Women living with drug abuse and HIV disease: drug abuse treatment access and secondary prevention issues.

In collaboration with the National Institute on Drug Abuse, the Health Resources and Services Administration is conducting a multisite, longitudinal study on issues of service needs, service utilization, and access to care for drug abusers with HIV. This article discusses access to drug abuse treatment and HIV secondary prevention for 116 women interviewed during the study's first year in five U.S. cities. Using interview data from 115 service providers in those same cities, it also discusses drug abuse treatment availability and barriers to service expansion for drug users with HIV. Study findings indicate that there are highly significant gaps between the drug abuse treatment services these women feel they need and those they have been able to receive; these were particularly pronounced for drug detoxification and residential and outpatient drug-free treatment. Women who used crack cocaine or injection drugs had particularly high levels of need for residential and outpatient drug abuse treatment, while women who use crack were found to have significantly less experience with the drug abuse treatment system than IDUs. HIV secondary prevention was also found to be a critical need for these women, many of whom were engaging in behaviors that place them at risk for reinfection, infection with other diseases, and transmission to others. Providers indicated that lack of funding was the major barrier to expanding services for this population; other barriers, such as lack of ancillary services and transportation, were also noted. Two positive findings were that many drug abuse treatment agencies in these cities provide a wide range of ancillary services and that many different kinds of agencies offer drug abuse treatment services.

Women living with substance abuse and HIV disease: medical care access issues.

This paper presents first-year findings from a multi-site, longitudinal study being coordinated by the Health Resources and Services Administration (HRSA) in collaboration with the National Institute on Drug Abuse (NIDA) on access to care for drug abusers with HIV. The sample of 116 women and 187 men in five sites (Denver, Detroit, New Haven, New Orleans, and St. Louis) were interviewed regarding HIV testing history, HIV disease course, and use of health and social services. For both men and women, there were significant gaps between the medical services they reported needing and those they received. Significantly more women needed and received mental health services. Cost and waiting times emerged as the most important barriers to care. The study also found that significantly fewer women than men subjects received pre- and post-test counseling and were advised to get medical services after their first positive HIV test. Overall, first-year study results suggest that multiple barriers in access to service exist for drug-using women, the largest group of women affected by HIV in the United States.

Perceptual distortions and hallucinations reported during the course of sleep deprivation.

Subjects worked 30 to 45 min. of each hour for either 48 (n = 2) or 72 hr. (n = 8) without sleep. The frequency of reported visual task-related perceptual distortions and hallucinations showed both a linear increasing component and a strong circadian component. Perceptual distortions were most frequent in the late night-early morning hours (0400) and least frequent in the late afternoon-early evening hours (1600-2000).

Lexical decision, parafoveal eccentricity and visual hemifield.

The effect of the eccentricity of parafoveal stimulation on a lexical decision task was studied using stimuli presented to the two visual hemifield. Five-letter word and nonword stimuli were presented to three parafoveal locations ranging over 1 degree angle of eccentricity. Subjects responded manually. The results of the analyses indicated that the average RT to words was approximately 48 msec. shorter than to nonwords. The average RT to a stimulus presented to the RVF was approximately 11 msec. shorter than to a stimulus presented to the LVF. As parafoveal location became more eccentric, RT to all stimuli increased by approximately 37 msec. per degree of eccentricity. A very significant interaction was found between the visual hemifield stimulated and the direction of response to the type of stimulus presented (word/nonword).

The Walter Reed performance assessment battery.

This paper describes technical details of a computerized psychological test battery designed for examining the effects of various state-variables on a representative sample of normal psychomotor, perceptual and cognitive tasks. The duration, number and type of tasks can be customized to different experimental needs, and then administered and analyzed automatically, at intervals as short as one hour. The battery can be run on either the Apple-II family of computers or on machines compatible with the IBM-PC.

Effects of 72 hour sleep deprivation on urinary cortisol and indices of metabolism.

Cortisol, urea, glucose, electrolytes, and other compounds were measured in five consecutive 24 h urine collections during a 72 h sleep deprivation study in six young men. Urine was collected during a 24 h predeprivation day, 3 days of sleep deprivation, and a recovery day. Whereas urinary cortisol decreased only slightly, marked changes in other urinary constituents were observed. During sleep deprivation, urinary urea rose markedly, glucose decreased, and urinary electrolytes decreased. These data indicate that sleep deprivation under ad lib food and water conditions can cause disturbances in normal metabolism.