HIV/AIDS and drug abuse: epidemiology and prevention

In the United States, the AIDS epidemic is a dynamic process with increasing rates of AIDS reported among women, minority populations, heterosexual men, and users of drugs by routes other than injection. The 1993 CDC AIDS definition change has created some difficulties in interpreting trends in the United States. Drug use continues to represent a significant problem among HIV-infected persons. Several strategies have been advanced to decrease transmission of HIV among drug users, their sexual partners and children. However, more effective and comprehensive prevention and treatment strategies are needed.     

Review of AIDS and alcohol/drug abuse: Psychosocial research.

Reviews the book, AIDS and alcohol/drug abuse: Psychosocial research, edited by Dennis G. Fisher (1991). Substance use, primarily intravenous drug use, accounts for an increasingly large proportion of new acquired immunodeficiency syndrome (AIDS) cases. As such, psychosocial research in the addictions plays an important role in evaluating strategies for reaching out to and educating those at risk for the human immunodeficiency virus (HIV) and in developing effective prevention and risk-reduction strategies for this special population. This book is thus a timely contribution to the field. The seven brief chapters in this volume cover an extremely broad range of topics related to the relationship between AIDS and substance abuse. On the whole, however, the chapters in this volume are strikingly uneven in their sophistication and degree of relevance to the general psychologist working in addictive behaviors. Whereas some of the chapters are too brief to fully explore the implications of some of the issues they raise, the brevity of others is appropriate. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A federal agency perspective on AIDS.

AIDS prevention depends on changing behaviors to lessen the risk of infection. Given that about 25% of persons with AIDS in the United States are intravenous drug abusers, the National Institute on Drug Abuse has initiated a wide variety of research and demonstration outreach projects and training and public information programs focused on reducing the spread of AIDS among intravenous drug abusers, their sexual partners, and their children. Helping addicts discontinue their drug use is a high priority. Psychologists can contribute research, behavior change strategies, improved counseling, and outreach and can help to change negative public attitudes toward AIDS patients. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Depressive symptoms and risk factors for HIV acquisition among black women attending urban health centers in Baltimore

Blacks comprise 55% of all AIDS cases among women, and have 9 times the risk of white women of mortality from AIDS. Thus, prevention of HIV infection is critical among black women. Programs to prevent HIV infection have focused upon the adoption of behavioral strategies such as limiting the number of sexual partners, avoiding intercourse with i.v. drug users, and using condoms. However, such programs are dependent upon the ability of the woman to assume responsibility for her health and successfully adopt behavior changes. Generally overlooked in the development of health education interventions are those factors, such as depressive symptoms, which may make it very difficult for an individual to adopt healthy behaviors. In the present study, an analysis was conducted of the association between depressive symptoms and risk factors for the acquisition of HIV infection among black women using two urban health centers. Those women with higher levels of depressive symptoms were significantly more likely than other women to report more risk factors for HIV acquisition. The implications of these findings for the development of preventive interventions are discussed.     

Letters to loved ones: please don't bring HIV home

While away from their families and communities, migrant workers often engage in behavior which puts them at increased risk of HIV infection. Such behavior includes drug and alcohol use, and sex with multiple partners or prostitutes. A significant proportion of northeast Thailand's rural population works away from home in either Thailand or abroad for at least part of the year. The risk behavior of this subpopulation while away from home and their subsequent behavior upon their return home has contributed to the spread of HIV in the region. In the "Letters to Loved Ones" program, women in northeast Thailand write letters to their loved ones who are working away from home to remind them of the risks of HIV/AIDS and teach them about prevention. This program and other AIDS prevention strategies grew out of the Multisectoral AIDS Prevention Strategy in Northeast Thailand. Through the program, a considerable number of women can now play important roles in sexual negotiation and health education for themselves, their families, and their communities.     

Review of Child sexual abuse: Critical perspectives on prevention, intervention, and treatment.

Reviews the book, Child sexual abuse: Critical perspectives on prevention, intervention, and treatment edited by Christopher R. Bagley and Ray J. Thomlison (1991). This book is a compilation of a series of literature reviews originally commissioned by Health and Welfare Canada in 1987 and completed in 1988. The individual papers included in this edited version represent a cross section of Canadian academicians, clinicians, and case workers who are integrally involved in the policies and practices regarding child sexual abuse in Canada. The work provides a comprehensive perspective on prevention at the primary, secondary, and tertiary levels. The list of authors is impressive in terms of their expertise and experience. At a time when numerous books on child sexual abuse are appearing on the market, it is nice to see a book that has some unusual aspects. Aside from its distinctly Canadian perspective, the book addresses several important, yet frequently ignored, topics. The book provides an up-to-date review of several core issues: conceptualization of the problem, prevention strategies, impact of sexual abuse, investigative interviewing, treatment outcome studies, and treatment issues for child molesters. The more unique topics include a review of the strategies used to evaluate prevention programs, prevalence rates among a number of special populations, the role of medical practitioners in preventing and intervening in child sexual abuse, and sexual abuse and exploitation among disabled individuals. Overall, I can recommend this book for clinicians and researchers in Canada and elsewhere who are interested in child sexual abuse. This compilation of literature reviews highlights the leading role that Canadian social service agencies have taken in developing programs for sexually abused children and their families. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychological interventions with AIDS and HIV: Prevention and treatment.

In the decade since AIDS was first diagnosed, behavioral research has focused intensively on risk reduction change processes and, to a lesser extent, on mental health needs of persons with HIV conditions. Although research to date has yielded important findings for primary prevention efforts and has identified some psychological dimensions relevant to mental health interventions, there is a pressing need for much more systematic intervention outcome research in both the prevention/behavior change and emotional coping areas. Progress in these areas will be facilitated by better linkage of intervention approaches to behavioral theory; identification of intervention elements that produce HIV risk behavior change; evaluated field-testing of promising intervention models; continued focus on populations that remain at risk (such as gay men and iv drug users); and expansion of prevention efforts to urban, poor, and minority populations increasingly threatened as AIDS/HIV enters a "2nd wave." Although AIDS is still a relatively new problem, existing behavioral medicine conceptual models and intervention strategies can be adapted to meet the enormous challenges created by AIDS and HIV infection. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Differential regulation of Na+ and Cl- conductances by PTX-sensitive G proteins in fetal lung apical membrane vesicles

In late 1990 the National Institute on Drug Abuse (NIDA) initiated the Cooperative Agreement (CA) for AIDS Community-Based Outreach/Intervention Research Program. The goal of this program was to prevent the further spread of HIV among out-of-treatment drug users, in particular injection drug users (IDUs) and crack cocaine users, their sexual partners, and those at risk for initiating injection behavior. To accomplish this goal, the CA set out to monitor drug use and HIV risk behaviors, assess the efficacy of various HIV risk reduction interventions, and develop and refine outreach and intervention strategies. Twenty-three research sites, 21 rural and urban sites in the United States and one each in Puerto Rico and Brazil, were included in the CA program. This article presents an overview of the CA as well as a synopsis of the studies covered in this special issue examining the total CA database.     

Dorsal defect of the patella

The aim of this study was to measure the prevalence of HIV infection and assess the level of equipment-sharing and unsafe sexual activity among attendees at a Dublin needle exchange. Using an anonymous unlinked approach, attendees were asked to complete a brief questionnaire and provide a sample of saliva for HIV testing. Of the 144 attendees eligible for inclusion during the study period, 106 agreed to participate and complete a questionnaire, a response rate of 74%. Of the 81 respondents who submitted a usable saliva sample, 14.8% were HIV positive. Half of the respondents claimed that they had not shared equipment during the preceding 28 days, but a third had shared with multiple partners. Half of the respondents claimed that they had multiple sexual partners during the preceding year, but only a quarter said that they always used condoms. The prevalence of HIV infection is similar to that found in routine linked testing of drug users in Ireland. The high level of unsafe injecting and sexual activity makes clear the need for more effective health promotion among drug users in Dublin.     

Normal long axis function

Data from a surveillance system for type-specific acute viral hepatitis in Italy has been used to evaluate the risk of heterosexual transmission of hepatitis C virus (HCV) associated with sexual activity with multiple partners in subjects > or = 15 years of age. Hepatitis A cases were used as controls. During the period 1991-1996, 1,359 acute hepatitis C and 4,365 hepatitis A cases were recorded among subjects > or = 15 years of age. Intravenous drug use was the most frequent source of infection (35.9%) reported by HCV cases; two or more sexual partners during the 6 months before disease onset accounted for 34.9% of hepatitis C cases. Adjusting by multiple logistic regression analysis for the confounding effect of all risk factors considered (blood transfusion, intravenous drug use, surgical intervention, dental therapy, other parenteral exposure), and for age, sex, area of residence, and educational level of subjects, showed that having two or more sexual partners is an independent predictor of the likelihood of hepatitis C (OR=2.2; 95% CI=1.7-2.7). After excluding intravenous drug users and patients transfused with blood from analysis, the increase in the adjusted OR for the association between HCV and the number of sexual partners correlated with the increase in the number of sexual partners. The risk of hepatitis C was 2.0 times higher (95% CI=1.4-2.9) for subjects with two sexual partners and 2.8 times higher (95% CI=2.1-3.8) for subjects with three or more sexual partners, as compared to subjects with less than two sexual partners. These findings suggest that heterosexual transmission may play an important role in the spread of hepatitis C in Italy.     

NIDA's HIV prevention programs.

Comments on the review by J. A. Kelly et al (see record 1994-10963-001) regarding HIV prevention programs. Programs that Kelly et al did not describe are discussed, focusing on the large-scale community trials coordinated by the National Institute on Drug Abuse (NIDA) for injection drug users, crack users, and sex partners of drug users. R. H. Needle et al agree that stronger partnerships should be forged between research and community organizations and that dissemination of successful strategies should be improved. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Correlates and predictors of HIV risk among inner-city African American female teenagers.

Objective Design: For human immunodeficiency virus (HIV)-related prevention initiatives to be most effective, they should be broad-based and incorporate multiple domains of influence. This study tested how several ecodevelopmental domains influenced HIV-risk related attitudes and behaviors in a community sample of African American female teens (N = 242). Main Outcome Measures: Outcome measures were number of partners, frequency of intercourse, number of pregnancies, abstinence/condom use, HIV/AIDS-related attitudes and behaviors, and HIV testing. Results: Structural Equation Modeling revealed many direct paths from ecodvelopmental domains to risky sexual behaviors. The findings include having more partners was associated with parental alcohol-related problems, more drug use, and a younger age at first intercourse. More frequent intercourse was associated with less cultural pride and more drug use. More pregnancies were related to a younger age at first intercourse and parental alcohol problems. HIV testing was associated with having experienced sexual abuse, an older age at first intercourse, and stronger self-efficacy. Conclusions: Prevention programs that focus on risk reduction could expand their focus beyond sexual behavior to include a broad-range of psychosocial domains that are associated with HIV-risk. The effectiveness of prevention programs should be monitored carefully for appropriateness in different ethnic groups. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The role of reactive nitrogen intermediates in modulation of gametocyte infectivity of rodent malaria parasites

Two hundred and fourteen young women received acquired immunodeficiency syndrome (AIDS) prevention interventions at an inner-city family health center serving minority patients predominantly. The community in which the health center is located has a high incidence of intravenous (IV) drug abuse. Either a peer or a health care provider delivered the intervention. In the peer-delivered intervention, a trained peer educator reviewed with patients an AIDS "Rap" videotape and several AIDS brochures, which imparted information about human immunodeficiency virus (HIV), its transmission, and prevention. In the provider-delivered intervention, family practice residents, attending physicians, and nurse practitioners used a patient-centered counseling approach to convey the same information. Questionnaires administered immediately before and after the intervention and at one month follow-up evaluated changes in knowledge, attitudes, and behavior. Analyses of data from both combined intervention groups revealed significant improvements in several areas of knowledge, including the effectiveness of using a condom and cleaning IV drug implements with bleach to prevent transmission of HIV. Many improvements were retained at the one-month follow-up. In addition, subjects in both groups who were sexually active stated immediately after the intervention that asking a sexual partner about past sexual experience would now be less difficult, and at one-month follow-up they reported a significant decrease in the frequency of vaginal sex. Our findings suggest that counseling by physicians can achieve more changes in knowledge of sexual risks, whereas peer education can achieve greater changes in knowledge about IV drug use. Results show that both approaches to AIDS prevention used in this study can significantly affect knowledge, attitudes, and sexual behavior.     

Close relationships and elevated HIV risk behavior: Evidence and possible underlying psychological processes.

A review of research on AIDS preventive behavior indicates that minority and nonminority heterosexual adolescents and adults, gay men, injection drug users, and commercial sex workers are all less likely to practice safer sex with close relationship partners, compared with partners they perceive to be "casual" sexual partners. Because many individuals in close relationships have engaged in HIV risk behavior over extended periods of time and are unaware of their actual HIV status, practicing unprotected sexual intercourse with a committed relationship partner who is not tested for HIV appears to be a major and unrecognized source of HIV risk. This article reviews the evidence for higher levels of HIV risk behavior in close relationships and then presents relevant conceptual and empirical work to explore the psychological processes that may underlie risky sexual behavior in close relationships, using as a framework the information-motivation-behavioral skills model of preventive behavior. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Prevalence of HIV infection and HIV risk behaviors associated with living place: on-the-street homeless drug users as a special target population for public health intervention

The study described here examined the prevalence of HIV infection as a function of place of residence and high-risk behaviors in six subpopulations of out-of-treatment drug injectors and crack cocaine users who participated in the National Institute on Drug Abuse (NIDA) Cooperative Agreement project. The subpopulations were blacks, Hispanics, and non-Hispanic whites sampled separately by gender. The research asked three questions: (a) Is the HIV infection rate higher among the on-the-street homeless than among those in other places of residence? (b) Do high-risk drug-related behaviors differ by housing status? and (c) What are the joint effects of high-risk drug-related behaviors and housing status on the probability of HIV infection? Overall, on-the-street homeless had a significantly higher HIV+ rate (19.0%) than the study population as a whole (11.2%). Rates differed by gender and race, with exceptionally high HIV+ rates for on-the-street homeless Hispanic males (29%) and females (32%) and for on-the-street homeless black females (38%). Having used drug works previously used by a HIV-infected person was a strong predictor of HIV+ status, as was frequency of drug injections and crack use. Having multiple sex partners was also a significant risk behavior. Findings argue against considering on-the-street homelessness as equivalent to shelter dwelling or aggregated homelessness for purposes of the AIDS epidemic. On-the-street homeless drug users were at strong risk for acquisition and transmission of HIV infection and therefore in need of targeted-racially relevant, ethnically relevant, and gender-relevant-public health interventions to help prevent the spread of AIDS.     

Streets, drugs, and the economy of sex in the age of AIDS

Drug addicted women whose economic and social base is urban streets face limited options for income generation and multiple dangers of predation, assault, arrest, and illness. Exchanging sex for money or drugs offers one important source of income in this context. Yet the legal, social, and safety risks associated with these exchanges reduce the likelihood of regular safer sex practices during these encounters, thereby increasing the risk of HIV infection. Such conditions lead women engaged in sexual exchanges for money to varied and complex responses influenced by multiple and often contradictory pressures, both personal and contextual. Street-recruited women drug users in an AIDS prevention program in Hart-ford, Connecticut reported a range of condom use when engaging in sex for money exchanges. This paper explores their differences by ethnicity, economic resources, and drug use, and analyzes these and other factors that impact on street risks through sexual income generation. Surveys and in-depth interviews with drug-addicted women sex workers describe their various approaches to addressing multiple risks on the streets and suggest significant effort by women in these contexts to avoid the many risks, including HIV infection.     

Drug use and AIDS: Developments from the International Conference on AIDS.

This article presents recent information about injection drug use as it relates to the human immunodeficiency virus (HIV) epidemic. Presentations from the VIII International Conference on AIDS, held in Amsterdam in July 1992, are highlighted. Several recent developments are noteworthy for psychologists coping with addictive behaviors, including the return of tuberculosis as a communicable disease affecting people with acquired immunodeficiency syndrome (AIDS), advancements in prevention of HIV infection, and treatment of AIDS in drug users. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Love, sex, and power: Considering women's realities in HIV prevention.

The rates of HIV infection and AIDS cases among women in the United States have increased significantly in the last decade. Thanks in large part to the work of advocacy groups and to action by the U.S. Congress, there has been some progress in making HIV/AIDS research and services more responsive to women's needs (e.g., including women in clinical drug trials and revising the Centers for Disease Control definition of AIDS to include infections typical in women). However, little progress has been made in addressing the need for prevention of HIV infection among women. This article examines how researchers using behavioral approaches to HIV prevention have largely ignored how gender, women's social status, and women's roles affect sexual risk behaviors and the ability to take steps to reduce risk of infection. Additional factors to be considered in theories that guide future HIV/AIDS prevention programs are examined. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Personal social networks and HIV status among women on methadone

This objective of this study was to examine the association between a women's HIV status and specific (IDUs) characteristics of her social networks with respect to (1) number of injection drug users (2) number of drug partners and (3) number of HIV-positive contacts in her personal networks, after controlling for the respondent's demographic characteristics and drug use. Participants were recruited through posted announcements in three methadone clinics in Harlem, New York City. Individuals were considered eligible if they were enrolled as patients in one of the clinics for at least three months. A social network questionnaire modeled after the General Social Survey network section was developed by the investigators. Face-to-face interviews were conducted by trained interviewers and included demographics, drug use, self-reported HIV status of the woman and her network members, and the social network structures. Univariate analyses found that HIV-positive and HIV-negative women had different network profiles. HIV-positive women were more likely to associate with a higher number of current drug users, injection drug users, injection drug users who were HIV-positive, drug partners, drug partners who used injection drugs, and drug partners who were HIV-positive. Multivariate analyses indicated that HIV-positive respondents were more likely to associate with HIV-positive network members than their HIV-negative counterparts. The findings suggest that to better understand the spread of HIV among female drug users and to design more effective HIV/AIDS prevention programmes, efforts should move beyond focusing on individual attributes to address the contextual dynamics of social networks.