing condom skills among female drug users

Use of latex condoms is a primary form of sexual risk reduction, and consequently many intervention programs have focused efforts on increasing condom use among high-risk populations. Use alone, however, will not fully protect the individual if condoms are not used correctly. The objective of this study was to describe the development and properties of a scale measuring demonstrated condom use skill using a sample of 261 drug-using women. Guttman's coefficient of reproducibility and Jackson's Plus Percentage Ratio (PPR) were used to determine the scalability of the Condom Skill Scale (CSS). Analysis of scale scores revealed high levels of condom skill among the population, although there was reduced performance for three items. Preliminary analysis suggests that the CSS is a potentially valid and reliable instrument, and may have application as a tool assessing condom skill level.     

Past and new victimization among African American female drug users who participated in an HIV risk-reduction intervention

This study examined to what extent a women- and culturally-specific sexual risk reduction intervention resulted in a decline of new victimization intervention. Additionally, we sought to identify factors associated with new victimization, defined as victimization during the 6 months after enrollment in the study. Female African American drug users (N = 333, ages 18-59 years) completed questionnaires. Past victimization was a major predictor of new victimization. The likelihood of new victimization, however, declined significantly when compared to past victimization. Factors associated with victimization included enhanced intervention assignment, frequency of drug use, lifestyle factors such as criminal behavior, drug use in a public setting, and living in an unstable situation. Results indicate the need to incorporate strategies to reduce victimization in HIV/AIDS and other health-related prevention and intervention programs.     

Tideline and turn: Possible reasons for the continuing low HIV prevalence among Glasgow's injecting drug users

This is an early report of data from an on-going, repeated, cross-sectional study of a community sample of Glasgow injecting drug users. Although HIV was first detected among Glasgow's drug injectors in 1985, data from the first two years of our annual samples (1990 and 1991) indicate that HIV prevalence continues to be low in this population, in the order of 1 or 2 per cent. Possible reasons for this apparent continuing low prevalence are examined. It is suggested that substantial risk reduction – reductions in injection equipment-sharing, reductions in numbers of sharing partners and restrictions in social circles of sharing partners – may have been sufficient reasons, in conjunction with limited contributions to near-stabilisation from the disproportionate attrition of the numerator population through death and cessation of injecting.     

Cultural sensitivity treatment and research issues with black adolescent drug users

Adolescent drug abuse is one of the nations' leading social problems. Secondary intervention programs have rarely designed treatments to address specific issues pertinent to the black adolescent drug user. Among these special issues is cultural sensitivity in clinical practice and research. A review of the research literature revealed no empirical work that has been conducted in the area of cultural sensitivity as it relates to black male adolescent substance abusers.The author proposes methodological considerations as applied to four phases of treatment: assessment, planning intervention, implementation, and termination and gives suggestions for how culturally sensitive therapeutic intervention can be conducted with chemically dependent adolescent black males.     

The social constructions of drug users in professional interventions

This qualitative study analyses the construction of a subject who uses drugs (injected drugs) so as to offer psychosocial proposals for social healthcare interventions within this collective, and thereby contribute to social healthcare policies that optimise treatment for drug use. The results indicate that identity is connected to positions that are activated in interactions and relationships between users and professionals in various day-to-day contexts of healthcare and treatment. We have labelled these activated positions: therapeutic, drug-sensory, consumerist, legal-repressive and group-community. Understanding them provides clues that may improve interventions in health and legal contexts. These clues include understanding the tensions between the subject and the substance, considering the stigmatised image and identity, and supporting the idea of the existence of dilemmas in users and professionals, as this may allow transformations to occur in the mutual relationships that are established.     

Networked intimacy. Intimacy and friendship among Italian Facebook users

In this paper, we describe the results of a qualitative study conducted with 120 Italian Facebook users to investigate how Facebook enables people to achieve a mutually constitutive intimacy with their own friendship network: a negotiation of intimacy in public through self-disclosure, where the affordances of the platform are useful to elicit significant reactions, validations and demonstrations of affection from others. We observed that, in order to achieve various levels of intimacy on Facebook, people engage in various strategies: Showing rather than telling, Sharing implicit content, Tagging, Expectation of mutual understanding and Liking. These strategies produce a collaborative disclosure that relies on others’ cooperation to maintain the boundaries between private and public space. Based on these premises, we developed a framework of collaborative strategies for managing public intimacy that both systematizes and extends the findings identified in previous studies of intimacy on Facebook. We describe this framework as networked intimacy and we discuss the consequences of it in the light of already existing research on online self-disclosure.     

Malaria treatment practices among mothers in Guinea

A survey of mothers of young children in Guinea, West Africa (June-July 1988) suggests that individual, sociocultural, and structural factors influence the use of antimalarials for episodes of fever presumed to be malaria. A survey of 243 mothers was carried out in eight different sites (four urban and four rural) in two regions of the country. Among mothers interviewed, use of Western antimalarials for infants and children with fever was acceptable, but access to treatment was problematic. Mothers interviewed were less likely to use antimalarials during pregnancy, partly because of certain misconceptions about their effects and lack of access to the medication. Despite programmatic efforts to promote practices of presumptive treatment of fever among young children and chemoprophylaxis during pregnancy among mothers in towns and villages surveyed, variables associated with low use of antimalarials by mothers and their young children reflect important barriers to the implementation of child survival initiatives.     

Maintaining contact with drug users over an 18-month period

This article reports on Leximancer and Discursis, two visual text analytic software tools developed at the University of Queensland. Both analyse spatial and temporal relationships in text data, but in complementary ways: Leximancer focuses on thematic analysis, while Discursis focuses on sequential analysis. Our report explains how they work, how to work with them and how visual concepts are relevant to all stages of their use in analytic decision-making.