Reducing HIV risks among active injection drug and crack users: the safety counts program.

The efficacy of Safety Counts, a CDC-diffused intervention, was reanalyzed. In a quasi experimental, cross-over design, injection drug users (IDU) and crack users in two neighborhoods were assigned by neighborhood to receive individual Voluntary HIV Counseling and Testing or Safety Counts and 78% were reassessed at 5-9 months. Drug users in the Safety Counts program reported significantly greater reductions in risky sex, crack and hard drug use, and risky drug injection. The more sessions of Safety Counts attended, the greater were the reductions in risky acts. Different analytic decisions result in very different findings for the same intervention. Safety Counts is an effective intervention for IDU and crack users. Analytic decision of intervention outcomes is highly related to evaluations of an intervention's efficacy.

Using theory to understand how interventions work: Project RESPECT, condom use, and the Integrative Model.

The Integrative Model of Behavioral Prediction (IM) provides guidelines for the development of successful HIV/STD interventions, yet few HIV prevention programs have identified which components of the IM have been associated with successful behavioral outcomes. Using structural equation modeling, this study examines in detail how components of the IM assessed prior to, and immediately after, the delivery of an intervention are associated with reported condom use 3 months later among participants in Project RESPECT, a multisite randomized controlled trial testing HIV/STD risk reduction strategies among clients attending public health clinics for sexually transmitted diseases. Overall, the IM predicted condom use at 3 months; there were, however, variations in the relative contribution of differing IM components as a function of gender and type of sexual partner as well as the type of intervention the participant had received.

Correlates of sex trading among drug-using men who have sex with men.

OBJECTIVES: We examined correlates of trading sex for money, drugs, and shelter, or food among drug-using men who have sex with men (MSM). METHODS: Audio computer-assisted self-interviewing questionnaires were completed by 387 MSM. The association of predictors with sex trading was assessed with chi(2) tests and multiple logistic regression. RESULTS: Sex-trading prevalence was 62.5% (95% confidence interval=57.7%, 67.4%). Sex trading was associated with crack use, injection drug use, childhood maltreatment, non-gay self-identification, and homelessness (adjusted odds ratios=3.72, 2.28, 2.62, 2.21, and 1.88, respectively). CONCLUSIONS: Multiple risk factors are associated with sex trading among MSM. Interventions may need to address crack and injection drug use, homelessness, and childhood maltreatment and target non-gay-identified MSM who engage in sex trading.

Prevention of HIV among drug users.

The relationship between injection drug use and HIV was established early in the HIV epidemic, and injection drug use has continued to be an important risk factor for HIV throughout the world. This panel included 4 papers related to HIV prevention among drug users, focusing on effective prevention strategies, the importance of organizing the AIDS-affected community, the impact of knowledge of serostatus on risk behaviors, and developing interventions for drug-using homosexual and bisexual men. These papers, addressing various aspects of the epidemic and methods to enhance prevention efforts, all indicate that although extensive knowledge regarding how to reduce HIV risks among drug users has accumulated, many areas for further research and intervention development remain.