Quality of parent-child relationship and adolescent HIV risk behaviour in St. Maarten.

The highest incidence rates of HIV/AIDS in the Caribbean are recorded in heterosexual and youth populations. With sparse prevention and intervention programmes in place, there is a pressing need to address the HIV/AIDS risk of youth. The objective of this analysis was to describe the extent of youth risk behaviour in St. Maarten and explore the relationship between quality of parental-child relationship and adolescent HIV risk behaviours. The sample consisted of 1,078 students (age range 14-18, mean 15.6 (s.d. 1.7). The data were collected by self-report survey in the Spring of 2001 in the classrooms of all seven secondary schools in St. Maarten. The survey instrument included demographic information, and used questions derived from the Center for Disease Control's (CDC) Youth Risk Behavior Survey (YRBS) to assess health risk behaviour prevalence, including tobacco, alcohol, and drug use, and sexual activity. The survey also asked youth to rate their relationship with their parents. Analysis showed a relatively high rate of risk behaviour in this school population. Multi-variate analysis showed that a 'great' relationship with both parents, as perceived by the student, was significantly associated with lower rates of tobacco and alcohol use as well as lower rates of sexual activity.

African-American injection drug users: tensions and barriers in HIV/AIDS prevention.

This exploratory study utilized a focus group methodology to explore tensions and barriers in HIV/AIDS prevention among African-American injection drug users. Participants discussed HIV infection risks, national/community HIV prevention effectiveness, prevention barriers, ideas on barrier removal, and the tensions which exist between users and the larger African-American community. Recognizing the inevitability of continued drug use for many injectors, participants requested basic harm-reduction supplies including condoms, needle exchange programs, additional drug user treatment services, and the use of culturally- and gender-matched peer-led prevention and treatment outreach. Preliminary recommendations are made for consideration in HIV/AIDS prevention among African-American IDUs.

First injection and current risk factors for HIV among new and long-term injection drug users.

The purpose of this paper is to estimate HIV seroprevalence and to examine the injection and sexual risk behaviours of a cohort of active new heroin injectors who have initiated injection within the past four years and to compare their risk behaviours with those of long-term heroin injectors who initiated injection prior to January 1, 1985. A stratified network-based sample was used to recruit injection drug users (IDUs) from the streets of Miami-Dade, Florida. New IDUs displayed a significantly lower HIV seroprevalence than long-term injectors (13.3 versus 24.7%). Both new and long-term drug injectors exhibited a high level of current HIV risk behaviour. While new injectors were more likely than long-term injectors to practise safer injection behaviours at the initial injection episode, the current risk behaviours of new and long-term injectors are similar.

Provision of drug treatment services in the juvenile justice system: a system reform.

This article proposes a systemic reform of the organizational structure and delivery of substance abuse services for adolescents within the juvenile justice system. It first discusses the impact of substance use on the juvenile justice system and then reviews which drug treatment programs and services are currently available. Following an evaluation of the most effective drug treatment programs and modalities, recommendations for system reform are given. The recommendations are based on a graduated sanctions framework, supported by systems collaboration and comprehensive case management. Systems collaboration between service providers must exist for juveniles to receive appropriate and comprehensive services. Case managers (CMs) both assess juveniles and help them move through and between judicial, drug treatment, and social service systems. In this way, juveniles receive the most suitable and complete services a community can offer while remaining firmly under juvenile justice system supervision.

AIDS susceptibility in a migrant population: perception and behavior.

Within the framework of the Health Belief Model, this paper examines correlates of perception of AIDS susceptibility among 846 drug-using migrant farm workers and their sex partners. Significant but relatively small differences by ethnicity and gender were found. The data showed a consistent significant statistical relationship between frequency of drug use, high-risk sexual behavior, and perception of AIDS susceptibility. Perception of AIDS susceptibility was significantly related to a subsequent reduction in sexual risk behaviors. Consistent with the Health Belief Model, the data suggest that increasing perception of AIDS susceptibility may be an important motivator in reducing high-risk behaviors.

Health care need and utilization: a preliminary comparison of injection drug users, other illicit drug users, and nonusers.

This paper investigates the relationship between chronic drug use and the health care system. Data from 536 African-American, Hispanic, and non-Hispanic White men and women were analyzed to determine independent risk factors for three outcome variables: 1) Need for health care treatment, 2) Utilization of health care treatment, and 3) Failure to receive needed treatment. Nine independent demographic, health, and drug-use history variables were assessed in logistic regression models. Chronic drug users were more likely in the past year to need health care treatment, were as likely to receive some health care treatment, and were more likely not to receive needed treatment than were nonusers.

Networking computers.

This decade the role of the personal computer has shifted dramatically from a desktop device designed to increase individual productivity and efficiency to an instrument of communication linking people and machines in different places with one another. A computer in one city can communicate with another that may be thousands of miles away. Networking is how this is accomplished. Just like the voice network used by the telephone, computer networks transmit data and other information via modems over these same telephone lines. A network can be created over both short and long distances. Networks can be established within a hospital or medical building or over many hospitals or buildings covering many geographic areas. Those confined to one location are called LANs, local area networks. Those that link computers in one building to those at other locations are known as WANs, or wide area networks. The ultimate wide area network is the one we've all been hearing so much about these days--the Internet, and its World Wide Web. Setting up a network is a process that requires careful planning and commitment. To avoid potential pitfalls and to make certain the network you establish meets your needs today and several years down the road, several steps need to be followed. This article reviews the initial steps involved in getting ready to network.

Injection drug users' practices and attitudes toward intervention and potential for reducing the transmission of HIV.

Miami is one of the major centers of illegal drug activity and has a significant proportion of AIDS cases among injection drug users (IDUs). Since Needle Exchange Programs (NEP) are illegal and therefore do not exist in the state of Florida, other strategies must play a large role in reducing the transmission of HIV among IDUs. In order to effectively communicate with IDUs about needle safety, it is necessary to understand the practices and culture of IDUs, including where and how the needle/syringes are obtained and used. Data from recent studies conducted in Miami and other local sites indicate that IDUs inject frequently, averaging more than 1,000 per year, per person. While the vast majority of IDUs feel it is very important to clean needles and to use a needle only one time, these sentiments are not always practiced. Furthermore, data indicate that the context where shooting takes place must be considered in the planning of HIV risk reduction interventions. These findings suggest the importance of understanding patterns of drug use, attitudes toward intervention, and the cultural context where risky behaviors occur. Although Needle Exchange Programs are illegal in Florida, intervention programs must still stress the importance of using only new needles, but since new needles cannot always be obtained, IDUs should be taught and motivated not to use contaminated drug paraphernalia.

Compliance to bleach disinfection protocols among injecting drug users in Miami.

Bleach cleansing of injection equipment has been recommended to reduce the risk of human immunodeficiency virus (HIV) transmission associated with the reuse of injection equipment by injecting drug users (IDUs). We evaluated the recall and performance of the most commonly recommended bleach cleansing procedure of two complete fillings of the syringe with bleach, followed by two complete fillings with rinse water, and not putting used bleach and water back into source containers. IDUs were taught this procedure on enrollment in an HIV prevention demonstration project in Dade County, Florida. During follow-up session 6-12 months after initial training, the knowledge and ability of IDUs to perform bleach cleansing were assessed by trained observers using a standardized method. In 1988-90, we assessed the knowledge and ability of 450 IDUs to perform the bleach cleansing procedure taught at enrollment. More than 90% of IDUs assessed performed the basic steps. However, only 43.1% completely filled the syringe with bleach and only 35.8% completely filled the syringe with bleach at least twice. Substantial proportions of IDUs did not perform all the steps of the previously taught bleach cleansing procedure. Compliance decreased as the number of steps required was increased. This limited compliance may make bleach cleansing less effective and suggests that some IDUs may fail to adequately disinfect injection equipment and therefore sterile needles and syringes are safer than bleach-cleansed ones. Compliance testing can help assess the effectiveness of HIV prevention programs.

Crack use and correlates of use in a national population of street heroin users. The National AIDS Research Consortium.

Traditionally, researchers and clinicians have viewed street heroin users as representing an end point in a drug-using career. It is toward this population that major national treatment efforts have been directed. Concomitant with the historical national concern about heroin use has been concern about the increase in crack cocaine use. There has been speculation that crack use may have become a substitute for the higher risk of heroin injection. This article examines the impact of crack use in a national population of heroin users. It was consistently found that there was a correlation between the frequency of crack use and the frequency of speedballing as well as the use of other forms of cocaine, amphetamines, and marijuana. There was also a positive relationship between frequency of crack use and such HIV risk behaviors as renting needles and having a large number of sex partners. The data suggest that in this population of heroin users, crack is not a substitute for heroin but rather is a part of a drug-use pattern that includes an increased use of other drugs and increased high-risk behaviors for contracting HIV.

HIV seropositivity of needles from shooting galleries in south Florida.

Needle/syringe combinations were collected from three shooting galleries in South Florida and tested for the presence of antibodies to HIV-1. Fifteen of 148 needles (10.1 percent) tested positive for HIV-1 antibody. Seropositivity rates did not vary by the day of the week of collection, nor by shooting gallery from which they were collected. When the needle appeared to contain blood residue, 20.0 percent were positive versus 5.1 percent with no blood residue. These findings suggest that needles/syringes used in shooting galleries are likely to serve as reservoirs and/or vectors of transmission of the HIV-1 virus, and that although visual inspection of the needle/syringe may be useful in lessening the chance for transmission, even the visually "clean" needles may result in transmission of infection.

Assessment of IgE-mediated sensitivity during immunotherapy: comparison of the RAST with and without adsorption of IgG to titrated prick skin tests.

The effect of specific IgG induced by allergy immunotherapy on specific IgE binding in the RAST was assessed by removal of the IgG with staphylococcus protein A bound to Sepharose. In sera from those patients with the highest titers of specific IgG, RAST binding was increased 8% following adsorption of the post-immunotherapy sera while in sera obtained from the same patients before immunotherapy adsorption increased binding only 3%. The effect of allergy immunotherapy on the titrated prick skin test was compared to the effect on the RAST to the same allergen. In nine patients who received the highest dose of grass extract, the area of the titrated prick skin tests was reduced following immunotherapy by 75%. Staphylococcus protein-A adsorption of sera from these patients drawn before immunotherapy resulted in an increase in RAST binding of 2.7% compared to an increase of 6% in sera obtained after immunotherapy, suggesting suppression of RAST binding of only 3% by specific IgG. It is concluded that RAST levels are affected less than prick skin tests by the immunologic response to allergy immunotherapy. Some interference in RAST binding is produced by specific IgG antibody in high titers, but for many critical purposes the degree of interference is not significant.

Dilaudid use: trends and characteristics of users.

The purpose of this paper is to examine the extent of Dilaudid use and characteristics of users in a population of individuals admitted to drug treatment programs over a four-year period. It was found that the number and rate of Dilaudid use had increased from 1% of those admitted in 1974 to 10% in late 1977. In comparison to other drug users, Dilaudid users were more likely to be white and middle-class. Dilaudid users were also likely to use the drug intravenously and to obtain it by street buys and to also use heroin. Data suggest that Dilaudid use is easily integrated into a heroin-using life style and may serve as a heroin substitute, and that Dilaudid users are a population that has characteristics similar to the type described as the Southern addict.

An analysis of the accessibility and nonaccessibility of patients in a follow-up study.

In a follow-up study of 184 emergency room patients experiencing acute drug reactions, several respondents were inaccessible. In this paper the 83 accessible and 101 nonaccessible patients are compared in order to determine why respondents are often difficult to locate in a follow-up study. Those patients who were the most accessible proved to be primarily young, White males who had been referred to a traditional drug treatment program from the hospital emergency room. Those patients who were the least accessible proved to be primarily White females between 24 and 29 years of age who had not been referred for further treatment.