Child and adolescent sexual abuse history in a sample of 1,490 women sexual partners of injection drug-using men.

Subjects for this study were 1490 community-recruited women sexual partners of injection drug-using men who were interviewed in three U.S. cities during 1990-'92. Data were collected on respondents' childhood and adolescent sexual abuse history, identity of abuse perpetrators and duration of abuse. Over 56 percent of respondents reported a history of sexual victimization by age 18, including 39 percent who were abused before age 12 and over 53 percent who were victimized by abuse involving bodily contact by age 18. One in three women were victimized by unwanted penetration by age 18. White women more likely than African-American and Hispanic women to have been the victims of virtually every type of abusive act investigated here. Overall, nearly two out of three White women had experienced some form of sexual abuse by age 18, including almost 42 percent who were the victims of unwanted penetration by this age. Acts of forced sexual touching and penetration occurring in childhood were most likely to have been carried out by an uncle or other relative of the victim; family members were much less likely to be the perpetrators of adolescent contact abuse. Based on these findings, it appears that many in this special population of women are likely to be at substantial risk for some of the long-term effects of early life sexual abuse, including those that may reduce victims' ability to take preventive action against HIV risk. Recommendations are offered for those who function as caregivers to this population, including drug treatment personnel.

A comparison of the reliability of self-reported drug use and sexual behaviors using computer-assisted versus face-to-face interviewing.

The purpose of this study was to assess the reliability of responses to HIV risk behavior questions obtained using a voice-enhanced, computer-administered self-interview (audio-CASI) system with touch-screen response compared with those obtained via face-to-face interviews administered by trained and experienced interviewers. Additionally, the study assessed bias that may be attributable to an audio-CASI data collection format. The design of the study was a four-group crossover design with random assignment to one of four study conditions: (a) audio-CASI interview at both intake and retest, (b) face-to-face interview at both intake and retest, (c) audio-CASI interview at intake and face-to-face interview at retest, and (d) face-to-face interview at intake and audio-CASI interview at retest. The study was conducted with a sample of drug users at risk for HIV infection interviewed in nonclinical settings. Data were collected at intake and 48 hours after intake. Analyses show that data obtained using voice-enhanced computer interviewing with touch-screen response are reliable and are comparable to data obtained using interviewer administered face-to-face interviews. However, bias was found to be associated with data collection format and may be partially attributable to the complexity of the questionnaire.

A cluster analysis of not-in-treatment drug users at risk for HIV infection.

The purpose of the analysis described here was to classify not-in-treatment drug users participating in the National Institute on Drug Abuse (NIDA)-sponsored Cooperative Agreement study into several "homogeneous" HIV risk groups using cluster analysis. Data for this analysis (N=17,778) were collected at 19 study sites in the United States and Puerto Rico. Measures selected for the cluster analysis were limited to (a) current drug use and HIV risk behaviors, (b) mutually exclusive behaviors, (c) behaviors directly related to HIV risk, and (d) behaviors that were not statistically rare. Eight homogeneous HIV risk clusters were produced. Crack cocaine use was the most distinguishing feature of three clusters. Another three clusters were distinguishable by drug injection and needle use practices. Two additional clusters could not be grouped with either the crack- or the injection-dominant clusters. Prostitution was the most distinguishing risk behavior of one of these clusters, and extremely high drug injection frequencies and relative rates of risky needle use characterized the other. Composition of the clusters varied significantly by gender, race/ethnicity, educational attainment, and drug use characteristics. In addition, perceptions and behaviors initiated to reduce the chances of becoming infected with HIV varied by cluster. Subjects in the crack-predominant clusters reported low perceptions of the chances of getting AIDS. Perceptions of the chances of becoming infected with HIV among subjects in the injection-predominant clusters were strongly related to injection frequency. Seroprevalence was also related to cluster. Higher rates of HIV infection were evident among the injection-predominant clusters, and higher rates were related to frequency of injection and the rate of risky needle use. Among the crack-predominant clusters, the relationship between drug use and sexual behaviors and HIV infection was less clear.

Introduction of HIV into drug injector networks outside AIDS epicentres.

Injection drug users (IDUs) continue to be at risk for HIV infection despite high levels of knowledge about how human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) is transmitted. Yet, among not-in-treatment injection drug users, the chances of becoming infected with HIV vary substantially. Information regarding the factors that facilitate the introduction of HIV into networks of drug injectors in low HIV seroprevalence cities is urgently needed. This study examines the factors related to HIV seroprevalence in a large (n=9492), multi-site sample of IDUs recruited in 11 low seroprevalence cities. Univariate and multivariate associations between drug injection and sexual behaviours and travel to an AIDS epicentre were examined. Results show that, next to male-to-male sexual contact, having sex at least twice in an AIDS epicentre was the strongest predictor of HIV infection. Also associated with higher odds of being HIV-positive were racial/ethnic characteristics, daily drug injection, and injecting drugs in an AIDS epicentre. These results confirm that travelling to an AIDS epicentre and having sex or injecting drugs play a large role in the introduction of HIV into drug injector networks in low seroprevalence cities.