Alcohol Use Severity and Sexual Risk Behavior Among Female Substance Users.

BACKGROUND: Substance use has been identified as one of the leading factors related to HIV transmission in the United States. The association of problematic drinking with sexual risk behavior puts individuals at greater risk for HIV transmission. This may be of particular concern for women given that approximately 66% of new HIV infections occurring through heterosexual transmission are female. OBJECTIVES: To investigate alcohol use severity and sexual risk behavior among females who use heavy, illicit drugs. METHODS: Female substances users (N = 251; Mage = 31.90, SD = 7.67; 63.7% Black) self-reported past month alcohol use and lifetime sexual risk behaviors with both casual and steady sex partners. RESULTS: Problematic alcohol users were more likely to use noninjection drugs and less likely to use injection drugs than abstainers and more likely than moderate alcohol users to use alcohol before/during sex with a steady partner. White problematic alcohol users were less likely to use injection drugs before/during sex with a steady partner than abstainers. Black problematic alcohol users were more likely to use non-injection and alcohol than moderate alcohol users before/during sex with steady partners. CONCLUSIONS: The current study extends the existing literature by taking a closer look at the role of alcohol use severity in sexual risk taking behavior of Black and White female substance users, a particularly vulnerable group for HIV transmission.

An exploration of alcohol use severity and route of drug administration among persons that use heroin and cocaine.

BACKGROUND: Alcohol use is prevalent among populations of persons that use illicit drugs. Problematic alcohol use among persons that use heroin and cocaine has been associated with poor treatment adherence, abstinence maintenance, and mental health concerns. Fully exploring how alcohol use severity interacts with route of administration (ROA) may be of notable importance in development of treatment protocols for persons that use heroin and cocaine. METHODS: Data from a neurological and sociobehavioral assessment of risk factors among injection and noninjection drug users known as the NEURO-HIV Epidemiologic Study was used in the analyses. Participants (N = 551) included those who reported their level of past-30-day alcohol use and past-6-month heroin and cocaine use. RESULTS: Multiple logistic regression analyses found that both problematic and moderate alcohol users were significantly less likely than abstainers to report injecting heroin and cocaine. Both problematic and moderate alcohol users were significantly more likely than abstainers to snort substances. CONCLUSIONS: Alcohol use may play a role in promoting or impeding the use of substances through certain ROAs. Treatment protocols that transition persons that use injection heroin and cocaine to noninjection use of these substances may be used in conjunction with treatments that reduce alcohol consumption as a means to reduce noninjection drug use.

Time Since Release from Incarceration and HIV Risk Behaviors Among Women: The Potential Protective Role of Committed Partners During Re-entry.

After release from incarceration, former female inmates face considerable stressors, which may influence drug use and other risk behaviors that increase risk for HIV infection. Involvement in a committed partnership may protect women against re-entry stressors that may lead to risky behaviors. This study measured the association between time since release from incarceration (1-6 months ago, and >6 months ago versus never incarcerated) and HIV risk behaviors and evaluated whether these associations differed by involvement in a committed partnership. Women released within the past 6 months were significantly more likely to have smoked crack cocaine, used injection drugs and engaged in transactional sex in the past month compared to never-incarcerated women and women released more distally. Stratified analyses indicated that incarceration within the past 6 months was associated with crack cocaine smoking, injection drug use and transactional sex among women without a committed partner yet unassociated with these risk behaviors among those with a committed partner.

Increased risk for substance use and health-related problems among homeless veterans.

BACKGROUND AND OBJECTIVES: The first aim of this study was to compare self-reported causes of homelessness between veterans and nonveterans. A second aim examined whether homeless male veterans were more likely than homeless male nonveterans to experience current problems with addictions, mental health, and physical health. Additionally, a third aim was to compare frequency of emergency room visits and treatment needs between the two groups. METHODS: Secondary data analyses compared male homeless veterans and nonveterans (N = 353) enrolled in the Alachua County Point in Time study in central Florida. Participants completed a questionnaire on demographics and health variables. Additional questions included recent emergency room visits and medical or other needs not being met. RESULTS: Veterans reported higher rates of substance use and mental health problems as a primary cause of homelessness when compared to nonveterans. Homeless veterans were more likely than nonveterans to report current problems with addictions (OR = 6.29, 95% CI: 3.43-11.53, p < .001), mental health problems (OR = 4.12, 95% CI: 2.28-7.42, p < .001), and physical problems (OR = 1.83, 95% CI: 1.08-3.67, p < .01). Finally, over half of homeless veterans (53.1%) reported an ER visit in the past year compared to only 40.9% of nonveterans (OR = 1.73, 95% CI: 1.07-2.80, p < .05). CONCLUSION AND SCIENTIFIC SIGNIFICANCE: Veterans may be more likely to become homeless due to addiction and mental health and over half of homeless veterans are presenting to hospital emergency rooms. Given the greater utilization among homeless veterans, emergency rooms may serve as a prime opportunity to provide brief treatment and referrals for needed services.

Correlates of Trichomonas vaginalis Among Middle Age and Older Adults Who Use Drugs.

BACKGROUND: Recent studies have reported high rates of Trichomonas vaginalis among middle age and older adults. Though trichomoniasis risk factors in this age cohort remain largely unknown, illicit drug use has been associated with increased incidence of sexually transmitted infections (STIs). The number of mid-older adults using illicit drugs has increased significantly in recent years suggesting the need to understand the relationship between drug use and STIs in this age cohort. OBJECTIVES: This study examined the relationship between drug use, sexual-risk behaviors, and biologically confirmed T. vaginalis in a sample of mid-older and younger adults who reported recent drug use. METHODS: The cross-sectional design examined the relationship between past 6-month drug use, sexual risk-behaviors, and PCR-confirmed T. vaginalis in 264 adults age 18-64 who were recruited from Baltimore, Maryland. These relationships were also explored in the age-stratified sample among those 18-44 years ("younger") and individuals 45+ years ("mid-older"). RESULTS: Trichomoniasis prevalence did not differ significantly between younger (18.8%) and mid-older (19.1%) adults. Mid-older adults that tested positive for T. vaginalis were more likely to have used marijuana and crack in the past 6 months. Among younger adults, there were no associations between trichomoniasis and past 6-month drug use and sexual-risk behavior. CONCLUSIONS/IMPORTANCE: Age- and drug-related immune decline is hypothesized to contribute to increase susceptibility to T. vaginalis in mid-older adults. Broad screening for trichomoniasis, particularly among older adults who are often not regarded as at risk for STIs, is needed to control this often asymptomatic infection.

HIV prevalence and risk behaviors among African American Women Who Trade Sex for Drugs Versus Economic Resources.

Trading sex for money, drugs, goods, services, or a place to stay is prevalent among women who use drugs and has been associated with women's risk of HIV acquisition. There is evidence that trading sex for drugs only may be associated with elevated risk of HIV compared with trading sex for money. The purpose of this study was to assess whether HIV risk behaviors and HIV prevalence differ among African American drug using women (N = 92) who traded sex for drugs only, traded sex for economic resources (defined as money, shelter, or other resources) only, or traded sex for both economic resources and drugs. In this study, lower rates of condom use and higher rates of HIV were found among women who traded sex for drugs only compared to women who traded sex for economic resources or for economic resources and drugs. These findings suggest that African American women who trade sex for drugs only represent an understudied yet highly vulnerable group.

Cognitive performance profiles by latent classes of drug use.

BACKGROUND AND OBJECTIVES: The relationship between substance use and cognitive deficits is complex and requires innovative methods to enhance understanding. The present study is the first to use LCA to examine associations of drug use patterns with cognitive performance. METHODS: Cocaine/heroin users (N = 552) completed questionnaires, and cognitive measures. LCA identified classes based on past-month drug use and adjusted for probabilities of group membership when examining cognitive performance. Latent indicators were: alcohol (ALC), cigarettes (CIG), marijuana (MJ), crack smoking (CS), nasal heroin (NH), injection cocaine (IC), injection heroin (IH), and injection speedball (IS). Age and education were included as covariates in model creation. RESULTS: Bootstrap likelihood ratio test (BLRT) supported a 5-class model. Prevalent indicators (estimated probability of over 50%) for each class are as follows: "Older Nasal Heroin/Crack Smokers" (ONH/CS, n = 166.9): ALC, CIG, NH, CS; "Older, Less Educated Polysubstance" (OLEP, n = 54.8): ALC, CIG, CS, IH, IC, and IS; "Younger Multi-Injectors" (MI, n = 128.7): ALC, CIG, MJ, IH, IC, and IS; "Less Educated Heroin Injectors" (LEHI, n = 87.4): CIG, IH; and "More Educated Nasal Heroin" users (MENH, n = ALC, CIG, NH. In general, all classes performed worse than established norms and older, less educated classes performed worse, with the exception that MENH demonstrated worse cognitive flexibility than YMI. DISCUSSION AND CONCLUSIONS: This study demonstrated novel applications of a methodology for examining complicated relationships between polysubstance use and cognitive performance. SCIENTIFIC SIGNIFICANCE: Education and/or nasal heroin use are associated with reduced cognitive flexibility in this sample of inner city drug users.

Awareness of biologically confirmed HCV among a community residing sample of drug users in Baltimore City.

The present study sought to examine: (1) the prevalence and correlates of biologically confirmed Hepatitis C (HCV) and (2) the prevalence and correlates of prior HCV diagnosis and an unmet need for HCV treatment, among a community residing sample of drug users. The current study used a subset of HCV tested participants from the larger NEURO-HIV Epidemiologic Study from Baltimore, Maryland (M(age) = 34.81, SD = 9.25; 46% female). All participants were tested for HCV at baseline. Self-report was used to assess awareness of an HCV diagnosis and participation in treatment. Of the 782 participants tested for HCV, 19% reported having received an HCV diagnosis in the past while 48% tested positive for HCV. Only 6% reported having received treatment for any form of hepatitis. Of those who tested HCV positive, 63% reported never being diagnosed, and only 13% received any treatment for HCV. We found that only 35% of those who reported a prior HCV diagnosis received any treatment. The findings regarding lack of HCV awareness and diagnosis were considerable as expected. These deficits suggest that there are numerous gaps in patients' knowledge and beliefs regarding HCV that may interfere at multiple steps along the path from diagnosis to treatment. This study clearly demonstrates that a critical need exists to improve public knowledge of HCV risk factors, the need for testing, and the availability of effective treatment.

Perceived barriers to treatment in a community-based sample of illicit-drug-using African American men and women.

This study examines perceived substance use treatment barriers in a community-based sample of 267 African Americans from Baltimore, MD. Both men and women endorsed "they can handle it alone" as a primary reason they were not currently in treatment. However, men were two times more likely (AOR = 2.29 CI = 1.05, 5.02) to endorse "concerns about losing family" as the reason they are not currently in treatment. The present study yields interesting findings among African Americans, which should be considered when creating interventions for particular groups of African Americans.

Younger versus older African Americans: patterns and prevalence of recent illicit drug use.

OBJECTIVES: The current study examined recent substance use among younger and older African Americans and factors associated with recent use. METHODS: The current study used a subset of African American men and women (N = 260) from the NEURO-HIV Epidemiological Study (Mage = 42, SD = 9.27; 59% female). Self-report of past 6 month substance use was evaluated for 21 different substances by routes of administration (ROA). RESULTS: Older adults were 1.9 times (AOR = 1.92, 95% CI = 1.13-3.26) more likely to have used crack in the past 6 months and half as likely to have used marijuana (AOR = .44, 95% CI = .25-.77). There were no significant differences for heroin use. DISCUSSION: Substance use at midlife may have significant implications for adverse social and health outcomes among African Americans. Findings support the need to better understand the developmental pathways of drug use and dependence among African Americans.

The role of drinking severity on sex risk behavior and HIV exposure among illicit drug users.

OBJECTIVES: The current study examined how drinking severity among injection and non-injection drug users is associated with sex risk behaviors and risk of HIV exposure. METHOD: The study is a secondary analysis of an investigation of risk factors among drug users in Baltimore known as the NEURO-HIV epidemiologic study. Participants (N = 557) completed an interview, self-reported 30-day alcohol use, lifetime injection and non-injection drug use, and provided blood samples to screen for HIV. Participants were grouped into one of three drinking severity conditions: abstinent (no reported alcohol use in prior 30 days), moderate alcohol use (≤30 drinks for females, or ≤60 drinks for males), or problematic alcohol use (>30 drinks for females, or >60 drinks for males). Drinking severity groups were significantly different on lifetime injection drug use, heroin injection, snorting/sniffing cocaine, and smoking crack. RESULTS: Logistic regression analyses found problematic alcohol users to be more likely than alcohol abstainers to inject drugs before or during sex (AOR = 5.78; 95% CI = 2.07-16.10), and more likely than moderate alcohol users to use alcohol before/during sex (AOR = 4.96; 95% CI = 2.09-11.81), inject drugs before/during sex (AOR = 2.96; 95% CI = 1.29-6.80), and to be HIV+ among Black participants (AOR = 2.72; 95% CI = 1.14-6.49). CONCLUSIONS: These results outline the necessity for research and clinical intervention among this population to reduce sex risk behaviors and potential HIV exposure, while highlighting the need to examine drinking severity as a predictor of sex risk behaviors.

Knowledge of HIV transmission through breast milk among drug-dependent pregnant women.

Abstract The current study examined the correlates of knowledge about human immunodeficiency virus (HIV) transmission through breast milk among drug-dependent pregnant women. There is a tremendous need to examine the knowledge about HIV transmission through breastfeeding among this largely understudied, but high-risk subset of pregnant women in order to minimize the extent to which they pass HIV to their children after giving birth. Participants included 97 pregnant women from Baltimore, MD, USA. Prevalence of drug use over the last 6 months included 37.1% reporting smoking marijuana, 36.1% injecting heroin, and 67.0% smoking crack. When asked whether HIV could be transmitted through breast milk, 72 women (74.2%) answered correctly. Our results indicate that the overall knowledge about transmission through breast milk is relatively low. Furthermore, participants who smoked crack during the past 6 months and participants who were white were significantly less likely to have correct knowledge about this topic. Our findings have important implications with regard to preventive interventions for this population. Future research is needed to determine how to best modify these interventions to address the specific needs of drug-dependent pregnant women, and how to specifically target white women and women who smoke crack.

A latent class analysis of alcohol abuse and dependence symptoms among Puerto Rican youth.

The study aim was to classify youths into homogenous groups based on their symptoms of Alcohol Abuse and Dependence. An NIDA-funded cross-sectional survey was administered to 622 middle and high school students in San Juan, Puerto Rico in 2000. Latent class analysis (LCA) examined the Alcohol Abuse and Dependence symptoms. Three distinct classes of drinkers were found: low (86.0% of sample), moderate (11.7% of sample), and high (2.3% of sample) severity classes which were distinguished by differing estimated probabilities of symptom reporting. The study has implications for the diagnosis of Alcohol Abuse and Dependence among Puerto Rican youths. Limitations are also noted.

A model of school problems, academic failure, alcohol initiation, and the relationship to adult heroin injection.

The current study uses structural equation modeling to investigate factors associated with alcohol initiation and injection heroin use. Baseline data from the NEURO-HIV Epidemiologic Study in Baltimore, Maryland, were used. Participants were 404 injection heroin users (M(age) = 32.72) with a history of regular injection in their lifetime. Latent variables were created for self-reported school problems and academic failure. The final model indicated that greater school problems were associated with earlier alcohol initiation (ß = -0.22, p < .001) and earlier alcohol initiation was associated with greater frequency of recent heroin use (ß = -0.12, p < .05). Academic failure was directly related to greater frequency of recent heroin injection (ß = 0.15, p < .01). The results expand research investigating the relationship between adolescent behavior and illicit drug use in adulthood.

Patterns of cognitive impairments among heroin and cocaine users: the association with self-reported learning disabilities and infectious disease.

This study used data from six neuropsychological measures of executive function (EF) and general intellectual functioning (GIF) administered to 303 regular users of heroin and/or cocaine as indicators in a latent profile analysis (LPA). Results indicated the presence of three profiles: impaired GIF and EF profile (30.8%), intact GIF and EF profile (58.8%), and high GIF/intact EF profile (10.4%). Using a multinomial logistic regression, it was determined that individuals who reported being diagnosed with either a learning disability (LD) and/or attention-deficit/hyperactivity disorder (ADHD) were more likely to be in the impaired GIF and EF profile than other profiles. Results from a logistic regression indicated that the impaired GIF and EF profile was associated with a greater prevalence of past hepatitis B and/or C infection. Implication for harm reduction and treatment programs and the need to take into account individuals with LD and ADHD are discussed.

The Impact of Homelessness on Recent Sex Trade among Pregnant Women in Drug Treatment.

This study is a secondary data analysis aimed to examine the influence of recent homelessness on recent sex trade among pregnant women in drug treatment after controlling for psychiatric comorbidity, age, education, and race. Eighty-one pregnant women from a drug treatment program in Baltimore, Maryland attended an in-person interview and completed the Structured Clinical Interview for Diagnostic and Statistical Manual for Mental Disorders-IV for Axis I disorders, the HIV Risk Behavior Interview, and demographic questionnaires, which assessed psychiatric symptoms, recent homelessness, and sexual risk behavior respectively. Women who experienced recent homelessness had a 4.74 greater odds of having recently traded sex than women who had not been recently homeless, suggesting that homelessness uniquely influences sex trade beyond psychiatric status, which was also a significant correlate of recent sex trade. Addressing both homelessness and psychiatric problems may effectively reduce sex trade and risk for infectious diseases, which could adversely impact maternal and child health outcomes.

Factors related to past HIV testing among South African non-injection drug users.

South Africa has some of the highest estimates of human immunodeficiency virus (HIV) in the world, with a prevalence of 21.5%. Despite this, based on population-level data, 39% of sexually active South Africans have never been tested for HIV. Non-injection drug users (NIDUs) are a high-risk and increasingly prevalent group in South Africa. However, few studies have examined HIV test utilization among high-risk groups such as drug users in South Africa. The study was conducted in Pretoria, South Africa between 2002 and 2006. Of the 382 individuals surveyed, 31% had been tested for HIV in the past. Results indicate that females and older individuals were significantly more likely to have been tested for HIV at some point in the past, while individuals who did not know someone with HIV/AIDS as well as individuals who are unsure of their risk of HIV infection were significantly less likely to have ever accessed testing. Identification of these subgroups has implications for the development of targeted interventions to promote greater HIV testing among at-risk groups in South Africa.

Alcohol, Drug and Sexual Risk Behavior Correlates of Recent Transactional Sex Among Female Black South African Drug Users.

Transactional sex among black South African women has become a mode of economic survival putting them at higher risk for HIV and other infectious disease. In order to inform HIV interventions, drug and sexual risk behavior correlates of recent transactional sex among a descriptive epidemiological, cross-sectional sample of 189, black, South African women in Pretoria were examined using log binomial regression. Prevalence of HIV seropositivity was extremely high among non-transactional sex workers (47.1%) and transactional sex workers (54.6%), albeit not significantly different. Adjusted regression results indicated that the probability of transactional sex was greater for drug using women who tested positive for cocaine use (Adjusted Prevalence Ratio (APR)=1.3, 95% CI=1.1, 1.5) and knew of anyone who died of AIDS (APR =1.5, 95% CI 1.1, 2.1). The probability of transactional sex was lower for female drug users who reported greater education (APR =0.6, 95% CI= 0.4, 0.8), condom use in their first sexual encounter (APR =0.7, 95% CI=0.6, 1.0) or reported a recent steady sexual partnership (APR =0.8, 95% CI=0.7, 0.9). Drug use-related interventions for female transactional sex workers may need to focus on methods for the reduction of not only drug use, especially cocaine use, but also the reduction of sexual risk behaviors.

Neighborhood poverty and injection cessation in a sample of injection drug users.

Neighborhood socioeconomic environment may be a determinant of injection drug use cessation. The authors used data from a prospective cohort study of Baltimore City, Maryland, injection drug users assessed between 1990 and 2006. The study examined the relation between living in a poorer neighborhood and the probability of injection cessation among active injectors, independent of individual characteristics and while respecting the temporality of potential confounders, exposure, and outcome. Participants' residences were geocoded, and the crude, adjusted, and inverse probability of exposure weighted associations between neighborhood poverty and injection drug use cessation were estimated. Weighted models showed a strong association between neighborhood poverty and injection drug use cessation; living in a neighborhood with fewer than 10%, compared with more than 30%, of residents in poverty was associated with a 44% increased odds of not injecting in the prior 6 months (odds ratio = 1.44, 95% confidence interval: 1.14, 1.82). Results show that neighborhood environment may be an important determinant of drug injection behavior independent of individual-level characteristics.

The relationship between performance on the Shipley Institute of Living Scale (SILS) and hepatitis C infection among active injection drug users in Baltimore, Maryland.

BACKGROUND: Hepatitis C represents a significant public health problem, particularly among injection drug users. Other than injection drug practices, little is understood about individual level characteristics that may place some injection drug users at particularly high risk. OBJECTIVES: The current study sought to examine two associations among active, regular heroin injection drug users. The first was to determine whether there was an association between two scales from the Shipley Institute of Living Scale (SILS: a neuropsychological measure used to estimate cognitive impairment/intellectual functioning) and self-reported preexisting conditions independent of years of drug use. The second was to examine whether performance on the scales was associated with hepatitis C infection. METHODS: Data from 260 HIV negative injection drug users from the Baltimore metropolitan region were used. Participants completed a risk behavior interview, brief neuropsychological battery, and were tested for Hepatitis C. RESULTS: Findings indicated that scale performances varied by self-reported learning disabilities and attention deficit disorder. Poorer performance on one scale was statistically significantly associated with greater hepatitis C prevalence on the vocabulary scale, the discrepancy scale showed a statistical trend. CONCLUSIONS: Cognitive impairment measured among this sample of injection drug use was related to pre-existing conditions and hepatitis C independent of years of drug use. Such impairment may exist prior to initiation of use and increase vulnerability to poor health outcomes among injection drug users. SCIENTIFIC SIGNIFICANCE: This study highlights the need for interventions targeting a possible high risk subpopulation of injection drug users.