"Here's what I'd do...": condom promotion strategies proposed by high-risk women in Anchorage, Alaska.

Women drug users are at significant risk of sexually transmitted HIV; however, interventions aimed at increasing condom use by this population have been relatively ineffective. The authors conducted a series of focus groups with 17 current and former drug-using women to identify (a) reasons for using versus not using condoms, (b) intervention strategies they believed would be most effective at increasing condom use, and (c) previous ineffective intervention strategies. Risk of HIV, sexually transmitted diseases, and pregnancy was the main reason given for using condoms. Many factors were identified that limited condom use, including lack of availability, substance use, and cost. Participants enthusiastically endorsed condom availability and AIDS awareness interventions, and suggested that no intervention was a waste of money. The authors discuss the limitations of the suggested interventions and recommend additional research to evaluate the efficacy of these strategies.

A condom skill scale: assessing condom skills among female drug users.

Use of latex condoms is a primary form of sexual risk reduction, and consequently many intervention programs have focused efforts on increasing condom use among high-risk populations. Use alone, however, will not fully protect the individual if condoms are not used correctly. The objective of this study was to describe the development and properties of a scale measuring demonstrated condom use skill using a sample of 261 drug-using women. Guttman's coefficient of reproducibility and Jackson's Plus Percentage Ratio (PPR) were used to determine the scalability of the Condom Skill Scale (CSS). Analysis of scale scores revealed high levels of condom skill among the population, although there was reduced performance for three items. Preliminary analysis suggests that the CSS is a potentially valid and reliable instrument, and may have application as a tool assessing condom skill level.

Needle exchange and injection drug use frequency: a randomized clinical trial.

Despite a lack of evidence that needle exchange programs (NEPs) cause an increase in injection drug use, there are still concerns over fostering increased injection behavior with NEPs. The design was a randomized controlled trial conducted from May 1997 to June 2000 comparing injection drug users (IDUs) who are randomly assigned to have access to an NEP versus training in how to purchase needles and syringes (NS) at pharmacies. Of 653 IDUs recruited into the study, 600 were randomized: 426 were followed-up at 6 months, and 369 were followed-up at 12 months. Four hundred ninety were followed up at least once. There was no difference in the number of injections over time between the NEP and the Pharmacy Sales arms of the study or in the percentage of positive urine test results over time between the NEP and the Pharmacy Sales arms of the study for morphine and amphetamine. The decrease in the presence of cocaine was marginally greater between the arms of the study. The results do not support the hypothesis of NEPs causing an increase in injection drug use. This clinical trial provides the strongest evidence to date that needle exchanges do not produce this negative effect.

Perceptions of power equality among drug-using women.

This study examined the associations between perceptions of the power equality in a current sexual relationship and each of several alternative indicators of power in a sample of drug-using women. Using targeted sampling, 262 women were recruited from the streets of Anchorage, Alaska. A battery of face-to-face questionnaires was administered to adult women who gave evidence of recent drug use (track marks or positive urinalysis) and had been recently sexually active. Perceived power equality was associated with physical, verbal, and sexual abuse, self-efficacy, sexual communication, and income for main partners, and the trade of sex and traditionalism of her views on home and family for casual partners. These findings suggest that power is a complex, multifaceted construct, and that type of relationship must be considered when trying to understand the meaning of power within drug-using women's lives. Implications for risk behavior interventions are discussed.

Social isolation and domestic violence among female drug users.

The objective of this study was to examine the association between social isolation, domestic violence, and substance dependence among street-recruited female drug users. Hierarchical logistic regression was used to assess the independent contribution of social isolation and substance dependence to the likelihood that women will experience physical abuse. One hundred women (38.2%. N = 262) reported at least one incident of physical violence perpetrated by her most-recent sexual partner. Controlling for substance dependence and relationship status (the only significantly associated demographic variable), women reporting indicators of social isolation were more likely to have been physically abused by their most-recent sexual partners than nonisolated women. Substance dependence was not related significantly to domestic violence. Providers who have contact with female drug users should be aware of the high domestic violence rates and work to counterbalance the isolation these women may experience.