HIV prevention among drug users: outcome of a network-oriented peer outreach intervention.

A network-oriented HIV prevention intervention based on social identity theory and peer outreach was implemented for HIV positive and negative drug users. A community sample of 250 were randomly assigned to an equal-attention control condition or a multisession, small-group experimental condition, which encouraged peer outreach; 94% of participants were African American, and 66% used cocaine or opiates. At follow-up, 92% of participants returned, and experimental compared with control group participants were 3 times more likely to report reduction of injection risk behaviors and 4 times more likely to report increased condom use with casual sex partners. Results suggest that psychosocial intervention emphasizing prosocial roles and social identity, and incorporating peer outreach strategies, can reduce HIV risk in low-income, drug-using communities.     

Neighborhood social disorder as a determinant of drug injection behaviors: a structural equation modeling approach.

Neighborhood environments are increasingly recognized as a contextual determinant of health, behaviors, and disease; however, the pathways through which neighborhood characteristics impact health behaviors are poorly understood. This article examines pathways to elucidate how neighborhood social disorder may lead to HIV transmission. Data are from a baseline survey of 701 injection drug users from the Self-Help in Eliminating Lethal Diseases Study, an HIV prevention intervention in Baltimore. Structural equation modeling was used to examine the pathways among social disorder, psychological distress, and drug injection behaviors. The relationship between disorder and injection behaviors in the models tested suggests that psychological distress is higher in more socially disordered neighborhoods, that distress leads to greater injection frequency and equipment sharing, and that injection frequency predicts equipment sharing.     

Predictors of needle-sharing behavior among IDUs entering treatment

Abstract

Public funded treatment intake data from 3905 injection drug users were analyzed to identify correlates of reported needle sharing. Respondents included all first admissions to treatment from July 1, 1988 to June 30, 1989 in the city and county of San Francisco. More previous experience in drug treatment predicted lower rates of needle sharing (OR = 0.85, 95% C.I.= 0.79 - 0.92). Young age, cocaine use and white or Hispanic ethnicity predicted higher rates of needle sharing. The finding that drug treatment reduces the frequency of needle sharing in this population has important policy implications; these data support the role of treatment availability in reducing the spread of HIV among injection drug users.     

My place,your place,and no place: Behavior settings as a risk factor for HIV-related injection practices of drug users in Baltimore,Maryland

Information is sparse on the social context of illicit drug injection behaviors and their relationship to HIV infection. This study examined relationships between injection settings, injecting with others, and HIV risk behaviors of sharing needles and not cleaning contaminated needles in a sample of 630 inner-city injecting drug users in Baltimore, MD. Through open-ended interviews, five primary settings of injection behavior were identified. These settings included one's own, friends' and mother's residence, shooting galleries, and semipublic areas. Most participants reported injecting in their own residence (92%) and friends' residence (86%) in the prior 6 months. In a multiple regression analysis, injecting at friends' residence, in shooting galleries, and in semipublic areas and frequency of injecting with others were significantly associated with frequency of sharing uncleaned needles, “slipping” (i.e., failure to disinfect shared needles), and not always cleaning used needles before injecting. Results suggest that interventions may benefit from targeting settings as well as behaviors to reduce the spread of HIV. This research was supported by grants DA04334, DA05911, DA06313, and DA08985 from the National Institute on Drug Abuse.     

A randomized clinical trial of a manual-guided risk reduction intervention for HIV-positive injection drug users.

This study randomized 90 HIV-seropositive, methadone-maintained injection drug users (IDUs) to an HIV Harm Reduction Program (HHRP+) or to an active control that included harm reduction components recommended by the National AIDS Demonstration Research Project. The treatment phase lasted 6 months, with follow-ups at 6 and 9 months after treatment entry. Patients in both treatments showed reductions in risk behaviors. However, patients assigned to HHRP+ were less likely to use illicit opiates and were more likely to adhere to antiretroviral medications during treatment; at follow-up, they had lower addiction severity scores and were less likely to have engaged in high risk behavior. Findings suggest that enhancing methadone maintenance with an intervention targeting HIV-seropositive IDUs increases both harm reduction and health promotion behaviors.     

Religiosity and HIV-Related Drug Risk Behavior: A Multidimensional Assessment of Individuals from Communities with High Rates of Drug Use

We examined the relationship between religiosity and HIV-related drug risk behavior among individuals from communities with high rates of drug use who participated in the SHIELD (Self-Help in Eliminating Life-Threatening Disease) study. This analysis examined the dimensions of religious ideation, religious participation, and religious support separately to further understand the relationship with risk taking. Results indicate that greater religious participation appeared to be the dimension most closely associated with drug behaviors. Specifically, we found that those with greater religious participation are significantly less likely to report recent opiates or cocaine use; injection drug use; crack use; and needle, cotton or cooker sharing. Future work to understand the nature of these associations will assist in the development of interventions in communities with high rates of drug use.     

Covariates of Multiplicity of Risk Behavior Among Injecting Drug Users in Nepal

Drug abuse, needle sharing, and high-risk sexual behaviour are often compounded to increase the risk of human immunodeficiency virus (HIV) transmission. This paper analyzes covariates of multiplicity of risk behavior among injecting drug users (IDUs). Findings are based on data from 1471 IDUs following modified time-location cluster sampling across Nepal in 2010–2011. Among Nepalese IDUs, average duration of injecting drugs is 4.4 years with two-fifths initiating it before age 20. Alcohol use is common with two-fifths reporting its daily consumption. Needle sharing is quite prevalent especially among younger and alcoholic IDUs. Further, IDUs practicing needle sharing exhibit rampant multi-partner behavior. Condom use with non-commercial partners is almost 80 %, whereas with intimate partner it is 41 %. Coexistence of needle sharing and unprotected sex enhances STI prevalence (7 %), which is further pronounced among alcoholics (9 %). Working towards risk reduction for IDUs must deal with multiplicity of risk. Interventions should deal with covariates of risk, addressing youth, substance abuse and risky sexual behavior.     

Brief counseling to reduce AIDS risk in intravenous drug users and their sexual partners: Preliminary results

Intravenous drug users (N = 88) and their sexual partners (N = 45) were randomly assigned to either a brief counseling intervention or an information-brochure only condition (aimed at reducing behavioral risk for HIV infection). At 10 day follow-up, intravenous drug users exposed to brief counseling were more knowledgeable about risk behaviors, and reported higher levels of self-efficacy and communication skill, and more frequent use of condoms and sterilisation of needles. At 90 day follow-up, intravenous drug users were more accepting of guidelines to reduce sex-related risk and reported greater self-efficacy in relation to drugs. Sexual partners who received brief counseling showed a small reduction in unprotected sex (at 90-day follow-up), while those receiving brochures were slightly less likely to use condoms. Methodological problems of the study are discussed.     

Innovative Work Behavior in Public Organizations: The Roles of Ethical and Knowledge Sharing Behaviors

Public organizations are in continuous need of innovation in their products, services, and processes in order to grow and survive. Innovative work behaviors play important role in employee innovation in these organizations. The present study aimed to test the roles of ethical and knowledge sharing behaviors on innovative work behavior in public organizations. The questionnaire consisting of 44 items was used. The data were collected from 266 participants in public organizations, and data analysis was performed through Structural Equation Modeling (SEM). According to the results, ethical behaviors had positive and significant effect on innovative work behavior, and knowledge sharing behaviors mediate the effect of ethical behavior on innovative work behaviors. The proposed model highlighted the importance of sharing mistakes and best practices in an organization to develop innovative work behavior. Furthermore, ethical behaviors were likely to be more significant predictors of innovative work behavior through knowledge sharing behaviors.     

The Association Between Age and Ethics-Related Issues in Using Social Media for HIV Prevention in Peru

Little research has focused on the ethical issues around using social media for HIV prevention in low- and middle-income countries, such as Peru. This study surveyed participants from the HOPE social media HIV intervention in Peru to assess their experiences and perceptions of ethical issues in the study and the impact of age on their experiences and perceptions. This study found that, compared to younger participants, older participants were more likely to express higher levels of understanding of the consent form and trust that other participants were real. Older participants also reported being less likely to benefit from learning about their HIV status. Findings suggest that age plays a role in participants’ experiences in a social-media-based HIV intervention.     

Sexual behaviour in injecting drug users

A survey of the self-reported sexual behaviors of 1239 intravenous drug users recruited off the streets in Sydney, Australia, highlighted the impact of both sexual orientation and gender on the risk of human immunodeficiency virus (HIV) infection in this population. The sample included 908 men (mean age, 27.9 years) and 331 women (mean age, 26.3 years), the majority of whom were unemployed or receiving social security benefits. Among male respondents, 50 were homosexual, 117 were bisexual, and 719 were heterosexual; for females these numbers were 10, 95, and 220, respectively. Oral and vaginal sex were the most commonly reported practices among heterosexuals, while homosexuals primarily reported manual stimulation and oro-genital contact. The regular sexual partners of male intravenous drug users tended not to be addicts, while female drug users were primarily involved with male partners who also abused drugs. Among male respondents, condom use was highest among homosexuals, followed by bisexuals, and lowest among heterosexuals; there were no significant differences by sexual orientation in female respondents' condom use. Overall, condoms were most likely to be utilized in anal sex and least likely in the case of oral sex. Condom use was about 5% lower when a regular as opposed to casual sexual partner was involved. Most of the 64 HIV-positive respondents were homosexuals, suggesting that sexual orientation rather than drug abuse was the primary risk factor. Given the finding that there is substantial variation in condom use among subgroups of intravenous drug abusers, it is recommended that HIV prevention programs adopt a diversified rather than uniform approach.     

CBT for Medication Adherence and Depression (CBT-AD) in HIV-Infected Patients Receiving Methadone Maintenance Therapy

For individuals with HIV who are current or former injection drug users, depression is a common, distressing condition that can interfere with a critical self-care behavior—adherence to antiretroviral therapy. The present study describes the feasibility and outcome, in a case series approach, of cognitive behavioral therapy to improve adherence and depression (CBT-AD) among individuals with HIV and depression undergoing methadone maintenance treatment for heroin dependence. CBT-AD integrates cognitive behavioral therapy for depression with our intervention for improving adherence to antiretroviral therapy for HIV (Life-Steps; [Safren, S. A., Otto, M. W., Worth, J., Salomon, E., Johnson, W., Mayer, K., et al. (2001). Two strategies to increase adherence to HIV antiretroviral medication: Life-Steps and medication monitoring. Behavioral Research and Therapy, 39, 1151–1162]). Specifically, in CBT-AD, patients first receive a cognitive behavioral intervention focusing on improving skills related to medication adherence. Each of the subsequent CBT modules (activity scheduling, cognitive restructuring, problem-solving training, and relaxation training/diaphragmatic breathing) is designed to address both self-care/adherence behaviors as well as depression. The process and outcome with 4 cases suggest that the treatment was feasible and acceptable and was generally associated with improvements. This case series provides an example of how cognitive behavioral therapists can integrate the treatment of depression with the enhancement of critical self-care behaviors in the context of highly complex, medical and psychiatric comorbidity.     

Preliminary efficacy of a computer-based HIV intervention for African-American women

This study evaluated the preliminary efficacy of a computer-based HIV intervention to enhance HIV-protective sexual behaviours, based on a randomised controlled trial among 135 African-American women, 21-29 years of age, seeking services at Planned Parenthood in Atlanta, GA. Participants were randomised either to a control session two, 60-minute computer-based HIV intervention sessions administered on a laptop computer that each concluded with a 15-minute small group session or to a control session of general health information including discussion on HIV prevention. Relative to controls, participants in the computer-based HIV intervention were more knowledgeable about HIV/STD prevention and reported higher scores on the measure of condom use self-efficacy at 3 months post-intervention; they also reported a higher percentage of condom-protected sex and were more likely to use condoms consistently for vaginal sex (odds ratio, OR = 5.9; p < 0.039) and were more likely to use condoms consistently for oral sex (OR = 13.83; p < 0.037). This relatively brief intervention provides preliminary support that an evidence-based group-based HIV prevention intervention for young African-American women can be adapted to a computer-based HIV intervention.     

Knowledge of drug-related health problems among injecting drug users: Implications for the transmission of HIV infection

Abstract

In a project that investigated the HIV-related risk behaviour of injecting drug users, respondents were categorized along dimensions of expertness in HIV/AIDS knowledge and knowledge about drug-related health problems. Knowledge about drug-related health problems was found to be significantly associated with sharing. Better informed respondents were less likely to share injecting equipment and to predict they would share in future. They were more likely to adopt consistent injecting hygiene, seek information about AIDS, and perceive themselves as in control of their lives. No significant relationships were observed between sharing and HIV/AIDS knowledge. The data have relevance for AIDS educational strategies, since knowledge about AIDS and HIV transmission appears to be insufficient to induce behavioural change. Greater emphasis on the health problems that afflict most injectors may be a way of encouraging general harm minimization.     

Using Multilevel Mixtures to Evaluate Intervention Effects in Group Randomized Trials

There is evidence to suggest that the effects of behavioral interventions may be limited to specific types of individuals, but methods for evaluating such outcomes have not been fully developed. This study proposes the use of finite mixture models to evaluate whether interventions, and, specifically, group randomized trials, impact participants with certain characteristics or levels of problem behaviors. This study uses latent classes defined by clustering of individuals based on the targeted behaviors and illustrates the model by testing whether a preventive intervention aimed at reducing problem behaviors affects experimental users of illicit substances differently than problematic substance users or those individuals engaged in more serious problem behaviors. An illustrative example is used to demonstrate the identification of latent classes, specification of random effects in a multilevel mixture model, independent validation of latent classes, and the estimation of power for the proposed models to detect intervention effects. This study proposes specific steps for the estimation of multilevel mixture models and their power and suggests that this model can be applied more broadly to understand the effectiveness of interventions.     

Optimism, coping, psychological distress, and high-risk sexual behavior among men at risk for acquired immunodeficiency syndrome (AIDS).

In a cohort of gay men responding to the threat of acquired immunodeficiency syndrome (AIDS), dispositional optimism was associated with less distress, less avoidant coping, positive attitudes as a coping strategy, and fewer AIDS-related concerns. Men who knew they were seropositive for human immunodeficiency virus (HIV) were significantly more optimistic about not developing AIDS than men who knew they were seronegative for HIV. This AIDS-specific optimism was related to higher perceived control over AIDS and to active coping among seropositive men only and to health behaviors in both serostatus groups. There was no relation of optimism to risk-related sexual behavior. It is concluded that optimism is psychologically adaptive without necessarily compromising health behavior. It is also concluded that it is useful to distinguish between event-based optimistic expectations and dispositional optimism.     

Multidimensional Family Therapy HIV/STD Risk-Reduction Intervention: An Integrative Family-Based Model for Drug-Involved Juvenile Offenders

Drug and juvenile justice involved youths show remarkably high rates of human immunodeficiency virus (HIV)/sexually transmitted disease (STD) risk behaviors. However, existing interventions aimed at reducing adolescent HIV risk behavior have rarely targeted these vulnerable young adolescents, and many approaches focus on individual-level change without attention to family or contextual influences. We describe a new, family-based HIV/STD prevention model that embeds HIV/STD focused multifamily groups within an adolescent drug abuse and delinquency evidence-based treatment, Multidimensional Family Therapy (MDFT). The approach has been evaluated in a multisite randomized clinical trial with juvenile justice involved youths in the National Institute on Drug Abuse Criminal Justice Drug Abuse Treatment Studies ( http://www.cjdats.org ). Preliminary baseline to 6-month outcomes are promising. We describe research on family risk and protective factors for adolescent problem behaviors, and offer a rationale for family-based approaches to reduce HIV/STD risk in this population. We describe the development and implementation of the Multidimensional Family Therapy HIV/STD risk-reduction intervention (MDFT-HIV/STD) in terms of using multifamily groups and their integration in standard MDFT and also offers a clinical vignette. The potential significance of this empirically based intervention development work is high; MDFT-HIV/STD is the first model to address largely unmet HIV/STD prevention and sexual health needs of substance abusing juvenile offenders within the context of a family-oriented evidence-based intervention.     

Intended Sex With Fewer Partners: An Empirical Test of the AIDS Risk Reduction Model Among Injection Drug Users1

The AIDS risk reduction model (ARRM) is a theory-based representation of psychosocial processes by which people may attempt to change their HIV risk behavior. This study tests the degree to which hypothesized relationships among ARRM factors are consistent with cross-sectional data collected from a sample of HIV-negative injection drug users in Los Angeles, California. The data pertain to users' intentions to reduce HIV transmission risk incurred through sex with multiple partners. Findings conform to ARRM hypotheses in some important respects. In particular, findings suggest that perceived self-efficacy for sexual risk reduction may be a crucial factor leading to the formation of intentions to change sex-related HIV risk behavior.     

Reducing sexual transmission of HIV for injecting drug users: The challenge for counselling

Harm minimization approaches have been recommended to reduce the risks of transmission of HIV for injecting drug users by the elimination of sharing injecting equipment. The risks associated with the sexual behaviours of these individuals have been given less emphasis, and where considered have been in terms of the threat to non-drug partners and potential penetration of HIV infection into the general population. Data are presented from four survey studies conducted between 1985 and 1990 focusing on both drug-taking behaviours and sexual activities. These provide evidence for larger shifts, over this period, in injecting practices than in sexual behaviours. The risks associated with sexual activities for injecting drug users and their sexual partners are considered. It is concluded that counsellors have an important role to play in introducing a second phase of harm minimization that involves interventions to modify sexual behaviours and offers integrated services for injecting drug users and their families.