Impact of age on the use of adjuvant treatments in patients undergoing surgery for colorectal cancer: patients with stage III colon or stage II/III rectal cancer.

BACKGROUND: Many older patients don't receive appropriate oncological treatment. Our aim was to analyse whether there are age differences in the use of adjuvant chemotherapy and preoperative radiotherapy in patients with colorectal cancer. METHODS: A prospective cohort study was conducted in 22 hospitals including 1157 patients with stage III colon or stage II/III rectal cancer who underwent surgery. Primary outcomes were the use of adjuvant chemotherapy for stage III colon cancer and preoperative radiotherapy for stage II/III rectal cancer. Generalised estimating equations were used to adjust for education, living arrangements, area deprivation, comorbidity and clinical tumour characteristics. RESULTS: In colon cancer 92% of patients aged under 65 years, 77% of those aged 65 to 80 years and 27% of those aged over 80 years received adjuvant chemotherapy (χ2trends < 0.001). In rectal cancer preoperative radiotherapy was used in 68% of patients aged under 65 years, 60% of those aged 65 to 80 years, and 42% of those aged over 80 years (χ2trends < 0.001). Adjusting by comorbidity level, tumour characteristics and socioeconomic level, the odds ratio of use of chemotherapy compared with those under age 65, was 0.3 (0.1-0.6) and 0.04 (0.02-0.09) for those aged 65 to 80 and those aged over 80, respectively; similarly, the odds ratio of use of preoperative radiotherapy was 0.9 (0.6-1.4) and 0.5 (0.3-0.8) compared with those under 65 years of age. CONCLUSIONS: The probability of older patients with colorectal cancer receiving adjuvant chemotherapy and preoperative radiotherapy is lower than that of younger patients; many of them are not receiving the treatments recommended by clinical practice guidelines. Differences in comorbidity, tumour characteristics, curative resection, and socioeconomic factors do not explain this lower probability of treatment. Research is needed to identify the role of physical and cognitive functional status, doctors' attitudes, and preferences of patients and their relatives, in the use of adjuvant therapies.

Socio-demographic correlates of late treatment initiation in a cohort of patients starting antiretroviral treatment in Mali, West Africa.

The objective of this study was to investigate factors correlated with late treatment initiation in a cohort of patients starting treatment in Mali, West Africa, while focusing on the role of sex/gender. This study consisted of a cross-sectional analysis of baseline data from a prospective, observational cohort of patients initiating antiretroviral treatment in Mali. Patient data were analyzed with a gender perspective to examine factors correlated with late treatment initiation, defined as having a CD4 count below 100 cells/µl. Aday and Andersen's conceptual framework of access to medical care was used to classify baseline participant characteristics associated with late treatment initiation. Logistic regression was used to evaluate the modifying effect of sex/gender. Results show that 39% of patients initiated treatment late; significantly more of these were men than women. Sex/gender, marital status, and education were associated with late treatment initiation. Unmarried men and uneducated women were significantly more likely to initiate treatment late. Programs need to target unmarried men while being cognizant that uneducated women are arriving late as well.

Factors influencing duration of exposure with symptoms and costs of occupational asthma.

The most important factor for the prognosis of occupational asthma is the length of exposure with symptoms prior to removal from exposure. We wanted to identify factors, including socioeconomic status, that can influence the delay in submitting a claim to a medicolegal agency after the onset of asthmatic symptoms, and to confirm that this delay is associated with worse respiratory prognosis and higher direct costs. This is a cross-sectional study of subjects who claimed compensation for occupational asthma at the Workers' Compensation Board of Quebec, Canada. Data were collected at re-evaluation ∼2.5 yrs after diagnosis. Information on the number of years with symptoms and removal from exposure was obtained from the medicolegal file. 60 subjects were included in the study. Being older, having a revenue of >30,000 Canadian dollars and having occupational asthma due to high molecular weight agents were all positively associated with the number of years of exposure with symptoms before removal from exposure. Subjects with persistent airway hyperresponsiveness at follow-up had a higher number of years with symptoms. Experiencing symptoms in the workplace for <1 yr generated lower direct costs. These findings might help in surveillance programmes that could be preferentially targeted for these subgroups of workers.

Gender, social relationships and depressive disorders in adults aged 65 and over in Quebec.

The objective of this study was to examine if social relationships have a differential association with the presence of depression in men and women aged 65 and over. Data came from a survey of a representative sample of 2670 community-dwelling older adults in Quebec. Depressive disorders were measured using DSM-IV criteria. The prevalence of depression was 17.8% for women and 7.6% for men. Men reported a greater diversity of ties but less support than women. Having a confidant and/or being engaged in a good marital relationship was negatively associated with depression in both men and women. Compared with married people in general, widowhood was associated with a considerably higher risk of depression in men than in women. Compared with non-volunteers in general, men who volunteer were at considerably lower risk of depression than women who volunteer. This exploratory study could serve as a basis for future longitudinal studies on the impact of community activities and volunteering on the incidence and remission of depression in older men and women in Canada.

Health Behaviors and Chronic Conditions Mediate the Protective Effects of Masculinity for Physical Performance in Older Adults.

OBJECTIVE: We estimated the 2-year incidence of poor physical performance according to gender roles and examined mediating pathways related to health behaviors and chronic conditions. METHOD: Data are from the International Mobility in Aging Study ( n = 1,676). The Bem Sex Role Inventory was used to classify participants into four gender roles as "masculine," "feminine," "androgynous," and "undifferentiated." RESULTS: We found a higher incidence of poor physical performance among participants endorsing the feminine (adjusted incidence rate ratio [IRR] = 2.36, 95% confidence interval (CI) = [1.55, 3.60]) or the undifferentiated role (adjusted IRR = 2.19, 95% CI = [1.45, 3.30]) compared with the androgynous role. Smoking, physical activity, the number of chronic conditions, high body mass index, and depression were mediators of this association but not alcohol consumption. DISCUSSION: This study provides evidence that gender roles are independently associated with physical performance. Health behaviors and chronic conditions are mediators of the relationship between gender roles and lower extremity physical function.

Abdominal Obesity and Mobility Disability in Older Adults: A 4-Year Follow-Up the International Mobility in Aging Study.

BACKGROUND: Abdominal obesity is related to the disability process in older adults, however, little is known about this relationship when adjusted for important confounders such as depression and physical performance measures in a diverse international aged population. OBJECTIVES: To explore the longitudinal relationship between abdominal obesity and mobility disability controlling for physical performance and depression. DESIGN AND SETTING: Longitudinal observational study using data from the International Mobility in Aging Study (IMIAS) Study. PARTICIPANTS: 1104 out of 2002 older adults aged 64-74 years old free of mobility disability at baseline (2012) and then reassessed in 2016. MEASUREMENTS: Mobility disability was defined as reporting difficulty in walking 400 m or climbing stairs. Activities of daily living (ADL) disability was based on any self-reported difficulty in five mobility-related ADLs. Abdominal obesity was defined as waist circumference ≥ 88cm for women or ≥ 102 cm for men. Four meters gait speed, handgrip strength and depressive symptoms (CES-D) were assessed. Generalized Estimating Equations (GEE) and multinomial regressions were used to estimate associations between disability and abdominal obesity. RESULTS: 1104 free of disability participants were followed over 4 years, the mean age was 68.9 (±2.9) years among men and 68.7 (±2.6) years among women. Prevalence and incidence rates of mobility disability varied widely across research site and sex. The longitudinal associations between mobility disability and abdominal obesity remained significant even when adjusted by depressive symptoms, handgrip strength, gait speed, age, sex, education and research site. Participants with abdominal obesity had higher mobility disability (OR=1.68, 95% CI 1.23-1.76, p-value=0.01) and also increased risk for ADL disability (OR: 1.47, 95% CI 1.23-1.76, p-value=0.01). Abdominal obesity in baseline was also predictor of mobility disability in 2016 (OR: 1.93, 95% CI 1.17-3.17, p-value <0.01) but not for ADL disability (OR: 1.59, 95% CI 0.93-2.71, p-value =0.09) with accounting mortality. CONCLUSION: Abdominal obesity is associated longitudinally and predicts mobility disability, even over a short period (4 years) in community-dwelling older adults from different epidemiological contexts.

Inadequate adherence to antiretroviral treatment and prevention in hospital and community sites in Burkina Faso and Mali: a study by the ATARAO group.

Our objective was to determine the prevalence and identify the factors that influence antiretroviral therapy (ART) adherence among patients in Bamako and Ouagadougou. A cross-sectional study was conducted among 94 men and 176 women receiving ART. Data were collected through questionnaires and chart reviews. Logistic regressions were performed to isolate determinants of adherence. Overall, 58% of the patients were adherent, but there were differences in the levels of adherence according to country and treatment site. Sociodemographic factors were not associated with adherence. However, social characteristics such as having children, in Ouagadougou, or being a housewife and not planning to have a child in the next year, in Bamako were associated with adherence. Time on ART was negatively associated with adherence in both countries with decline occurring later in Bamako. Levels of adherence are inadequate particularly among more experienced patients. Further adherence research and monitoring using longitudinal designs are warranted to assess the extent to which adherence is declining with time on treatment.

Factors associated with hypertension prevalence, awareness, treatment and control among participants in the International Mobility in Aging Study (IMIAS).

The aim of this study is to assess the factors associated with hypertension prevalence, awareness, treatment, and control, in the elderly populations of the International Mobility in Aging Study (IMIAS). Approximately 200 men and 200 women aged 65-74 years were recruited at each site (n=1995) during IMIAS' 2012 baseline survey at five cities: Kingston (Canada), Saint-Hyacinthe (Canada), Tirana (Albania), Manizales (Colombia) and Natal (Brazil). Blood pressure and anthropometric measurements were taken at participants' homes. Hypertension prevalence ranged from 53.4% in Saint-Hyacinthe to 83.5% in Tirana. Diabetes and obesity were identified as risk factors in all cities. More than two-thirds of hypertensive participants were aware of their condition (from 67.3% in Saint-Hyacinthe to 85.4% in Tirana); women were more aware than men. Awareness was positively associated with diabetes in Kingston, Manizales and Natal. Though most of those aware of their hypertensive condition were being treated pharmacologically, associations between awareness and physical activity and refraining from smoking were weak. Control among treated hypertensive participants was low, especially in Tirana and Natal. Diabetes and physical inactivity were associated with poor hypertension control. Hypertension is common in the older populations of IMIAS. Diabetes is strongly associated with hypertension prevalence, awareness and lack of control of hypertension. The fact that awareness is not strongly associated with healthy behaviours suggests that antihypertensive medication is not accompanied by non-pharmacological therapies. Improved health behaviours could strengthen hypertension control. Efforts should be made to increase men's awareness of hypertension. Hypertension control in diabetic patients is a challenge.

A harmonized measure of activities of daily living was a reliable and valid instrument for comparing disability in older people across countries.

BACKGROUND AND OBJECTIVES: Our aim was to construct a harmonized measure of activities of daily living (ADL) across six countries, and to evaluate the reliability and validity of this measure. METHODS: A population of 9,297 persons, aged 65-89 years, was drawn from the Comparison of Longitudinal European Studies on Aging (CLESA) study, which includes data from five European countries and Israel. Because the number, type, and response format of the ADL items differed across the six studies, a four-item scale was constructed to harmonize the data, using items common to most countries. A procedure was devised to substitute or construct items that were not available in two of the countries. RESULTS: Cronbach's alpha for the four-item ADL measure varied from 0.81 in Spain to 0.92 in Finland, and was similar to the alpha of scales including five or six items. Kappa scores between substituted or constructed items and the actual items varied from 0.50 to 0.78. In all countries, the percentage of persons with ADL disability differed significantly across age and was associated with chronic diseases, poor self-rated health, global disability, and home help utilization. CONCLUSION: The harmonized four-item ADL measure seems a reliable and valid instrument for comparing ADL disability in older people across countries.

The mobility gap between older men and women: the embodiment of gender.

OBJECTIVES: To present the study design and baseline results of the longitudinal International Mobility in Aging Study (IMIAS) on gender differences in physical performance and mobility disability prevalence in five diverse societies. METHODS: Data are from surveys on random samples of people aged 65-74 years at Canadian (Kingston, Ontario; Saint-Hyacinthe, Quebec), Mediterranean (Tirana, Albania) and Latin American sites (Natal, Brazil; Manizales, Colombia) (N=1995). Mobility disability was defined as reporting difficulty in walking 400m or climbing stairs. Activities of daily living (ADL) disability was based on any self-reported difficulty in five mobility-related ADLs. The short physical performance battery (SPPB) was used to assess physical performance. Poisson regression models were fitted to estimate prevalence ratios. RESULTS: Age-adjusted prevalence of low SPPB, mobility disability and ADL disability were higher in women than in men in all sites except for Kingston. After adjustment for education and income, gender differences in SPPB and ADL disability attenuated or disappeared in Saint-Hyacinthe and Manizales but remained large in Tirana and Natal and mobility disability remained more frequent in women than in men at all sites except Kingston. After further adjustment by chronic conditions and depressive symptoms, gender differences in mobility remained large at all sites except Kingston but only in Tirana did women have significantly poorer physical performance than men. DISCUSSION: Results provide evidence for gender as a risk factor to explain poorer physical function in women and suggest that moving toward gender equality could attenuate the gender gap in physical function in old age.

Loss to follow-up in a longitudinal study on aging in Spain.

The objectives of this study were to describe follow-up dynamics in a longitudinal study on aging conducted in Spain between 1993 and 1997, and to identify the demographic, behavioral and health characteristics of persons who would later refuse to continue participating, move out of the area or be hard to locate (i.e., become lost to follow-up subjects). Data from the 1993 baseline survey were used to predict the probabilities of being lost to follow-up in the 1995 and 1997 waves. Structural multiple logistic regressions were fitted and mean probabilities were estimated to identify patterns of loss to follow-up. After 4 years, 52% of baseline participants remained in the study, 24% had died, 17% refused to continue participating, and 8.7% were impossible to locate. In the multivariate analysis, advanced age and living alone were independent predictors of loss to follow-up, and none of the health status variables remained significant. However, participation status in previous waves and the number of nonresponse items were strong independent predictors of further non-participation. Our results suggest that an attitude against participation in surveys may be an independent predictor of losses to follow-up and efforts should be made to retain this subgroup of the population in the study. Further research on reasons why people are unwilling to participate in surveys and strategies to retain people in longitudinal studies is needed.

Support from children, living arrangements, self-rated health and depressive symptoms of older people in Spain.

OBJECTIVE: To assess the association between emotional and instrumental support from children and living arrangements with the physical and mental health of older people in Spain. METHODS: A face-to-face home interview was carried out with 1284 community-dwelling people over 65 (response rate = 83%) randomly sampled according to an age- and sex-stratified sampling scheme in 1993 at Leganés (Spain). Close to 93% of the participants had children and 45% of them coresided with them. Depressive symptoms were assessed by the CES-D (Center for Epidemiologic study depression scale) and self-rated health (SRH) by a single-item question. Emotional support was measured with a six-item scale on affection and reciprocity. Instrumental support was assessed by help received from children in 17 activities of daily living. Four living arrangements were considered: Living with spouse only, living with a spouse and children, widower living alone, and widower living with children. RESULTS: Multivariate analysis controlling for age, gender, education and functional status showed that low emotional support and reception of instrumental aid were significantly associated with poor SRH. Being a widower and sharing living arrangements with children was associated with good SRH. Living arrangements modify some of the associations of support of children with SRH. Depressive symptoms were associated with low emotional support, reception of instrumental help and being a widower who did not share living arrangements with children. For widowers who do not cohabit with children, reception of instrumental aid is associated with low depressive symptomatology. DISCUSSION: Emotional support from children seems to play an important role in maintaining the physical and mental health of elderly people in Spain. Instrumental support is widely available. Coresidence with children is very common and it is associated with good self-perceived health and low prevalence of depressive symptoms in a culture where family interdependence is highly valued. Families should be protected and encouraged to continue care-giving through a variety of community services and respite care, adapted to their needs and preferences. Research should be undertaken to find more efficient ways to help family caregivers in the Mediterranean context.

Women, drugs and HIV/AIDS: results of a multicentre European study.

BACKGROUND: In the light of rising human immunodeficiency virus (HIV) incidence rates amongst women in Western Europe, a multicentred, cross-sectional study was undertaken to explore the multitude of possible factors associated with HIV in a population of female injecting drug users (IDU). METHODS: Face-to-face interviews were conducted with 1198 female IDU recruited from a variety of settings in Paris, Madrid, Rome, London and Berlin. Their HIV status was determined from antibody testing of blood or saliva samples or from written confirmation of HIV test results from a physician. A hierarchical logistic regression model was used to identify direct and indirect associations between socioeconomic factors, marginalization and risk behaviour with HIV prevalence. RESULTS: The HIV prevalence in the sample of female IDU was 27.8% (range: 1.4% in London and 52.6% in Madrid). Factors independently associated with HIV prevalence in the regression analysis included: age >25 years (OR = 2.0-2.9), left full-time education before age 14 (OR = 2.4), no fixed address (OR = 2.2), previous imprisonment (OR = 1.4), commercial sex (OR = 1.3), having a regular HIV positive sexual partner (OR = 6.6), ever shared needles (OR = 1.5) and any sexually transmitted disease (STD) infection in the last year (OR = 1.7). CONCLUSIONS: The sexual behaviour and partners of female IDU in Western Europe are as important a component in explaining the HIV epidemic in this population as other risk factors, including high-risk drug taking behaviour. Homeless IDU women may be an important residual risk group warranting future preventive interventions and women with a history of STD should be a particular target for health education. Differences in HIV prevalence across cities are very large and may be related to differences in harm reduction policies.

Family, religion, and depressive symptoms in caregivers of disabled elderly.

STUDY OBJECTIVE: To explain the variations in depressive symptomatology among primary caregivers of community dwelling activities of daily living disabled elderly and to evaluate the role of family and religiosity on the mental health consequences of caregiving in Spain. DESIGN: Cross sectional study. SETTING: City of Leganés in the metropolitan area of Madrid, Spain. PARTICIPANTS: All caregivers of a representative sample of community dwelling activities of daily living disabled persons, aged 65 and over were approached. The response rate was 85% (n = 194). Depression was assessed by the Center for Epidemiologic Studies Depression (CES-D) Scale. MAIN RESULTS: Controlling for caregivers' income, education, health status, and caregiving stress, religiosity was associated with more depressive symptoms among children caregivers while for spouses the association was negative. Emotional support was negatively associated with depression, but instrumental support was not significant. CONCLUSIONS: Depressive symptomatology is frequent among Spanish caregivers of disabled elderly. This study concludes that religiosity and family emotional support play an important part in the mental health of Spanish caregivers. The role of religiosity may be different according to kinship tie and needs further investigation.

Social networks and self-rated health in two French-speaking Canadian community dwelling populations over 65.

The objective was to evaluate the associations between older persons' health status and their social integration and social networks (family, children, friends and community), in two French-speaking, Canadian community dwelling populations aged 65 years and over, using the conceptual framework proposed by Berkman and Thomas. Data were taken from two 1995 surveys conducted in the city of Moncton (n = 1518) and the Montreal neighbourhood of Hochelaga-Maisonneuve (n = 1500). Social engagement (a cumulative index of social activities), networks consisting of friends, family and children and social support were measured using validated scales. Multiple logistic regressions based on structured inclusion of potentially mediating variables were fitted to estimate the associations between health status and social networks. Self-rated health was better for those with a high level of social integration and a strong network of friends in both locations. In addition, in Hochelaga-Maisonneuve family and children networks were positively associated with good health, though the effect of friend networks was attenuated in the presence of disability, good social support from children was associated with good health. Age, sex and education were included as antecedent variables; smoking, alcohol consumption, exercise, locus of control and depressive symptoms were considered intermediary variables between social networks and health. In conclusion, social networks, integration and support demonstrated unique positive associations with health. The nature of these associations may vary between populations and cultures.

Screening for impaired cognitive function among the elderly in Spain: reducing the number of items in the Short Portable Mental Status Questionnaire.

The objectives of this work are to assess the agreement in classifying the 10th percentile of the population with impaired cognitive function resulting from different combinations of items in the Short Portable Mental Status Questionnaire, to evaluate the effect of literacy status on the new reduced versions, and to propose items less biased by education. Three data sets of representative samples of non-institutionalized elderly (65-year-olds and older) living in urban and rural communities in Spain were analyzed. Cognitive function was assessed using either the original or a modified Spanish version of the Short Portable Mental Status Questionnaire (SPMSQ). Different combinations of items were excluded from the scale and for each resulting reduced scale the lower 10th percentile of the distribution assessed a cut-off score. Cohen's kappa was used to test the agreement between the whole scale and the reduced scales in identifying the lowest 10th percentile of people with cognitive impairment. To test the effect of literacy status, the three samples were combined. New distributions were obtained for reduced versions of the scale including the items with the highest correlation with cognitive impairment controlling for literacy status. All three samples follow a similar distribution of errors. Most kappa values obtained when excluding one or more items from the original scales were between 0.80 and 0.95, while proportion of agreement varied between 94.2% and 100%. Lack of agreement is highest when eliminating all items that represent one dimension. Shorter versions of the SPMSQ are as reliable as the complete 10-item version in identifying those at risk for cognitive dysfunction. Cut-off points differed by literacy status but remained stable regardless of the number of items included.

The prevalence of serological markers for syphilis amongst a sample of Spanish prostitutes.

The results of a multicentre study of 1668 Spanish prostitutes are described with regard to syphilis infection. For those women who permitted serological tests (n = 1095), 30.59% (confidence interval (CI): 30.55%-30.63%) were positive for markers indicating current or prior infection. After adjustment was made for other variables, a significant association with syphilis infection was observed for periods of exposure (i.e. age and years working as a prostitute). No significant associations were detected for either intravenous drug use, or educational attainment. The results of this study are similar to those of some other investigations into the prevalence of syphilis amongst prostitutes.

[The prevalence of and factors associated with falls in older persons living in the community]. / Prevalencia y factores asociados a las caídas en las personas mayores que viven en la comunidad.

BACKGROUND: To describe falls in urban community elderly people and to identify factors associated with their occurrence. MATERIAL AND METHODS: Data from an age and sex stratified sample of the elderly people living in Leganes (n = 1183). Potentially associated factors are explored in bivariate analyses and a multivariate logistic regression analysis. The variables are entered into the equations in the causal order hypothesized. RESULTS: 14% of the elderly persons in Leganes reported at least a fall in the previous twelve months, 41% of them had consequences, 19% ended in hospitalization. In the bivariate analyses significant positive associations were found with being older than 65, female, widowhood, having more than six chronic conditions, functional limitations in lower extremities, disability, urinary incontinence and sleep problems. In the multivariate model independent associations were observed for females, functional limitations of the lower extremities, cognitive deficit, visual impairment, urinary incontinence and sleep problems. CONCLUSION: The frequency of falls in the elderly population in Leganes, Madrid, is approximately half of that reported in international studies using similar methodology. However, associations with known risk factors are confirmed in our population. The association between falls and difficulties in falling asleep found in this study should be confirmed by others.

[The prediction of the minimum incidence of AIDS in Spain for the period 1992-1995]. / Predicción de la incidencia mínima de SIDA en España para el período 1992-1995.

In order to estimate minimum AIDS incidence in Spain between 1992 and 1995, annual AIDS incidence up to 1991 has been obtained from the June 1992 update of the National Register. Correction was made for reporting delays in cases diagnosed since July 1989, in order to run a subsequent back calculation on all cases and for each separate mode of transmission. It was assumed that no new HIV infections would appear after 1991. Since 1981 to 1995, more than 38,000 AIDS cases will have been diagnosed. Minimum AIDS incidence as forecast exhibits a rise between 1992 and 1995 for the total number of cases and for all categories of transmission, except for recipients of blood and blood products, and children of mothers at risk. Real incidence will probably prove higher than estimated owing to the effect of new infections which may arise, and to the underreporting of cases.

[The consistent use of condoms among intravenous drug users and their regular partners]. / Uso consistente del condón entre los usuarios de droga por vía intravenosa y sus parejas estables.

OBJECTIVE: To describe consistent condom use between drug injectors and their regular sexual partners and to identify factors associated to its use which may be amenable to intervention. METHODS: Information was collected by personal interviews of drug injectors in 13 sampling points of the city of Granada, Spain. A bivariate analysis of factors identified in the literature was carried out and a multivariate logistic regression was fitted to the data to test the hypothesized associations. RESULTS: The proportion of drug injectors who report consistent condom use with their regular partners was 26. 4%. Talking about condoms with other injectors and with their regular sexual partners, professional sources of information and counselling when receiving results of HIV testing are independently associated with the use of condoms. In terms of social indicators, those with the highest and lowest levels of social integration use condoms less than those who belong to the middle social group. Sociodemographic characteristics and history of drug injection are not associated with consistent condom use with the regular partner. CONCLUSION: The use of condoms between drug injectors and their regular sexual partners is associated with communication with other drug injectors, the sexual partner and hearth professionals, on this topic. Promoting consistent condom use with regular partners among intravenous drug users is best accomplished through peer groups and during HIV counseling.