Profiles of self-reported HIV-risk behaviors among injection drug users in methadone maintenance treatment, detoxification, and needle exchange programs.

OBJECTIVE: Injection drug use has accounted for more than one third of acquired immune deficiency syndrome cases in the United States. The purpose of this study was to compare the demographic characteristics, types, and frequency of human immunodeficiency virus (HIV)-risk behaviors among injection drug users (IDUs) recruited from a needle exchange program (NEP), methadone maintenance treatment (MMT), and detoxification (detox) program. DESIGN: A cross-sectional, correlational design was used to determine whether the selected HIV-risk behaviors and demographic characteristics of IDUs varied by site of recruitment. SAMPLE AND MEASUREMENTS: Confidential questionnaires were completed by 445 IDUs in Philadelphia, Pennsylvania. RESULTS: Data analysis revealed that HIV sexual and injection-risk behavior varied by recruitment site. Subjects recruited from the NEP were more likely to engage in HIV-risk behaviors than subjects recruited from the MMT or detox sites. CONCLUSIONS: Interventions occurring in program and treatment sites need to be sensitive to various demographic characteristics and behaviors if they are to reach those at highest risk of HIV infection. Targeting HIV prevention interventions based upon risk group membership alone (e.g. IDUs) fails to address the distinct risk behaviors and demographic characteristics of enrollees in different programs.

Human immunodeficiency virus prevention and the potential of drug abuse treatment.

Since first recognition of the scope of the acquired immunodeficiency syndrome epidemic among the drug-using community, substance abuse treatment has been viewed as playing an important role in preventing new infections. In the past 20 years, many studies have documented significantly lower rates of drug use, drug-related risk behaviors, and human immunodeficiency virus (HIV) infections among drug users who remain in treatment programs. There is also growing evidence that drug detoxification alone is insufficient to provide protection from HIV infection. These findings have important implications for users of cocaine and noninjection drugs, as well as heroin injectors. Despite strong evidence of effectiveness and widespread support for the important public health role of drug treatment, its impact has been compromised by limited availability and acceptability. The available data clearly establish drug abuse treatment as HIV prevention, yet without expansion of existing treatment programs and the continued development of treatments for addiction to cocaine and other widely used stimulants, its public health potential cannot be realized.

Sociodemographic and behavioral characteristics associated with timeliness and retention in a 6-month follow-up study of high-risk injection drug users.

Timeliness and retention in a 6-month follow-up study were analyzed by subjects' baseline characteristics in a seroincidence study of 263 injection drug users at high risk of human immunodeficiency virus infection. Subjects were recruited from September 1997 to June 1998 in community settings in Philadelphia, Pennsylvania. Of these subjects, 93% were completers: 11% before the targeted date, 38% at the targeted date, 32% within 1 month of delay, and 12% beyond 1 month. Late completers were more likely than other completers to be younger and to live farther away from the study center, less likely to have stayed in a shelter or a welfare residence during the past year, more likely to have a lower income, and more likely to have shared rinse water, cotton, or cooker. By contrast, loss to follow-up was not associated with these variables. Subjects lost to follow-up were more likely than those retained to have a high school diploma and to have moved during the past year; their source of needles was less likely to be a needle exchange program and more likely to be a shooting gallery. None of the drug-related behaviors that increase the risk of human immunodeficiency virus infection was associated with timeliness or retention, suggesting that the study might be minimally biased.

HIV prevention among injection drug users: the need for integrated models.

Opportunistic infections (OIs) were first recognized among injection drug users (IDUs) in New York City in 1981. By the mid-1980s, OIs had become associated with HIV infection, and attention began to focus on efforts to prevent HIV transmission among IDUs. Since then, a range of prevention strategies has been implemented and evaluated in an attempt to reduce the spread of HIV infection among drug users. These prevention strategies include (1) HIV testing and counseling and educational and behavioral interventions delivered through community outreach; (2) condom, bleach, and needle distribution and syringe access and exchange programs; (3) substance abuse treatment; and, more recently, (4) prevention interventions targeting HIV-positive IDUs. Data from evaluations of these strategies over the past 20 years have provided substantial evidence of effectiveness and have helped to inform network-based and structural interventions. Despite the cumulative empirical evidence, however, research findings have yet to be widely disseminated, adopted, and implemented in a sustained and integrated fashion. The reasons for this are unclear, but point to a need for improved communications with program developers and community planners to facilitate the implementation and evaluation of integrated intervention strategies, and for collaborative research to help understand policy, legal, economic, and local barriers to implementation.