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We aimed to examine the mediating role of alcohol use in the pathway from the interventions to depression and anxiety symptoms using data from a randomized controlled trial among people living with HIV (PWH) with hazardous alcohol use (n = 440) in Thai Nguyen, Vietnam. Participants were randomized into either a combined intervention (CoI), a brief intervention (BI) and a standard of care arm. Both interventions were based on cognitive behavioral therapy and motivational enhancement therapy. Alcohol use was measured as the percentage of days abstinent from alcohol in the last 30 days. Symptoms of depression and anxiety were measured with the Patient Health Questionnaire-9 and Generalized Anxiety Disorder-7 scales. Alcohol use was a significant mediator of the effects of two alcohol interventions on depression symptoms, but not anxiety symptoms. There were significant indirect effects via alcohol use of both interventions on depression symptoms at 12 months (CoI: mean difference (MD) = -0.134; 95%CI: -0.251, -0.035); (BI: MD = -0.141; 95%CI: -0.261, -0.038). There were no significant direct or total effects of the interventions on either symptoms at 12 months. Interventions with a dual focus on mental health and alcohol disorders are needed to determine optimal ways to tackle these common comorbidities among PWH.
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Terapia Cognitivo-Comportamental , Infecções por HIV , Humanos , Saúde Mental , Vietnã/epidemiologia , Infecções por HIV/terapia , Infecções por HIV/psicologia , Consumo de Bebidas Alcoólicas/epidemiologia , Consumo de Bebidas Alcoólicas/psicologia , Depressão/terapia , Depressão/diagnósticoRESUMO
Little is known about the potential mental health impacts of cognitive behavioral therapy and motivational interviewing interventions that focus on alcohol reduction among people with HIV (PWH). Our study aimed to assess the impact of two evidence-based alcohol reduction interventions on depression and anxiety symptoms of antiretroviral therapy (ART) clients with hazardous alcohol use. We conducted a secondary data analysis of data from a three-arm randomized controlled trial among ART clients in Thai Nguyen, Vietnam that evaluated the impacts of two alcohol reduction interventions in Vietnam. ART clients 18 years old or more with hazardous alcohol use (based on the Alcohol Use Disorders Identification Test-Consumption) were enrolled and randomized into one of three arms: Combined intervention, Brief intervention, and Standard of care (SOC). Symptoms of depression, measured with the Patient Health Questionnaire-9, and anxiety, measured with the Generalized Anxiety Disorder-7 scale, were assessed at baseline and 3, 6, and 12 months post-intervention. Generalized estimating equations were used to evaluate the effects of the interventions on depression and anxiety symptoms. The prevalence of depression and anxiety symptoms at baseline was 25.1% and 16.1%, respectively. Decreases in depression and anxiety symptoms were observed in all three arms from baseline to 12-month follow-up. There were no significant differences in depression and anxiety symptoms among participants receiving either intervention, relative to the SOC. Interventions with a dual focus on alcohol and mental health are needed to achieve more pronounced and sustainable improvements in depression and anxiety symptoms for PWH with hazardous alcohol use.
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Alcoolismo , Infecções por HIV , Adolescente , Alcoolismo/complicações , Alcoolismo/epidemiologia , Alcoolismo/terapia , Ansiedade/epidemiologia , Ansiedade/terapia , Depressão/epidemiologia , Depressão/psicologia , Depressão/terapia , Etanol , Infecções por HIV/complicações , Infecções por HIV/epidemiologia , Infecções por HIV/psicologia , Humanos , Vietnã/epidemiologiaRESUMO
OBJECTIVES: Migrant workers are one of the most vulnerable population groups during the coronavirus disease 2019 (COVID-19) pandemic. This study investigated knowledge and awareness of COVID-19 among Indonesian migrant workers (IMWs) in Macao (SAR), Hong Kong (SAR), and Taiwan. STUDY DESIGN: This was a cross-sectional study. METHODS: Data were collected through an online survey in February and March 2020 to gain information on (1) participants' sociodemographic characteristics, (2) experience and awareness regarding COVID-19 information, and (3) knowledge and understanding of COVID-19. A series of Chi-squared, t-test, and logistic regression analyses were conducted. RESULTS: The survey was completed by 491 participants (92.1% female). Knowledge of COVID-19 was obtained from multiple sources, including a large proportion from online social media. However, participants who obtained information from their employer, local social networks, and migrant organisations answered a greater number of questions correctly. One-third of participants reported receiving hoax, fake news, and incorrect information and obtained information from unverified sources. Participants were most interested in information about how to cure COVID-19, and 57.8% knew that no specific drug or vaccine was currently available. Almost all participants correctly identified fever and wearing a facemask as the main COVID-19 symptom and prevention strategy, respectively. Participants with senior high school or higher education and who worked as domestic or care workers had a greater knowledge of COVID-19 than their counterparts. CONCLUSIONS: Public health communication strategies using multiple channels, including employers and community organisations, would help to minimise COVID-19 knowledge gaps. In addition, it is recommended that digital literacy content is added to public health campaigns.
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COVID-19 , Migrantes , China , Estudos Transversais , Feminino , Humanos , Indonésia , Masculino , SARS-CoV-2 , Inquéritos e QuestionáriosRESUMO
Mixing matrices quantify how people with similar or different characteristics make contact with each other, creating potential for disease transmission. Little empirical data on mixing patterns among persons who inject drugs (PWID) are available to inform models of blood-borne disease such as HIV and hepatitis C virus. Egocentric drug network data provided by PWID in Baltimore, Maryland between 2005 and 2007 were used to characterise drug equipment-sharing patterns according to age, race and gender. Black PWID and PWID who were single (i.e. no stable sexual partner) self-reported larger equipment-sharing networks than their white and non-single counterparts. We also found evidence of assortative mixing according to age, gender and race, though to a slightly lesser degree in the case of gender. Highly assortative mixing according to race and gender highlights the existence of demographically isolated clusters, for whom generalised treatment interventions may have limited benefits unless targeted directly. These findings provide novel insights into mixing patterns of PWID for which little empirical data are available. The age-specific assortativity we observed is also significant in light of its role as a key driver of transmission for other pathogens such as influenza and tuberculosis.
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Uso Comum de Agulhas e Seringas/estatística & dados numéricos , Abuso de Substâncias por Via Intravenosa/epidemiologia , Adulto , Fatores Etários , Baltimore/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores Sexuais , Adulto JovemRESUMO
BACKGROUND: Persons who use opioids have a high risk of overdose and associated mortality. In Vietnam, little is known about the characteristics of this population and the persons who are witness to those overdoses. One approach to combatting fatal overdose has been the use of peer interventions in which a friend or injecting partner administers overdose reversal medication, but availability in Vietnam of these medications is limited to pilot programs with aims to expand in the future (Le Minh and V.F. Go, Personal Communication, 2016). The primary objective of this paper is to explore the characteristics associated with witnessing three or more overdoses in a lifetime. METHODS: This cross-sectional analysis used baseline data from a four-arm randomized control trial conducted in Thai Nguyen, Vietnam, known as the Prevention for Positives project. One thousand six hundred seventy-three PWID were included in the analysis. We conducted bivariable and multivariable logistic regression to identify characteristics associated with witnessing three or more overdoses in a lifetime. Characteristics explored included education, employment, marital status, risky drug use behaviors, locations for accessing syringes, recent overdose, history of incarceration, drug treatment, and having slept outside in the past 3 months. RESULTS: Seventy-two percent (n = 1203) of participants had witnessed at least one overdose in their lifetime, and 46% had witnessed three or more overdoses (n = 765). In the multivariable model, having less than secondary education (AOR 0.70; 95% CI 0.57, 0.86), having slept outside in the past 3 months (AOR 1.77; 95% CI 1.31, 2.40), having a history of incarceration (AOR 1.33; 95% CI 1.07, 1.65), having a history of drug treatment (AOR 1.41; 95% CI 1.12, 1.77), experiencing a recent non-fatal overdose (AOR 3.84; 95% CI 2.36, 6.25), injecting drugs daily (AOR 1.79; 95% CI 1.45, 2.20), receptive needle sharing (AOR 1.30; 95% CI 1.04, 1.63), and number of years injecting (AOR 1.04; 95% CI 1.02, 1.07) were significantly associated with witnessing three or more overdoses. CONCLUSIONS: Targeted interventions are needed to train persons witnessing an overdose to administer overdose-reversal medication. This includes targeting persons prior to release from prisons, drug treatment centers, and those accessing syringe exchange programs. Additional research should assess the burden of witnessing an overdose as well as locations for medication distribution. Assessments of the training capacity and needs for implementing these programs among drug using peers in Vietnam are of the utmost importance.
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Overdose de Drogas/epidemiologia , Usuários de Drogas/estatística & dados numéricos , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Abuso de Substâncias por Via Intravenosa/epidemiologia , Adulto , Criminosos/estatística & dados numéricos , Estudos Transversais , Escolaridade , Emprego/estatística & dados numéricos , Feminino , Redução do Dano , Pessoas Mal Alojadas/estatística & dados numéricos , Humanos , Estado Civil/estatística & dados numéricos , Uso Comum de Agulhas e Seringas/estatística & dados numéricos , Programas de Troca de Agulhas/estatística & dados numéricos , Fatores de Risco , Assunção de Riscos , Fatores Socioeconômicos , Vietnã/epidemiologiaRESUMO
This study explores the role of perceived HCV stigma and social networks on HCV care among people who inject drugs (PWID) of both sexes, and solely among women who inject drugs (WWID). Data were from 269 HCV positive PWID, community-recruited through street-based outreach in Baltimore, MD. We defined HCV stigma based on participants' perceptions of treatment by others and their need to conceal their HCV status. Among WWID, HCV stigma was linked with decreased odds of undergoing liver disease staging (aOR = 0.33, 95% CI: 0.13,0.85) or to have attempted to get the HCV cure (aOR = 0.39, CI: 0.16,0.97), these associations were not evident in the overall sample with both sexes. Social network characteristics were significant correlates of HCV care in the overall sample, and these associations were stronger among WWID. WWID with more HCV positive social network members had higher odds of an HCV-related healthcare visit in the prior 12 months (aOR = 4.28, CI: 1.29,14.17) and to have undergone liver disease staging (aOR = 2.85, CI: 1.01,8.05). WWID with more social network members aware of the HCV cure were more likely to report an attempt at obtaining the HCV cure (aOR = 5.25, CI: 1.85,14.89). Our results suggest complexity in the role of social networks and stigma on HCV care.
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OBJECTIVE: Opioids and stimulants are increasingly implicated in overdose deaths, particularly among minoritized groups. We examined daily opioid and cocaine co-use, nonfatal overdoses, and naloxone carrying among minoritized people who inject drugs (PWID). METHODS: The study derived data from 499 PWID in Baltimore City, MD, recruited using street-based outreach between 2016 and 2019. Participants reported overdoses; sociodemographic characteristics; and use of nonmedical prescription opioids, heroin, cocaine, and naloxone. RESULTS: Among the participants, the mean age was 46, 34 % were female, 64 % self-identified as Black, and 53 % experienced recent homelessness. Black PWID, compared to White PWID, were as likely to use opioids and cocaine daily but were 61 % less likely to have naloxone. After controlling for sociodemographic characteristics, women (aOR:1.88, 95%CI: 1.14, 3.11), persons experiencing homelessness (aOR:3.07, 95%CI: 1.79, 5.24), and those who experienced a recent overdose (aOR:2.14, 95%CI: 1.29, 3.58) were significantly more likely to use opioids and any form of cocaine every day. In a subanalysis of only female PWID, females engaged in sex work (aOR:2.27, 95%CI: 1.02, 5.07) and females experiencing recent homelessness (aOR:5.82, 95%CI: 2.50, 13.52) were significantly more likely to use opioids and cocaine daily. Furthermore, females (aOR:1.69, 95%CI:1.03, 2.77), persons experiencing homelessness (aOR:1.94, 95%CI:1.16, 3.24), and those with higher educational attainment (aOR:2.06, 95%CI:1.09, 3.91) were more likely to often/always carry naloxone, while Black PWID were less likely to have naloxone (aOR:0.39, 95%CI:0.22, 0.69). CONCLUSIONS: These findings highlight the need for targeted naloxone distribution and other harm-reduction interventions among minoritized groups in urban areas.
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Transtornos Relacionados ao Uso de Cocaína , Cocaína , Overdose de Drogas , Transtornos Relacionados ao Uso de Opioides , Abuso de Substâncias por Via Intravenosa , Humanos , Feminino , Masculino , Analgésicos Opioides , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Overdose de Drogas/epidemiologia , Naloxona/uso terapêutico , Cocaína/uso terapêuticoRESUMO
AIMS: This study explores the effects of two evidence-based alcohol reduction counseling interventions on readiness to change, alcohol abstinence self-efficacy, social support, and alcohol abstinence stigma among people with HIV (PWH) who have hazardous alcohol use in Vietnam. METHODS: PWH receiving antiretroviral therapy (ART) were screened for hazardous drinking and randomized to one of three study arms: combined intervention (CoI), brief intervention (BI), and standard of care (SOC). A quantitative survey was conducted at baseline (N = 440) and 3-month post-intervention (N = 405), while in-depth interviews were conducted with a subset of BI and CoI participants at baseline (N = 14) and 3 months (N = 14). Data was collected from March 2016 to August 2017. A concurrent mixed-methods model was used to triangulate quantitative and qualitative data to cross-validate findings. RESULTS: At 3 months, receiving the BI and CoI arms was associated with 2.64 and 3.50 points higher in mean readiness to change scores, respectively, compared to the SOC group (BI: ß = 2.64, 95% CI: 1.17-4.12; CoI: ß = 3.50, 95% CI 2.02-4.98). Mean alcohol abstinence self-efficacy scores were 4.03 and 3.93 points higher among the BI and CoI arm at 3 months, compared to SOC (BI: ß = 4.03, 95% CI: 0.17-7.89; CoI: ß = 3.93, 95% CI: 0.05-7.81). The impacts of the interventions on social support and alcohol abstinence stigma were not significant. Perceived challenges to refusing drinks at social events remained due to strong alcohol abstinence stigma and perceived negative support from family and friends who encouraged participants to drink posed additional barriers to reducing alcohol use. CONCLUSIONS: Both the CoI and BI were effective in improving readiness to change and alcohol abstinence self-efficacy among PWH. Yet, participants still faced significant barriers to reducing their drinking due to social influences and pressure to drink. Interventions at different levels addressing social support and alcohol abstinence stigma are warranted.
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Abstinência de Álcool , Infecções por HIV , Consumo de Bebidas Alcoólicas/psicologia , Povo Asiático , Infecções por HIV/complicações , Infecções por HIV/psicologia , Humanos , Estigma Social , VietnãRESUMO
Social network structure and norms are linked to HIV risk behavior. However little is known about the gradient of norm of HIV risk that exists among social networks. We examined the association between injection risk network structure and HIV risk norms among 818 injection drug users (IDUs). IDUs were categorized into four distinct groups based on their risk behaviors with their drug networks: no network members with whom they shared cookers or needles, only cooker-sharing member, one needle-sharing member, and multiple needle-sharing members. The riskiest group, networks of multiple needle sharers, was more likely to endorse both risky needle-sharing and sex norms. Networks of only cooker sharers were less likely to endorse high-risk norms, as compared to the networks with no sharing. There were also differences based on gender. Future HIV prevention interventions for IDUs should target both injection and sex risk norms, particularly among IDUs in the multiple needle-sharing networks.
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Infecções por HIV/psicologia , Uso Comum de Agulhas e Seringas/psicologia , Assunção de Riscos , Apoio Social , Valores Sociais , Abuso de Substâncias por Via Intravenosa/psicologia , Adulto , Usuários de Drogas/psicologia , Usuários de Drogas/estatística & dados numéricos , Feminino , Infecções por HIV/prevenção & controle , Infecções por HIV/transmissão , Humanos , Relações Interpessoais , Entrevistas como Assunto , Modelos Logísticos , Masculino , Fatores Sexuais , Comportamento Sexual/psicologia , Comportamento Sexual/estatística & dados numéricos , Facilitação Social , Adulto JovemRESUMO
INTRODUCTION: Hazardous drinking is widespread among people with HIV (PWH). PWH are also vulnerable to depression due to HIV-related social stigma, and social support can play an important role in improving mental health for this population. No studies have explored whether social support modifies the association of hazardous drinking and depressive symptoms among PWH. METHODS: We used baseline data from a randomized controlled trial of two evidence-based alcohol reduction interventions among antiretroviral therapy clients in Vietnam. Hazardous alcohol use was defined as having a score ≥8 for men and ≥ 7 for women on the Alcohol Use Disorders Identification Test. The presence of depression symptoms was defined as a score ≥ 5 on the Patient Health Questionnaire-9. Social support was measured with a 5-question modified version of the Medical Outcomes Study Social Support Instrument. Crude (CPRs) and adjusted prevalence ratios (aPRs) of the association were presented. RESULTS: Hazardous drinking was significantly associated with increased likelihood of having depressive symptoms (aPR = 1.26;95%CI 1.04-1.52). Hazardous drinking and depression symptoms were not associated among those with high social support (aPR = 1.01;95%CI 0.76-1.35), but were associated among those with medium (aPR = 1.24;95%CI 0.92-1.69) and low social support (aPR = 1.71;95%CI 1.25-2.34). CONCLUSIONS: Social support significantly modified the association between hazardous drinking and depression symptoms among ART clients in Vietnam. Interventions to decrease hazardous alcohol use are broadly indicated for PWH in Vietnam and other low-resource settings, but special attention or modifications may be needed to support mental health among those with lower levels of social support.
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Alcoolismo/terapia , Antirretrovirais/uso terapêutico , Infecções por HIV/tratamento farmacológico , Apoio Social , Adulto , Alcoolismo/epidemiologia , Alcoolismo/psicologia , Depressão/psicologia , Etanol , Feminino , Infecções por HIV/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Estigma Social , Vietnã/epidemiologiaRESUMO
BACKGROUND: In Vietnam tobacco smoking is prevalent among people living with HIV (PLHIV) and causes excess mortality in this population. Injection drug use is a driver of HIV infections in Vietnam. Changes in HIV disease state may correlate to changes in smoking among PLHIV. This study investigates the relationship between increases in smoking and health-related variables among recently diagnosed HIV+ people who inject drugs (PWID) in Vietnam. METHODS: We analyzed longitudinal data from 323 recently diagnosed HIV+ PWID in a randomized controlled trial from 2009 to 2013 in Thai Nguyen province, Vietnam. The outcome was an increase of >one cigarette/day from baseline visit cigarette smoking. A generalized estimating equation for repeated measures was used to estimate bivariable and multivariable associations between participant characteristics and smoking increases. We collected qualitative data to enhance our understanding of quantitative results, from 16 HIV+ PWID who smoke. RESULTS: Ninety three point 5% of participants reported some smoking at baseline. Smoking fewer cigarettes, higher health related quality of life (QOL), and higher CD4 counts were predictive of increases in smoking at future visits in a multivariable model. Qualitative data showed smoking increases were tied to improved perceived health, and counseling during respiratory illnesses may increase intention to quit. CONCLUSION: HIV+ PWID in Vietnam smoke at a very high rate. Increases in their smoking are correlated to increases in heath-related QOL, and increases in perceptions of health. Any tobacco-use intervention should account for internal tobacco use triggers faced by HIV+ PWID.
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Fumar Cigarros/epidemiologia , Infecções por HIV/epidemiologia , Comportamentos Relacionados com a Saúde , Qualidade de Vida , Abuso de Substâncias por Via Intravenosa/epidemiologia , Produtos do Tabaco , Adulto , Infecções por HIV/diagnóstico , Humanos , Estudos Longitudinais , Masculino , Pesquisa Qualitativa , VietnãRESUMO
OBJECTIVES: The purpose of this study was to compare the social network characteristics of men who have sex with men (MSM) to men who did not have sex with men (NMSM) in a sample of predominately African-American drug users. Specifically, we were interested in examining the differences in structure of the networks and drug and sexual risk partners within the network. METHODS: Data came from 481 male participants who reported having > or =1 sex partner in the past 90 days. MSM were defined as having sex with a male. Data on social network composition were collected using a Social Network Inventory. RESULTS: Of 481 men, 7% (n = 32) were categorised as MSM. Nearly two-thirds of MSM did not identify as gay. MSM were more likely to be HIV positive compared with NMSM. Social networks of MSM were younger and a greater proportion was HIV positive. After adjusting for HIV status, networks of MSM were less dense indicating fewer connections among network members. Among injection drug using men in the sample, MSM reported a greater number of needle sharing networks than NMSM. CONCLUSIONS: These findings underscore the importance of including social network factors in investigations of HIV risk among MSM. Further studies should focus on dynamics within a network and how they may operate to affect behaviour and health.
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Homossexualidade Masculina/estatística & dados numéricos , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Sexo sem Proteção/estatística & dados numéricos , Adulto , Baltimore/epidemiologia , Homossexualidade Masculina/psicologia , Humanos , Masculino , Parceiros Sexuais , Apoio Social , Transtornos Relacionados ao Uso de Substâncias/psicologia , Sexo sem Proteção/psicologiaRESUMO
OBJECTIVES: This study estimates the value that clients place on methadone maintenance and how this value varies with the effectiveness of treatment and availability of case management. We provide the first estimate of the price elasticity of the demand for drug treatment. METHODS: We interviewed 241 heroin users who had been referred to, but had not yet entered, methadone maintenance treatment in Baltimore, Maryland. We asked each subject to state a preference among three hypothetical treatment programs that varied across three domains: weekly fee paid by the client out-of-pocket ($5-$100), presence/absence of case management, and time spent heroin-free (3-24 months). Each subject was asked to complete 18 orthogonal comparisons. Subsequently each subject was asked if they likely would enroll in their preferred choice among the set of three. We computed the expected willingness to pay (WTP) as the probability of enrollment times the fee considered in each choice considered from a multivariate logistic model that controlled for product attributes. We also estimated the price elasticity of demand. RESULTS: The median expected fee subjects were willing to pay for a program that offered 3 months of heroin-free time was $7.30 per week, rising to $17.11 per week for programs that offered 24 months of heroin-free time. The availability of case management increased median WTP by $5.64 per week. The price elasticity was -0.39 (S.E. 0.042). CONCLUSIONS: Clients will pay more for higher rates of treatment success and for the presence of case management. Clients are willing to pay for drug treatment but the median willingness to pay falls short of the estimated program costs of $82 per week. Thus a combined approach of user fees and subsidization may be the optimal financing strategy for the drug treatment system.
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Financiamento Pessoal , Aceitação pelo Paciente de Cuidados de Saúde , Reabilitação/economia , Transtornos Relacionados ao Uso de Substâncias/reabilitação , Adulto , Feminino , Humanos , Entrevistas como Assunto , Masculino , Pessoa de Meia-IdadeRESUMO
Injection drug users who exchange sex for money or drugs may serve as a bridge group for transmitting HIV between injectors and non-injectors. While many individual characteristics have been linked to exchanging sex, little attention has been given to the influence of social network members. The present study assessed the relationship between exchanging sex and perceptions of peers' sex exchange behaviour and attitude toward sex exchange. The sample was composed of 267 women heroin and cocaine injectors in Baltimore, MD, USA. The results indicate that women who believed that their friends exchanged sex were more twice as likely to exchange sex in the past 90 days (95% CI: 1.49-2.70). Also, participants who thought their peers disapproved of sex exchange were 20% less likely to exchange sex (95% CI: 0.67-0.95). These findings suggest the need for peer education interventions that promote norms about safer behaviours.
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Comportamento Sexual/fisiologia , Comportamento Sexual/estatística & dados numéricos , Abuso de Substâncias por Via Intravenosa/psicologia , Adulto , Baltimore , Feminino , Infecções por HIV/transmissão , Humanos , Pessoa de Meia-Idade , MulheresRESUMO
PURPOSE: The nature of competing social environmental factors' influence on substance abuse is unclear. A longitudinal study was undertaken to determine the relative power of social network and neighborhood characteristics to predict continuing illicit drug use. METHODS: Three hundred forty-two inner-city adults with a history of injection drug use were followed for 1 year; their heroin and cocaine use were assessed semiannually. Multiple logistic regression models were fit to determine the degree to which social network and neighborhood characteristics, assessed at baseline, predicted continuing heroin and/or cocaine use throughout the study period. RESULTS: Two hundred thirty-six (69%) participants reported continuing heroin and/or cocaine use. Drug use by members of the social network was a stronger predictor of participants' continuing drug use (OR = 4.31, 95% CI 2.51 to 7.40) than was a high level of drug-related arrests in the participant's neighborhood (OR = 2.41, 95% CI 1.24 to 4.71), after adjusting for drug treatment and demographic variables. Both seemed to have independent effects on study participants' drug use. CONCLUSIONS: These findings reiterate the importance of breaking ties with drug-using associates, even for those who reside in high-risk environments. Further work is needed to develop interventions that increase drug users' success in altering social network composition or also treat drug-using network members.
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Transtornos Relacionados ao Uso de Cocaína/epidemiologia , Dependência de Heroína/epidemiologia , Meio Social , Adulto , Feminino , Humanos , Modelos Logísticos , Estudos Longitudinais , Masculino , Maryland/epidemiologia , Fatores de Risco , Apoio Social , População UrbanaRESUMO
AIMS: This study examined the accuracy of self-reported HIV serostatus for injection drug users and the predictive validity of a measure of social desirability to detect inaccurate self-reports. DESIGN: Participants in the ALIVE study were provided testing for HIV antibodies and counseling every 6 months. In the separate SAFE study, the same volunteers were asked their HIV serostatus. PARTICIPANTS: The 348 active injection drug users recruited from the ALIVE study, a longitudinal study of the natural history of HIV among injection drug users, volunteered for an HIV prevention study (SAFE study). MEASUREMENTS: The ALIVE baseline interview included a scale to measure "self-deception", a dimension of socially desirable responding. FINDINGS: Of one hundred and four HIV seropositive participants, 71 (68%) accurately reported their HIV status, 28 (27%) inaccurately reported their HIV serostatus, and five (5%) reported that they did not know or were not sure about their HIV serostatus. Of 242 HIV seronegative participants, 239 (98%) correctly reported their serostatus. Thus the sensitivity of self-report was 72%, specificity 99%, positive predictive value 97%, and the negative predictive value was 90%. For individuals who scored at or below the median on self-deception, the sensitivity of self-reported HIV serostatus was 81%. CONCLUSIONS: The results suggest that high scores on some measures of social desirability may indicate questionable validity of self-reported HIV serostatus.
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Soropositividade para HIV/psicologia , Autorrevelação , Desejabilidade Social , Abuso de Substâncias por Via Intravenosa/psicologia , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Sensibilidade e EspecificidadeRESUMO
This study examined the extent to which self-report of human immunodeficiency virus (HIV) risk behaviors might depend upon socially desirable response tendencies, and whether socially desirable responding might serve as a confounding variable in the study of risk behaviors and HIV serostatus. The subjects were 2885 intravenous drug users participating in the ALIVE study in Baltimore, Maryland. Participants completed an interview and were tested for HIV serostatus. The interview covered HIV risk behaviors, and included established scales to measure 'self-deception' and 'impression management', two separate dimensions of socially desirable responding. Seven items for each scale were scored true/false, with a summary score used for analysis. Scores on self-deception and impression management were inversely related to self-reports of sharing injection equipment, injecting at shooting galleries, and injecting more than once a day. Neither self-deception nor impression management was associated with cocaine use. Self-reported receptive anal intercourse was associated inversely with self-deception but not with impression management. HIV serostatus was not associated with social desirability, and statistically controlling for social desirability had a negligible impact on the magnitude of associations between risk behaviors and HIV serostatus. The results indicate that measures of social desirability may be used to ascertain sensitive areas of inquiry in interviews of intravenous drug users.
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Infecções por HIV/psicologia , Comportamentos Relacionados com a Saúde , Desejabilidade Social , Abuso de Substâncias por Via Intravenosa/psicologia , População Urbana , Adolescente , Adulto , Baltimore , Mecanismos de Defesa , Feminino , Infecções por HIV/transmissão , Humanos , Estudos Longitudinais , Masculino , Assunção de RiscosRESUMO
Few studies have examined sexual risk behaviors among drug users in the context of their primary sexual relationships. The aim of this study is to examine characteristics of sexual partners associated with inconsistent condom use among a sample of 703 cocaine and opiate users from Baltimore, MD who participated in a network oriented intervention study of human immunodeficiency syndrome (HIV) risk behaviors among drug users. The current study examines relationship characteristics between drug users and their sexual partners (n=1003). Some of the study participants had more than one sexual partner, accounting for the greater number of sexual pairs than study participants. Study participants reported using multiple drugs (56% injected, 48% sniffed heroin, and 48% smoked crack) and that 70% of their sexual partners also used heroin and/or cocaine. Forty percent reported consistent condom use in the past 3 months. In multiple logistic regression, characteristics associated with consistent condom use were, the drug user being HIV infected; not living with their sexual partners; and not being financially interdependent. Previous research has demonstrated lower rates of condom use with main compared with casual and exchange partners. Primary sexual partners provide a sense of stability and introducing condoms may not be desirable or realistic. HIV prevention programs that target drug users should focus on the benefits, such as trust and a sense of security, and risks of not using condoms in primary relationships. Programs should also focus on enhancing communication and negotiation skills through targeting individuals as well as couples.
Assuntos
Preservativos/estatística & dados numéricos , Sexo Seguro/efeitos dos fármacos , Comportamento Sexual/psicologia , Transtornos Relacionados ao Uso de Substâncias/psicologia , Adolescente , Adulto , Negro ou Afro-Americano , Baltimore , Estudos de Coortes , Feminino , Infecções por HIV/prevenção & controle , Infecções por HIV/transmissão , Humanos , Entrevistas como Assunto , Modelos Logísticos , Masculino , Pobreza , Assunção de Riscos , Parceiros SexuaisRESUMO
Social context may be an important determinant of drug and alcohol consumption and HIV-related behaviors. To assess the influence of peers on drug users' risk behaviors this study examined the association between individual level and group level behaviors. This analysis reports on the prospective association between baseline self-reported drug and alcohol use of the network members of injection drug users, and self-reported sexual behaviors and alcohol use at 5-month follow-up. Participants were a nontreatment sample of inner-city injection drug users who volunteered for a network-oriented HIV preventive intervention. They were predominantly unemployed, African American males. Of the 71 index participants who completed both the baseline and follow-up interviews, 227 of their drug network members were enrolled in the study. At baseline indexes' sexual risk behaviors were significantly associated with their drug network members' level of crack cocaine use. At follow-up higher levels of alcohol and crack use among drug network members were associated with indexes' reports of multiple sex partners and increased alcohol consumption. Higher levels of crack use among the drug network members were associated with the indexes' reporting casual sex partners at follow-up. These results highlight the importance of studying the role of peer group influence and the social context of risk behaviors.
Assuntos
Alcoolismo/psicologia , Cocaína Crack , Infecções por HIV/transmissão , Transtornos Relacionados ao Uso de Opioides/psicologia , Comportamento Sexual , Facilitação Social , Apoio Social , Abuso de Substâncias por Via Intravenosa/psicologia , Adulto , Negro ou Afro-Americano/psicologia , Negro ou Afro-Americano/estatística & dados numéricos , Alcoolismo/epidemiologia , Comorbidade , Feminino , Seguimentos , Infecções por HIV/prevenção & controle , Infecções por HIV/psicologia , Conhecimentos, Atitudes e Prática em Saúde , Dependência de Heroína/epidemiologia , Dependência de Heroína/psicologia , Humanos , Masculino , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Grupo Associado , Estudos Prospectivos , Fatores de Risco , Abuso de Substâncias por Via Intravenosa/epidemiologiaRESUMO
Access to care and optimal service utilization among 287 low income African American former and current drug injectors was examined. Results indicated suboptimal outpatient care, and no evidence of alternative use of hospital services. Participation in drug treatment and case management were associated with greater access to care and use of outpatient services, even after controlling for current drug use, gender, and insurance. AIDS and physical functioning limitation were associated with emergency room (ER) use and hospitalization. Participation in drug treatment and case management and an AIDS diagnosis were associated with optimal outpatient service use. Daily alcohol use was associated with ER as the usual facility for care. Integration of substance abuse treatment, case management, and medical services delivery may contribute to improved HIV care for this population.