What we have learned from research about the prevention of HIV transmission among drug abusers.

OBJECTIVE: After more than 10 years of experience conducting behavioral changes interventions and with accumulated research results, several emergent principle have been identified for the effective prevention of HIV-transmission among drug abusers. In August 1997, a symposium was held in Flagstaff, Arizona, to achieve tow major purposes: (1) to synthesize the finding from HIV prevention research conducted to date for interventions targeting drug abusers and (2) to extract a preliminary set of prevention principles that could be linked to effectiveness across at least two or more studies. This chapter summarizes the key findings of that symposium. METHODS: Major finding were abstracted from the conclusion sections of the presentations and from the chapters included in this special volume. Many consistencies regarding intervention approaches across studies were noted. These findings are discussed under the following headings: General Observations, Engagement, Multiple Interventions, Intervention Issues, Methodological Issues, and Translation from Research to Practice. Suggested areas for further research are also presented and discussed. RESULTS: Ten principles that have implications for HIV prevention interventions emerged from this preliminary review of the research. These principles engage drug users into the intervention; specify target behaviors and attitudes for intervention; suggest setting to optimize outreach: and recommend booster approaches to reinforce knowledge, skills, and attitudes learned through the intervention. CONCLUSIONS: The drug abuse community is threatened by the incursion of HIV and by the hepatitis viruses A, B, and C. The same behaviors are involved in transmitting all of these viruses. The first generation of research to assess the impact of a variety of interventions delivered among drug abusers to prevent HIV has shown consistently favorable findings, proving that drug abusers can be helped to change their risky drug-using behaviors and, to a lesser extent, their risky sexual behaviors. The need to translate these findings for community practitioners is heightened by the devastating impact of HIV and AIDS.

HIV risk factors among injecting drug users in five US cities.

OBJECTIVES: To examine factors associated with HIV infection in injecting drug users (IDU), the independent and interactive effects of potential risk factors, and geographic differences in risk factors. METHODS: IDU entering methadone treatment in New York City, Asbury Park and Trenton in New Jersey, Baltimore and Chicago between February 1987 and December 1991 were interviewed using a standard questionnaire and tested for HIV antibodies (n = 4584). Associations of HIV serostatus with race/ethnicity, other demographic characteristics, and injecting and sexual risk behaviors were assessed by logistic regression analyses. RESULTS: African Americans were at increased risk for HIV in four of the five cities, and Puerto Ricans in two cities. Injection in shooting galleries and 'speedball' injection emerged as behavioral variables highly associated with HIV, although interaction of these variables indicates that each variable contributes to HIV risk only in the absence of the other behavior. CONCLUSIONS: Geographic differences in HIV risk factors and the interaction of 'speedball' and shooting gallery use suggest that multiple HIV risk models are needed that reflect seroprevalence rates, variation in risk behaviors, and the social context of risk behaviors. Increased risk among racial/ethnic minorities independent of risk behaviors, suggests the need to examine further potential social and environmental factors, such as the social networks in which injecting and sexual behaviors occur, HIV seroprevalence within these networks, and the locales in which risk behaviors occur.