Needle sharing: a longitudinal study of female injection drug users.

The objective of this study was to examine the psychosocial risk and protective factors related to needle-sharing behavior among female intravenous drug users (IDUs) positive (N = 96) and negative (N = 128) for human immunodeficiency virus (HIV). Participants in this longitudinal study were interviewed individually at two points in time, with a 6-month interval between interviews. The interviewers used a structured questionnaire, which included psychosocial measures and questions about drug and sexual risk behaviors. Data were analyzed using Pearson correlations and hierarchical regression analyses. The findings supported a developmental model in which the psychosocial domains and HIV status predicted T1 (initial) needle-sharing behavior, which in turn was related to T2 (follow-up) needle-sharing behavior. In addition, the relationship between personality and peer risk factors and T2 needle sharing was buffered by family-related protective factors. While HIV-positive status had a direct effect on T1 needle sharing with strangers, its effect was mediated by all of the psychosocial variables in its relation to T1 needle sharing with familiar people. Comparisons of these results were made with a companion study of male IDUs. The results suggest several intervention and treatment approaches that can be implemented at different points in the developmental pathways leading to risky needle-sharing practices among female IDUs.

Longitudinal pathways to condom use: a psychosocial study of male IDUs.

This longitudinal study examined the psychosocial risk and protective factors involved in condom use among 265 male IDUs. Subjects were individually interviewed at two points in time using a structured questionnaire, which included psychosocial measures and questions about drug use and condom use. Data were analyzed using Pearson correlations and hierarchical regression analyses. T1 condom use was the most powerful predictor of T2 condom use, with or without control on other variables. T1 family support for condom use, friends' support for condom use, adaptive coping with AIDS or the threat of AIDS, and planning to use condoms were significantly related to T2 condom use. Protective father factors enhanced the effects of other protective psychosocial factors, increasing T2 condom use. The results suggest several approaches for changing risk-taking sexual behavior in male IDUs: enhancing coping abilities, selecting peers who take fewer risks, and planning to use condoms.

Coping strategies of HIV-positive and HIV-negative female injection drug users: a longitudinal study.

This study longitudinally examined the psychosocial correlates of coping strategies among 165 HIV positive and 179 HIV negative female injection drug users (IDUs). Participants were interviewed twice using a structured questionnaire, with a 6-month interval between interviews. The questionnaire included psychosocial measures as well as measures of general coping and specific HIV-related coping. Data were analyzed using logistic regression analyses. The findings indicated that favorable factors in the psychosocial domains at Time 1 were significantly associated with an increased likelihood at Time 2 of the use of general coping and specific adaptive coping strategies, such as problem solving and seeking social support, and with a decreased likelihood at Time 2 of the use of maladaptive coping strategies, such as aggression and the use of illicit drugs. These findings highlight particular areas of psychosocial functioning that can be targeted by intervention programs to promote adaptive coping and minimize maladaptive coping among HIV positive and HIV negative female IDUs.

Coping among HIV negative and HIV positive female injection drug users.

The study examined the psychosocial determinants of coping ability in a cohort of 249 HIV positive and HIV negative female injection drug users (IDUs), using a cross-sectional retrospective design. Information collected using a structured questionnaire included data on psychosocial risk and protective factors in the personality, family, and peer domains, HIV status, and coping ability. Coping ability was associated with conventionality, greater control of emotions, less psychopathology, and family cohesion in both HIV positive and HIV negative subjects. The psychosocial factors affected coping in HIV positive and HIV negative IDUs via two different mediational models. The interactional findings supported the influence of risk/protective interactions in both groups. The findings demonstrate the impact of the interplay between personality factors and external support on coping ability in female IDUs.

Psychosocial risk and protective factors for condom use among female injection drug users.

The authors examined the influences of domains of psychosocial risk and protective factors on male-partner condom use in a cobort of 209 female HIV-positive (HIV+) and HIV-negative (HIV-) injection drug users (IDUs) by use of a cross-sectional, retrospective design. Information collected from a structured questionnaire included data on psychosocial risk and protective factors in the personality, family, and peer domains; HIV status; and condom use. Among HIV+ IDUs, personality risk factors (e.g., unconventionality), family (e.g., low maternal identification), and peer factors were related to less male-partner condom use. Resources and condom availability were associated with greater male condom use with both HIV+ and HIV- IDUs. The psychosocial domains affected male condom use with both HIV+ and HIV- female IDU patients via two different mediational models. The findings suggest the need to use specific psychosocial interventions for risky sexual behavior among HIV+ and HIV- female IDUs.

Psychosocial risk factors for HIV transmission in female drug abusers.

The authors studied the influences of domains of psychosocial risk factors on needle-sharing with familiar people and with strangers in a cohort of female injecting drug users (IDUs). Subjects were 119 female IDUs, 46% of whom were HIV+. Subjects were given individually administered questionnaire interviews: Using Pearson correlation coefficients and multiple hierarchical regression analyses, the authors found that personality, family, and peer attributes related to needle-sharing in women were similar to those found in men, with certain exceptions. The role of the family, particularly the Significant Other, was more important and proximal in its effect on needle-sharing behavior in women than in men. There was a main effect as well as a mediating effect of family in women, buffering risk factors leading to needle-sharing.

Coping with AIDS. A longitudinal study.

The goals of this longitudinal, prospective study were to 1) examine coping strategies of HIV-positive (HIV+) and HIV-negative (HIV-) injecting drug users; 2) study the relationship of earlier social support to later coping in HIV+ men; and 3) examine the effects of earlier coping strategies on later psychosocial function. The authors studied 287 men given a structured questionnaire at two points in time. HIV+ subjects scored higher than HIV- subjects on measures of AIDS-related adaptive coping (social support) and AIDS-related maladaptive coping (aggression), but not on general coping. General coping was not specifically AIDS-related, but was correlated positively with adaptive coping and negatively with maladaptive coping. These results suggest that earlier general coping is related to the later avoidance of maladaptive coping, and they have specific implications for teaching preventive strategies. AIDS-related adaptive or maladaptive coping techniques may be used simultaneously, and coping behavior may change over time. Earlier social support is related positively to aspects of later coping in HIV+ men.

Treatment of HIV associated psoriatic arthritis with oral gold.

We report a patient with human immunodeficiency virus (HIV) infection and disabling psoriatic arthritis who was treated with auranofin. Her skin lesions and arthritis resolved after auranofin treatment and she has remained free of opportunistic infections during 24 mo followup. Her CD4 count during oral gold therapy showed a significant, sustained increase in CD4 cells. The literature on the effect of gold compounds on HIV infectivity and HIV reverse transcriptase is reviewed.

Coping with AIDS and the threat of AIDS in intravenous drug abusers.

In this investigation of patterns of coping with AIDS or the threat of AIDS by male intravenous drug abusers (both HIV positive and HIV negative), psychosocial measures were used to study the effects of personality factors and social support. Correlational analyses and multiple hierarchical regression analyses were used to assess the results. The pathways by which psychosocial factors affected coping differed in HIV-positive and HIV-negative subjects. A mediational model best depicted the interrelation of personality, family, and peer factors among HIV-positive subjects. Anger and rebelliousness interfered with coping among HIV-negative subjects, but not among HIV-positive subjects. This cross-sectional study provides insight into the interplay of inner personality factors and external support factors and their effects on coping ability in male intravenous drug abusers. Differences between those with HIV and those at risk for HIV infection are discussed.

Psychosocial risk factors for HIV transmission in male drug abusers.

We studied the psychosocial risk factors associated with Black, Hispanic, and White (N = 257) male intravenous drug abusers' needle-sharing behavior with familiar individuals and with strangers. Approximately half the subjects were HIV+. The findings supported a mediational model in that risk factors in the family domain were associated with peer and personality risk factors conducive to needle sharing that, in turn, were related to needle-sharing behavior.

Decreased efficacy of inhaled pentamidine in the prevention of Pneumocystis carinii pneumonia among HIV-infected patients with severe immunodeficiency.

STUDY OBJECTIVE: To determine the relationship between the degree of immune deficiency and the risk of Pneumocystis carinii pneumonia (PCP) among HIV-infected patients receiving inhaled pentamidine prophylaxis. DESIGN: Retrospective chart review. SETTING: AIDS clinic of inner-city hospital. PATIENTS: Patients attending inhaled pentamidine clinic between 1989 and 1991. INTERVENTION: Review of medical records of patients receiving inhaled pentamidine, 300 mg/month, via nebulizer (Respirgard II) as primary or secondary prophylaxis of PCP. Statistical analysis of lymphocyte subset results and selected clinical data. RESULTS: Ten of 57 patients developed PCP during the period of analysis. Patients with CD4 counts less than 60/mm3 were significantly more likely to develop PCP (p = 0.01; Fisher's exact test) with a relative risk of 7.55 compared to patients with CD4 lymphocyte counts greater than 60/mm3. CONCLUSION: Failure of inhaled pentamidine prophylaxis is seen almost exclusively among patients with CD4 lymphocyte counts below 60/mm3.

Primary care for patients with HIV.

AIDS will soon emerge as one of the top five causes of death in the United States. By 1995 it is going to be roughly equivalent to stroke in this regard: about 200,000 deaths annually. By that year between 400,000 and 500,000 AIDS cases will have been reported in this country. Right now our health care system, which is so sophisticated but which can be so inadequate, is effectively addressing AIDS in some areas of the country but is not effectively addressing the HIV epidemic. In order to identify HIV infection early, we all have to be involved. As internists we have to routinely offer screening. We have to make it easily accessible to our patients. There should be no more thought of ignoring the question of HIV infection than of ignoring smoking. There is no other answer to this major public health dilemma, and despite all the AIDS centers that are developing and the funding for in-patient and out-patient facilities, I think they are all going to be overwhelmed eventually, particularly in New York City, if we do not develop a more broad-based approach to the problem.

Amebiasis: clinical and laboratory perspectives.

Entamoeba histolytica, the premier intestinal protozoan, has traversed time in its relentless quest for survival in its dichotomous role of parasite and pathogen. Enigmatic in its transition from human intestinal commensal to invader of human tissue, diverse in its pathogenicity for the human host, and intricate in its bacterial interrelationship in the bowel, E. histolytica has become the focal point of intensive investigation in its basic biology underscoring human pathogenicity. This review will focus on facets of cell biology, pathophysiology, clinical, therapeutic, and epidemiologic, correlates, along with diagnostic modalities and future research trends.

Cryptococcal skeletal infections: case report and review.

Cryptococcus neoformans is an uncommon but treatable cause of osteomyelitis that affects both normal and immunocompromised hosts. When not considered as a diagnostic possibility, C. neoformans infection may result in increased morbidity. The spectrum of disease at presentation extends from an asymptomatic patient with an osteolytic lesion on radiograph to a patient with signs and symptoms of systemic disease. Once diagnosis has been established (often by closed aspiration), optimal therapy appears to involve a combination of amphotericin B, flucytosine, and surgical debridement.

Infectious problems in surgical patients.

postoperative infections, regardless of whether or not they are directly related to surgery, have a dramatic impact on the morbidity, mortality, and cost of surgery. With an emphasis on prevention and treatment, the author reviews infectious complications that may be encountered with any type of surgery and those that are unique to certain procedures and settings.