Clinic appointment attendance for sexually transmitted infection screening among Filipina sex workers: a multilevel analysis.

This study evaluates putative individual- and contextual-level social risk factors that may influence the likelihood that Filipina female sex workers (FSWs) attend and utilize health services for STI screening. Face-to-face interviews were conducted with 1004 FSWs and their 86 employers. Research staff also collected clinic appointment attendance data. Hierarchical linear modelling was used to estimate the simultaneous effects of individual- and workplace-level factors. Results showed that both individual- and contextual-level characteristics were associated with STI screening appointment attendance. Individual characteristics found to have significant effects on clinic attendance included occupation, income, length of work and commercial sex involvement. City of establishment was a workplace characteristic significantly associated with appointment attendance. In addition to cross-level interactions, the impact of individual-level occupation depended upon characteristics of the workplace. These findings suggest that individual health service utilization is contingent upon contextual-level risk factors in the workplace. Intervention implications aimed at increasing clinic attendance are discussed.

Substance-abusing adolescents at varying levels of HIV risk: psychosocial characteristics, drug use, and sexual behavior.

PURPOSE: To evaluate the relationship of various psychosocial factors on HIV sexual risk behavior in a sample of 169 "inner city" male and female adolescents mandated into in court-ordered substance abuse treatment. METHOD: The Millon Adolescent Clinical Inventory (MACI) and measures of sexual behavior, condom attitudes and skills, HIV knowledge, and substance abuse were administered. Data were evaluated according to five HIV risk groups: abstinent (n = 37); monogamous and practicing only protected sex (n = 19); monogamous and practicing unprotected sex (n = 45); multiple partners and practicing only protected sex (n = 11); and multiple partners and having only unprotected sex (n = 57). RESULTS: Significant main effects were found for impulsive propensity, submissiveness, marijuana and alcohol use, condom attitudes, and intentions to engage in safer sex. Protective behavior was directly associated with submissiveness and inversely associated with impulsive personality profiles, with increased marijuana use emerging as a significant predictive factor in the choice for sexual activity vs. abstinence. More alcohol use was predictive of choosing multiple partners vs. monogamy. IMPLICATIONS: Factoring risk variation into the design of HIV psychosocial research may enhance the tailoring of effective prevention strategies.

Effects of a cognitive-behavioral HIV prevention intervention among HIV negative male substance abusers in VA residential treatment.

This investigation compared the effectiveness of a cognitive-behavioral HIV risk reduction intervention with a standard care (SC) comparison condition in modifying HIV risk related knowledge, beliefs, attitudes, and behavior at 6-month and 12-month follow-ups among 149 HIV seronegative males. The two intervention conditions were administered while participants were in inpatient alcohol and other drug abuse treatment. Global drug abuse severity, as well as injection drug abuse, decreased significantly from preintervention to follow-up across conditions. There were significant increases in the proportions reporting sexual activity and increases in levels of unprotected sex acts between baseline and follow-up across conditions. However, no changes in sex risk behavior were found among those who reported sexual activity both prior to and after intervention across conditions. Participants revealed relatively adequate knowledge regarding HIV and HIV risk reduction practices, strong belief in the utility of safer practices and in their ability to enact such practices, and relatively strong commitment to practice safer sex across conditions at baseline assessment. In general, substantial postintervention improvements over baseline levels in these areas were not found. Relatively modest changes in sexual self-efficacy and in safe-sex guidelines were identified in analyses involving the total sample. Exploratory subgroup analysis suggested increases in knowledge and reductions in susceptibility and anxiety among those who reported sexual activity both prior to and after intervention. Among participants reporting initiation of sexual activity after intervention, those receiving SC revealed changes in perceived susceptibility and in condom attitudes. A discussion is presented of challenges associated with providing meaningful HIV risk reduction intervention when baseline levels of sex risk behavior, perceived HIV infection susceptibility, and HIV anxiety are only moderate and when initial levels of sexual self-efficacy and commitment are relatively high.

Psychiatric symptoms and HIV risk in MMPI-2 cluster subgroups of polysubstance abusers in treatment.

This-investigation identified personality subgroups based upon cluster analysis of MMPI-2 records of polysubstance abusers. Subgroups were compared on lifetime and current psychiatric symptoms and on attitudes and behaviors linked with HIV infection risk. High psychopathology, mild psychopathology, and subclinical MMPI-2 cluster types were identified which resemble those that have been identified in earlier studies with the original version of the MMPI. The High Psychopathology Subgroup had significantly higher proportions with all lifetime psychiatric problems (ASI), higher levels of all current psychiatric symptoms (SCL-90), and lower levels of confidence in ability to enact safer sexual practices than the Subclinical Cluster Subgroup. Fewer differences in lifetime and concurrent psychiatric symptoms were found in comparisons involving High Pathology and Mild Pathology cluster subgroups and Mild Psychopathology and Subclinical cluster subgroups. Those in the High Psychopathology Subgroup likely need treatment programs that address their more chronic and serious mental health problems and interventions that target their judgment and problem solving limitations that may increase HIV infection risk.

Enhancing adherence to combination antiretroviral therapy in non-adherent HIV-positive men.

This paper describes a preliminary study aimed at testing the efficacy of a brief medication counselling and behavioural intervention in improving adherence to combination antiretroviral medication therapy and prophylactic treatment among non-adherent men living with HIV. Twenty-one non-adherent HIV-positive men obtaining primary care clinical services at a Veterans Affairs Medical Center were recruited by health care providers. Intervention participants were primarily African-Americans with histories of intravenous drug use. During a period of five months, participants were provided with monthly medication counselling and a weekly medication pill organizer. Participants were compared with 21 non-adherent matched controls receiving standard pharmacy care including review of medications. Intervention and control subjects were compared on several variables: medication refill timeliness, appointment attendance, hospitalizations and opportunistic infections. Medical information was obtained from hospital and pharmacy records at baseline and post-intervention. Pre- to post-intervention rates of adherence to medication refills and clinic appointments increased significantly among intervention participants. Relative to matched controls, intervention participants also significantly increased drop-in visits and showed fewer hospitalizations. Intervention participants also showed significant decreases in the number of opportunistic infections. Results suggest that exposure to medication counselling and behavioural interventions increase adherence, with associated reductions in negative clinical outcomes.

Relationship of psychosocial factors to HIV risk among Haitian women.

This study describes the prevalence of HIV risk behaviors among low-income, Haitian women, identifies theoretically relevant mediating psychosocial HIV risk predictors, and provides formative data for developing culturally and gender sensitive interventions for this distinctive, high risk, and understudied population. Confidential interview surveys were administered to 101 women of Haitian descent while they awaited their medical appointments at a local low-income, community medical clinic. Moderately high levels of sexual risk behavior (i.e., unprotected sex with nonmonogamous partners; multiple lifetime partners) were reported. On average, these women reported a belief in their HIV susceptibility, relatively little HIV-related anxiety, somewhat inadequate levels of communication regarding safer sex practices, and lack of adequate confidence in their ability to negotiate safer behaviors in sexual encounters. Both personal and partner condom attitudes were unfavorable and these attitudes predicted condom use levels. It was concluded that interventions need to be developed for Haitian women to improve their attitudes toward condom use and their confidence in negotiating safer sexual practices. However, these interventions cannot be developed in a vacuum. Although it is crucial to consider the woman's individual attitudes and behaviors, it is also important to consider the male partner's attitudes toward sex and the woman's relationship with her male partner within the context of Haitian culture. Only by determining and targeting important potential motivations for safe sex within the cultural context can we most effectively reduce HIV sex risk behavior in Haitian women.

Use of female controlled microbicidal products for HIV risk reduction.

Many over-the-counter microbicidal contraceptive methods reduce the risk of acquiring sexually transmitted diseases. This pilot project compared the use of female controlled barrier methods in an extremely high-risk population of low-income drug abusing women following an intervention designed to promote HIV risk reduction and barrier use. An HIV transmission risk reduction interactive intervention emphasizing self-esteem, assertiveness and sexual negotiation was offered to 41 drug dependent women. Participants were randomly assigned to one of two conditions, a male and female condom condition or a male and female condom plus N-9 products (vaginal suppositories, film, gel) condition. Results from the three-month follow-up period suggest that there may be a synergistic effect of availability of multiple protective methods on the overall rate of protective behaviours. The use of the male condom for penile/vaginal sex increased from 19% at study entry to 27% during the three-month follow-up period. The total protected sexual episode rate, calculated to include use of the other protective barriers distributed, was 60%. Thus, the condom use rate was not found to decrease because of the availability of alternative methods of protection. Future research should address the use of microbicidal products to empower women to prevent STD/HIV transmission.

A comparative study of cocaine-treatment completers and dropouts.

This study compared matched groups of completers and dropouts from residential treatment for cocaine abuse on a range of outcome measures, including cocaine and alcohol use, stress, coping, and social support characteristics. The most striking finding of this study was that treatment dropouts differed from treatment completers on only 2 of 14 dependent measures reflecting substance use, stress, coping, and social support characteristics during two 3-month follow-up periods. Both dropouts and completers demonstrated large decreases in cocaine and alcohol use from pretreatment to the first follow-up period. Completers and dropouts did not differ in level of substance use during either follow-up period.

HIV/AIDS risk in heterosexual college students. A review of a decade of literature.

Empirical studies dealing with the psychosocial correlates of HIV risk among heterosexual college students are reviewed, including findings related to such theoretical variables as HIV/AIDS-related knowledge, personal and partner's attitudes toward condom use, perceived susceptibility, communication with sex partners, and sexual self-efficacy. Although college students are highly knowledgeable about basic HIV/AIDS facts, they retain some misperceptions about disease transmission. They hold neutral-to-negative hedonistic and practical attitudes about using condoms: those who have engaged in risky behavior accurately perceive their greater susceptibility to infection and experience anxiety regarding transmission of HIV infection. Heterosexual college students communicate infrequently with their partners about safer sex, but they often agree to a partner's suggestion that they use condoms. Higher levels of sexual self-efficacy among college students have been associated with a lower risk for HIV transmission. Limitations and clinical implications of the findings and recommendations for future interventions are discussed.

HIV risk correlates among non-injection cocaine dependent men in treatment.

Guided by the AIDS Risk Reduction Model (ARRM), psychosocial correlates of HIV risk behavior were examined among noninjection cocaine dependent, heterosexual men (NI-CD-HM) in treatment. Subjects (N = 111) completed a structured interview to measure ARRM mediating variables and HIV risk behaviors. The results indicated that greater perceived susceptibility to contracting HIV, lower sexual self-efficacy, higher lifetime incidence of sexually transmitted diseases, and being under the influence of alcohol or other drugs during sex predicted having more sexual partners in the month prior to admission. Despite adequate knowledge of safer sex guidelines, subjects remained misinformed regarding certain aspects of HIV transmission. Men who perceived that their partners viewed condoms more positively and who exchanged drugs for sex were more likely to use condoms, yet condom use skills were typically inadequate to ensure effective prevention. These results suggest that HIV prevention interventions among NI-CD-HM should focus on improving knowledge, enhancing beliefs in the capacity to enact safer sex behaviors for preventing HIV and other STDs, building relevant skills (e.g., condom use, open sexual communication between partners), and emphasizing psychoactive substance abstinence. Couple interventions, in which partners actually rehearse safer sex negotiations, may be particularly effective in this regard.

Outcome of psychoeducation for HIV risk reduction.

Our objectives were to assess the effects of a psychoeducational (PE) program designed to reduce HIV risk behaviors in recovering drug abusers and to evaluate mediating variables associated with risk reduction as described by the AIDS Risk Reduction Model (ARRM). Consecutive admissions to a Department of Veterans Affairs drug dependence inpatient treatment program (n = 152) were randomly assigned to PE or a standard information (INFO) condition. PE involved a 6-hour small group intervention designed to enhance knowledge and attitudes regarding HIV prevention, improve skills in condom use and needle sterilization, and modify high-risk sex- and drug-related behaviors. The INFO condition involved presentation of audiovisual and printed HIV prevention material with similar content. Following intervention, PE subjects showed significantly enhanced self-efficacy, condom use skills, and sexual communication skills relative to the INFO group. At 3-month follow-up, the PE group showed significantly greater reductions on some measures of sexual HIV risk behaviors relative to the INFO group. Hypotheses derived from the ARRM regarding presumed relationships between positive changes in mediating variables (e.g., self-efficacy and sexual communication) and ultimate outcome variables (e.g., condom use) were supported.

PIP: The objectives were to assess the effects of a psychoeducational (PE) program designed to reduce HIV risk behaviors in recovering drug abusers and to evaluate mediating variables associated with risk reduction as described by the AIDS Risk Reduction Model (ARRM). African-American male participants with no evidence of HIV seropositivity were recruited over a 10-month period from among 235 consecutive admissions to the Department of Veteran's Affair Drug Dependence Treatment Program (DDTP). 176 subjects fulfilled eligibility criteria. 152 consecutive admissions to DDTP were randomly assigned to either or standard information (INFO) groups of equal size. PE involved a 6-hour small group intervention to enhance knowledge regarding HIV prevention, improve condom use and needle sterilization skills, and modify high-risk sex- and drug-related behaviors. The INFO condition involved presentation of HIV prevention materials with similar content. Subjects were an average of 35.5 years old with 13.06 years old with 13.06 years of education, and an estimated IQ of 105.4 Overall, subjects reported a significant reduction in high-risk behaviors at 3 months compared to preintervention levels (p .0001). 75% of the subjects in the PE group reported higher sexual risk behaviors before the intervention vs. 32% at 3 months (p .0001). Also, 75% of INFO subjects were at higher risk pretreatment, which decreased to 48% at 3 months (p .01). There was a trend toward greater risk reduction in the PE group. 25 (62.5%) of the 40 PE subjects at higher risk prior to the intervention were at lower risk at the 3-month follow-up. In the INFO group, 51.2% of the preintervention higher risk subjects were at lower risk 3 months postintervention. Among the 107 subjects completing the 3-month follow-up, significantly fewer reported more than one partner, from 75.5% preintervention to 50.5% at 3 months (p = .0001). 75.5% of PE subjects reported more than one sexual partner preintervention vs. 47.5% at 3 months (binomial p = .0001). In the INFO group, this declined from 75.9% to 59.3%, which was without statistical significance.

A description of the Maternal Addiction Program of the University of Miami/Jackson Memorial Medical Center.

The MAP of the University of Miami/Jackson Memorial Medical Center/Highland Park Pavilion is a comprehensive inpatient and outpatient chemical dependency rehabilitation program that serves mostly lower socioeconomic, African-American perinatal substance-abusing women. The multidisciplinary treatment team incorporates a broad spectrum of group and individual therapeutic modalities, including 12-step, psychoeducational, and RP components. Within MAP programs, significant attention is given to issues and experiences that are unique to this population and that must be addressed if rehabilitation is to be successful. These topics include, but are not limited to, physical, emotional and sexual abuse, empowerment, family and parenting concerns, and HIV prevention and coping skills for HIV-seropositive women.

Psychosocial factors associated with condom use among African-American drug abusers in treatment.

Although strategies for decreasing injection drug use have met with moderate success, efforts to decrease high-risk sexual behaviors have been less successful. Because condom use reduces HIV transmission, it is critically important to identify the attitudinal, emotional, and behavioral factors associated with using condoms. This study evaluated the relationship between condom use and various psychological and behavioral variables among heterosexual, African-American, cocaine-dependent men within the context of the AIDS Risk Reduction Model (ARRM). Subjects who used condoms (n = 52) reported significantly higher levels of self-efficacy, condom use skills, and sexual communication with partners than non-users (n = 84). However, the groups did not differ in perceived susceptibility, anxiety concerning HIV transmission, response efficacy, or knowledge regarding HIV. These findings suggest that future interventions focus on enhancing self-efficacy and condom use skills, as well as eroticizing condom use.

PIP: While strategies to decrease the prevalence and frequency of injection drug use have proved to be moderately successful, only minimal success has been achieved in getting IV drug users to reduce the amount of high-risk sex they have. It is common among heavy drug users, however, to be promiscuous and exchange sex for drugs and money. Injecting drug users rarely use condoms to reduce their risk of HIV transmission, even though it has been found that more than 70% of AIDS cases among heterosexuals may be attributed to sexual contact with drug users. Since consistent condom use can reduce the risk of HIV transmission, it is extremely important to identify the attitudinal, emotional, and behavioral factors associated with their use. This study was therefore conducted to evaluate the relationship between condom use and various psychological and behavioral variables among heterosexual, African-American, cocaine-dependent men within the context of the AIDS Risk Reduction Model. 136 subjects of mean age 35.5 years and an average education of 13.1 years were studied. 112 subjects smoked cocaine and 24 injected it. The 52 subjects who used condoms reported significantly higher levels of self-efficacy, condom use skills, and sexual communication with partners than the 84 non-users. The groups did not, however, differ in perceived susceptibility, anxiety concerning HIV transmission, response efficacy, or knowledge regarding HIV. Study findings suggest that future interventions focus on enhancing self-efficacy and condom use skills, as well as eroticizing condom use.

Cocaine and speedball users: differences in psychopathology.

Affective distress and related symptoms associated with co-injected cocaine and opioid ("speedball") use are incompletely explored, and the extent to which they diverge from problems shown by cocaine abusers who do not prefer opioids is unknown. This investigation compared groups of speedball and non-speedball cocaine users on global measures of depression and anxiety and modal groupings of personality characteristics measured by the MMPI. Compared to men who use cocaine without opioids, compulsive speedball users evidenced significantly greater problems with depression, trait anxiety, and related symptomatology, and were more uniformly characterized by modal profiles reflecting severe psychopathology and maladjustment. These results agree with descriptions of severe pathology associated with speedball use.

Personality disorders classification and symptoms in cocaine and opioid addicts.

The extent to which personality disorders (PDs) and associated symptom criteria were found among 117 cocaine- and opioid-dependent men selected from 350 consecutive inpatient admissions to a Veterans Administration Drug Dependence Treatment Unit over a 30-month period was examined using structured interview methodology. Drug groups were distinguished by higher rates of antisocial and borderline symptomatology rather than by features associated with other PDs. Cocaine users showed lower rates of borderline and adult antisocial features and reported less subjective distress than opioid addicts, and different constellations of target problem features emerged for the two groups.