HIV prevalence and HIV risk behaviour among injecting drug users in London and Glasgow.

This paper reports on the British findings from a cross-national study of HIV prevalence and HIV risk behaviour among 1,037 injecting drug users (IDUs) recruited from a variety of treatment- and community-based settings during 1990. Confirmed HIV saliva test results show 12.8% (63) of London respondents and 1.8% (8) of Glasgow respondents to be HIV antibody positive. Among London respondents, a higher rate of prevalence was found in those with no experience of drug treatment. A greater proportion of Glasgow respondents (68%) than London respondents (47%) reported sharing used injecting equipment in the 6 months prior to interview. The majority (88% in both cities) attempted cleaning borrowed equipment, although less than a third (31% in London and 30% in Glasgow) usually used bleach. The majority of respondents (71% in London and 82% in Glasgow) were sexually active with partners of the opposite sex in the last 6 months, and respondents had a mean number of 2.4 non-commercial sexual partners in London and 2.1 in Glasgow. Levels of reported condom use were comparable with reports in the heterosexual population as a whole, with 70% of London respondents and 75% of Glasgow respondents never using condoms with primary partners, and 34% of London and 52% of Glasgow respondents never using condoms with casual partners. Half (48%) of London respondents and 42% of Glasgow respondents reported sexual intercourse with non-injecting private sexual partners, while 14% of female respondents in London and 22% in Glasgow had engaged in prostitution. Levels of risk-taking in each of the two cities indicate the potential for further transmission of HIV among drug injectors, and their sexual and sharing partners.

The inappropriateness of psycho-social models of risk behaviour for understanding HIV-related risk practices among Glasgow male prostitutes.

Much the most common models of HIV-related risk behaviour are those psychosocial models derived from studies of health behaviour and tested on large interview samples of American gay men. These models were not appropriate for understanding risk behaviour among 32 Glasgow male prostitutes. Whereas psycho-social models conceive of risk behaviour as volitional and individualistic, ethnographic data indicate that the male prostitutes' risk practices were constrained and emergent from the immediate circumstances of the sexual encounter. Unsafe sex was associated with client control. Safer sex was associated with countervailing prostitute strategies of influence. These data confirm the utility of self-empowerment approaches to health education.

Occupational status variations in disagreements on the diagnosis of cause of death.

Studies of occupational status-related risk factors in specific-cause mortality assume that the proportions of disagreements concerning the diagnoses of the cause of death do not vary between different statuses. This assumption was verified by the addition of data concerning the occupation of the decreased (collected at death registration) to a data set comparing the clinicians' and the pathologists' diagnoses at autopsy of the cause of death. It was found that clinicians and pathologists were least likely to agree on the diagnoses of the cause of death of non-manual workers and were most likely to agree on the diagnosis of the cause of death of skilled manual workers. These occupational status differences in diagnostic disagreements reached levels of statistical significance in the neoplasm chapter of the International Classification of Diseases. Artefactual and clinical reasons for these occupational status differences are discussed.

A possible artefactual component in specific cause mortality gradients. Social class variations in the clinical accuracy of death certificates.

This paper investigates one possible avenue of artefactual influence on the production and/or concealment of social class gradients in specific cause mortality rates, namely, the possibility of social class biases in the accuracy of diagnosis of cause of death and the systematic misallocation of certain social groups to particular diagnoses. Information on this topic was obtained by matching occupational data gathered at death registration with data on the accuracy of diagnosis of cause of death (measured by diagnostic agreement between clinician and pathologist) collected in a prospective study of 1152 hospital necropsies. Extrapolation from these data to national mortality rates should be cautious, but it appears that in the majority of the most common causes of death grouped by ICD chapter (neoplasms, cerebrovascular and digestive) social class gradients would be steeper if mortality data were based on pathologists' rather than clinicians' diagnoses. Only in the respiratory chapter would the gradient be reduced, with the gradient in cardiovascular deaths unaffected.

Teamwork, information control and therapeutic effectiveness: a tale of two therapeutic communities.

This paper maps the differential distribution of therapeutic work within the programmes of two therapeutic communities found in psychiatric hospitals. It is shown that in one of the two communities, therapeutic work was largely restricted to the small groups and to those large groups attended by the psychiatrists. The other community displayed a distribution of therapeutic work which was spread across the whole formal weekly programme and into informal interaction outside the programme. These contrasting distributions are traced to differing patterns of internal communication which affected the ability of nurses and patients to work collaboratively with the psychiatrists.

Problems of therapeutic community practice in two halfway houses for disturbed adolescents: a comparative sociological study.

Materials gathered from a participant observation study of two therapeutic communities for disturbed adolescents were used to highlight the respective problems of two contrasting approaches to therapy. Whereas one community pursued the principles of programming and instrumental intervention, the other community's approach centred on minimal supervision and reality confrontation; the two communities mirrored, at a micro-level, wider divisions of practice within the therapeutic communities movement.

Reality construction, reality exploration and treatment in two therapeutic communities.

Data collected by participant observation in two contrasting types of therapeutic community are compared to reveal broad similarities in the treatment process. In both communities treatment was centrally concerned with reality construction: patients/residents learned to follow, assimilate and reproduce accounts of the community structure and prescriptions for behaviour, and these accounts and prescriptions reflexively constituted the social world of patients/residents. Further, in both communities staff recognised and made deliberate therapeutic use of an aspect of accounts and behavioural prescriptions much reported on in sociological literature, namely their essentially contingent and defeasible character. Thus, alongside processes of reality construction we note processes of reality exploration, whereby patients/residents are encouraged to inspect apparently contradictory prescriptions and accounts within the socially constructed reality of the communities. Staff believed that, in coming to terms with the contingent and defeasible character of accounts and prescriptions within the community, patients/residents would be able to deal with the contingent and defeasible character of social life outside the community less pathogenically.

Therapeutic paradox - the patient culture and the formal treatment programme in a therapeutic community.

Data collected by participant observation in a day hospital are used to examine the complex relationship between informal patient interaction and the formal group therapy programme of this therapeutic community. It was evident that staff might view apparently similar informal patient activities in quite different lights, as either complementary or as detrimental to the work of the formal groups. This apparent inconsistency in staff prescriptions was turned to a therapeutic purpose. Staff would point out to patients the "paradox" of the constant inconsistency of prescriptions for behaviour in daily life: parallels were drawn with the contingent and defeasible prescriptions to which patients were subject in most spheres of human activity. In learning to cope with incipiently contradictory prescriptions inside the day hospital it was felt that patients might learn to cope with incipiently contradictory prescriptions in their relationships outside the day hospital.