Musical preference as an indicator of adolescent drug use.

AIMS: This paper aims to demonstrate whether a relationship exists between adolescent drug use and identification with styles of music linked to specific youth culture. DESIGN: Survey data were collected by researchers, under exam conditions, from two contrasting samples of Scottish secondary schoolchildren. SETTING: Fieldwork was conducted in five comprehensive schools in the city of Dundee in 1994 and five comprehensive schools in the rural area of Perth and Kinross District in 1996. PARTICIPANTS: Questionnaires were administered to two randomly selected mixed ability classes in each of the four compulsory school years (S1 to S4), at each participating school. The eventual sample (n = 1523) was approximately 10% of all children in these school years from the geographical areas surveyed. MEASUREMENTS: Comparisons were made between life-time measures of legal and illegal drug use and current favourite style of music. FINDINGS: Although few children in this study had ever taken the drug ecstasy (MDMA), 'fans' of rave music were more likely to have used drugs than those who preferred other styles of music. This relationship held true across a range of drugs used, across two geographical areas, over time and controlling for age, gender and parental social class. CONCLUSIONS: The paper is one of the first to quantify a possible relationship between drug use and music style. On the basis of the evidence presented, a significant relationship was found between identification with rave music and life-time drug use.

Prostitution and HIV: what do we know and where might research be targeted in the future?

PIP: A review of the literature indicates that the association between human immunodeficiency virus (HIV) and prostitution varies by geographic region and can be altered substantially by well-planned public health interventions. In most African countries and in Asian countries such as Thailand, the rate of HIV infection among female prostitutes is substantially higher than the rate in the general population. Relatively few commercial sex workers in South and Central America are HIV-positive; however, their extremely high rates of infection with sexually transmitted diseases indicates the potential for future epidemic spread of HIV. In Europe and North America, HIV infection is most prevalent among drug-injecting or crack-using prostitutes. Neglected has been research on the high incidence of HIV among male transvestite and transsexual prostitutes. The lowest levels of condom use in commercial sex encounters have been recorded in regions in developing countries with the highest HIV prevalence. Also of concern are high condom breakage rates (20-50%) among female prostitutes who use petroleum-based lubricants and male prostitutes who practice anal sex. Valuable would be quantification of the additional HIV risk resulting from sex with a prostitute. Other recommended research areas include estimates of the number of male and female prostitutes working in certain geographic areas, mechanisms for monitoring condom use and substance abuse among prostitutes, the impact of HIV infection on movement into and out of prostitution, the dynamics of prostitute-client condom negotiation, and profiles of the clients of male prostitutes.^ieng

Risk behaviours among male clients of female prostitutes.

PIP: 143 clients of prostitutes were recruited and asked to complete a short questionnaire. 68 were recruited in 2 genitourinary clinics in Glasgow, 66 were interviewed by telephone after answering an advertisement and 9 were contacted in Glasgow's red light area. The last 2 methods yielded a non clinic group. The men reported having paid for sexual services a median of 7 times (range 1-2000) since 1980. Higher numbers of contacts were reported by the non-clinic group: 28 (37%) if these men reported having had 21-50 contacts, significantly more than the clinic group, 28 (41%) of whom reported having had 1-10 contacts. The medial time of the men's last contact with a prostitute was 60 days. 103 men reported having paid for vaginal intercourse during this contact; 89 paid for masturbation or other non-penetrative sex; 87 paid for oral sex; and 11 paid for anal intercourse. Clearly, some men, engaged in more than one sexual activity. 17 men did not use condoms during the last paid vaginal intercourse nor did 31 men when they last had oral sex, but all anal intercourse was reportedly protected. 14% (19/133) of those who had used a condom reported condom failure during the last purchased sexual service. 32% (10/31) of men who contacted prostitutes working on the streets had not used a condom during their last contact. 121 men reported having private, noncommercial sexual contacts; 79 reported having one sexual partner, and 42 reported having 2 or more concurrent sexual partners (range 2-20), 2 of whom reported sexual contacts with other men. 117 men reported having had vaginal intercourse while 85 had had oral sex, 82 had had other non-penetrative sex, and 16 had had anal intercourse. A minority of these men reported always using condoms with their partners: 24% (27/114) of those having vaginal intercourse, 5% (4/80) of those having oral sex, and 33% (5/15) of those having anal intercourse.^ieng

The inappropriateness of psycho-social models of risk behaviour for understanding HIV-related risk practices among Glasgow male prostitutes.

Much the most common models of HIV-related risk behaviour are those psychosocial models derived from studies of health behaviour and tested on large interview samples of American gay men. These models were not appropriate for understanding risk behaviour among 32 Glasgow male prostitutes. Whereas psycho-social models conceive of risk behaviour as volitional and individualistic, ethnographic data indicate that the male prostitutes' risk practices were constrained and emergent from the immediate circumstances of the sexual encounter. Unsafe sex was associated with client control. Safer sex was associated with countervailing prostitute strategies of influence. These data confirm the utility of self-empowerment approaches to health education.

General practitioners and opiate-abusing patients.

General practitioners' involvement with patients who abuse opiates has increased in recent years but little is known about the difficulties they may encounter in working with such patients. This study examined a series of general practitioner consultations with patients who were abusing heroin and describes the problems that arose. Manipulative behaviour, lying about symptoms and a lack of motivation to give up drug use were common among drug abusers; by such behaviour, the patients failed to satisfy the underlying assumptions on which the doctor-patient relationship ordinarily depends. There is a need to evolve alternative approaches for the care of this group of patients which will help general practitioners to establish more effective relationships with them.

Teamwork, information control and therapeutic effectiveness: a tale of two therapeutic communities.

This paper maps the differential distribution of therapeutic work within the programmes of two therapeutic communities found in psychiatric hospitals. It is shown that in one of the two communities, therapeutic work was largely restricted to the small groups and to those large groups attended by the psychiatrists. The other community displayed a distribution of therapeutic work which was spread across the whole formal weekly programme and into informal interaction outside the programme. These contrasting distributions are traced to differing patterns of internal communication which affected the ability of nurses and patients to work collaboratively with the psychiatrists.