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.     

Treating substance-using women and their children in public housing: preliminary evaluation findings

The Key West Housing Authority created SafePort, a residential substance abuse treatment program within public housing to provide drug treatment to parenting women. All family members-women, children, and significant others-receive comprehensive assessments to determine appropriate therapeutic interventions to resolve their problems. Preliminary evaluation findings suggest that women who participate with their children are more likely to remain drug free than are those who participated without their children.     

HIV rapid testing in substance abuse treatment: implementation following a clinical trial

The Substance Abuse Mental Health Services Administration has promoted HIV testing and counseling as an evidence-based practice. Nevertheless, adoption of HIV testing in substance abuse treatment programs has been slow. This article describes the experience of a substance abuse treatment agency where, following participation in a clinical trial, the agency implemented an HIV testing and counseling program. During the trial, a post-trial pilot, and early implementation the agency identified challenges and developed strategies to overcome barriers to adoption of the intervention. Their experience may be instructive for other treatment providers seeking to implement an HIV testing program. Lessons learned encompassed the observed acceptability of testing and counseling to clients, the importance of a "champion" and staff buy-in, the necessity of multiple levels of community and agency support and collaboration, the ability to streamline staff training, the need for a clear chain of command, the need to develop program specific strategies, and the requirement for sufficient funding. An examination of costs indicated that some staff time may not be adequately reimbursed by funding sources for activities such as adapting the intervention, start-up training, ongoing supervision and quality assurance, and overhead costs.     

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.