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Brooks A, Meade CS, Potter JS, Lokhnygina Y, Calsyn DA, Greenfield SF. Gender differences in the rates and correlates of HIV risk behaviors among drug abusers. Subst Use Misuse 2010; 45:2444-69. [PMID: 20536356 PMCID: PMC3169437 DOI: 10.3109/10826084.2010.490928] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
This study examined gender differences in the rates and correlates of HIV risk behaviors among 1,429 clients participating in multi-site trials throughout the United States between 2001 and 2005 as part of the National Institute on Drug Abuse-funded Clinical Trials Network. Women engaged in higher risk sexual behaviors. Greater alcohol use and psychiatric severity were associated with higher risk behaviors for women, while impaired social relations were associated with decreased risk for men. Specific risk factors were differentially predictive of HIV risk behaviors for women and men, highlighting the need for gender-specific risk-reduction interventions. Limitations of the study are discussed.
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Affiliation(s)
- Audrey Brooks
- Department of Psychology, University of Arizona, Tucson, AZ 85721, USA.
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102
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Brown LS, Kritz S, Bini EJ, Louie B, Robinson J, Alderson D, Rotrosen J. Substance abuse treatment as HIV prevention: more questions than answers. J Natl Med Assoc 2010; 102:1183-91. [PMID: 21287899 PMCID: PMC3097534 DOI: 10.1016/s0027-9684(15)30773-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This report examines associations between the availability of human immunodeficiency virus (HIV)-related health services in substance abuse treatment programs and characteristics of the programs and the patients they serve. In a cross-sectional, descriptive design and via a validated survey, program administrators within the National Drug Abuse Treatment Clinical Trials Network provided information on program characteristics, patient characteristics (rates of risky sexual and drug behaviors and HIV infection), and the availability of 31 different HIV-related health services. Of 319 programs, 84% submitted surveys. Service availability rates ranged from: 10% (pneumococcal vaccination) to 86% (drug testing) for the 6 HIV-related services offered to all patients, 13% (Pap smear for women) to 54% (tuberculin skin testing) for the 6 services offered to new patients, 2% (sterile injection equipment) to 64% (male condoms) for the 4 risk-reduction services, 37% (Pap smear for women) to 61% (tuberculin skin testing) for the 11 biological assessments offered to HIV-positive patients, and 33% (medical treatments) to 52% (counseling) for the 4 other services offered to HIV-positive patients. The availability of these HIV-related services was associated with clinical settings, the types of addiction treatment services, the rates of risky drug and sexual behaviors, and HIV infection rates among patients. Availability of such services was below published guidelines. While the results provide another basis for the infection-related prevention benefits of substance abuse treatment, the variability in the availability of HIV-related health care deserves further study and has health policy implications in determining how to utilize substance abuse treatment in reducing drug-related HIV transmission.
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Affiliation(s)
- Lawrence S Brown
- Addiction Research and Treatment Corp, 22 Chapel St, Brooklyn, NY 11201, USA.
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103
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Toward a comprehensive approach to HIV prevention for people who use drugs. J Acquir Immune Defic Syndr 2010; 55 Suppl 1:S23-6. [PMID: 21045595 DOI: 10.1097/qai.0b013e3181f9c203] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Comprehensive HIV prevention interventions are increasingly recognized as critical in the global effort to reduce HIV transmission among people who use injection drugs. Scientific evidence clearly shows that a variety of biomedical, behavioral, and structural interventions can prevent and reduce injection drug user-driven HIV epidemics, yet social and structural barriers to their implementation remain. This review discusses the scientific evidence on the effectiveness of individual programs for reducing HIV incidence among people who use injection drugs and how, by integrating individual programs as complements within a comprehensive HIV prevention approach, it is possible to achieve, and to sustain, greater results than those of individual programs alone. The article concludes with a discussion of a critical research priority; namely, to improve the implementation of comprehensive HIV prevention interventions in settings of prevalent injection drug use and to overcome the often complex barriers that impede them. Such an effort will require more than research alone, however. It will also require the ongoing commitment of policymakers, public health officials, and the affected communities themselves to use comprehensive HIV treatment and prevention as the most effective strategy to reduce new HIV infections.
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104
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Abstract
Drug use continues to be a major factor fueling the global epidemic of HIV infection. This article reviews the current literature on the ability of drug treatment programs to reduce HIV transmission among injection and noninjection drug users. Most data come from research on the treatment of opiate dependence and provide strong evidence on the effectiveness of medication-assisted treatment for reducing the frequency of drug use, risk behaviors, and HIV infections. This has been a consistent finding since the epidemic began among diverse populations and cultural settings. Use of medications other than methadone (such as buprenorphine/naloxone and naltrexone) has increased in recent years with promising data on their effectiveness as HIV prevention and as new treatment options for communities heavily affected by opiate use and HIV infection. However, few treatment interventions for stimulant abuse and dependence have shown efficacy in reducing HIV risk. The cumulative literature provides strong support of drug treatment programs for improving access and adherence to antiretroviral treatment. Drug users in substance abuse treatment are significantly more likely to achieve sustained viral suppression, making viral transmission less likely. Although there are challenges to implementing drug treatment programs for maximum impact, the scientific literature leaves no doubt about the effectiveness of drug treatment as an HIV prevention strategy.
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105
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Eversman MH. High and low threshold service provision in drug-free settings: Practitioner views. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2010; 21:501-6. [DOI: 10.1016/j.drugpo.2010.03.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2009] [Revised: 03/05/2010] [Accepted: 03/16/2010] [Indexed: 11/29/2022]
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106
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Transition to and from injecting drug use among regular ecstasy users. Addict Behav 2010; 35:909-12. [PMID: 20587367 DOI: 10.1016/j.addbeh.2010.06.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2009] [Revised: 04/27/2010] [Accepted: 06/03/2010] [Indexed: 11/22/2022]
Abstract
There is a scant amount of research investigating injecting drug use among people not selected on the basis of their injecting behaviour, and less attention has been given to stimulant users who may have a different experience with injecting drug use than opioid users who are more commonly studied. The current study aimed to investigate initiation to, and transition from, injecting drug use among a sentinel sample of regular ecstasy users in Australia. Participants were regular ecstasy users recruited across Australia in 2007 who were administered a structured interview that contained questions regarding initiation to injecting, reasons for injecting cessation, and likelihood of future injecting. Among those with a history of injecting drug use, injecting first occurred at a similar age to that of first ecstasy use. The majority did not inject themselves at the first occasion, and two-fifths were under the influence of other drugs at the time. Two-fifths of injectors had not injected in the past 6 months, with many relating this to concerns surrounding stigma. Route of drug administration is clearly not static, and the findings from this study suggest that some who have ceased injecting may still be at risk for future injecting.
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107
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Colón RM, Deren S, Guarino H, Mino M, Kang SY. Challenges in recruiting and training drug treatment patients as peer outreach workers: a perspective from the field. Subst Use Misuse 2010; 45:1892-908. [PMID: 20380554 DOI: 10.3109/10826081003684863] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Hispanic patients were recruited from methadone maintenance treatment programs in 2005-2008 to be trained as peer outreach workers, targeting migrant drug users from Puerto Rico. Goals of the outreach focused on reducing HIV-related risk behaviors. A total of 80 peers were recruited from 4 clinics in New York and New Jersey. Following training, they conducted outreach in their communities for 12 weeks. This paper describes the challenges encountered during the recruitment, training, and outreach phases of the project, from the field perspective. Recommendations for future efforts in training drug treatment patients as outreach workers are provided.
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Affiliation(s)
- Rosa M Colón
- National Development & Research Institutes, Inc., New York, NY, USA
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108
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Tempalski B, Cleland CM, Pouget ER, Chatterjee S, Friedman SR. Persistence of low drug treatment coverage for injection drug users in large US metropolitan areas. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2010; 5:23. [PMID: 20858258 PMCID: PMC2954979 DOI: 10.1186/1747-597x-5-23] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/06/2010] [Accepted: 09/21/2010] [Indexed: 11/10/2022]
Abstract
OBJECTIVES Injection drug users (IDUs) are at high risk for HIV, hepatitis, overdose and other harms. Greater drug treatment availability has been shown to reduce these harms among IDUs. Yet, little is known about changes in drug treatment availability for IDUs in the U.S. This paper investigates change in drug treatment coverage for IDUs in 90 metropolitan statistical areas (MSAs) during 1993-2002. METHODS We define treatment coverage as the percent of IDUs who are in treatment. The number of IDUs in drug treatment is calculated from treatment entry data and treatment census data acquired from the Substance Abuse and Mental Health Service Administration, divided by our estimated number of IDUs in each MSA. RESULTS Treatment coverage was low in 1993 (mean 6.7%; median 6.0%) and only increased to a mean of 8.3% and median of 8.0% coverage in 2002. CONCLUSIONS Although some MSAs experienced increases in treatment coverage over time, overall levels of coverage were low. The persistence of low drug treatment coverage for IDUs represents a failure by the U.S. health care system to prevent avoidable harms and unnecessary deaths in this population. Policy makers should expand drug treatment for IDUs to reduce blood-borne infections and community harms associated with untreated injection drug use.
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Affiliation(s)
- Barbara Tempalski
- National Development and Research Institutes, Inc, 71 West 23rd Street, 8th Fl, New York, NY 10010, USA.
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109
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Calsyn DA, Campbell ANC, Crits-Christoph P, Doyle SR, Tross S, Hatch-Maillette MA, Mandler R. Men in methadone maintenance versus psychosocial outpatient treatment: differences in sexual risk behaviors and intervention effectiveness from a multisite HIV prevention intervention trial. J Addict Dis 2010; 29:370-82. [PMID: 20635286 DOI: 10.1080/10550887.2010.489451] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The effectiveness of the Real Men Are Safe (REMAS) HIV prevention intervention was examined as a function of treatment program modality. REMAS was associated with significantly larger decreases in unprotected sexual occasions than an HIV education control condition in both treatment modalities. REMAS had superior effectiveness for reducing unprotected sexual occasions in the psychosocial outpatient compared to methadone. At the 6-month follow-up, the adjusted mean change for REMAS completers in psychosocial outpatient (M=6.4, d=0.38) was greater than for REMAS completers in methadone programs (M=2.3, d=0.25). Reasons for why REMAS appears to be especially effective in psychosocial outpatient programs are explored.
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Affiliation(s)
- Donald A Calsyn
- University of Washington Alcohol and Drug Abuse Institute, Seattle, WA 98105, USA.
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110
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Newville H, Haller DL. Psychopathology and transmission risk behaviors in patients with HIV/AIDS. AIDS Care 2010; 22:1259-68. [DOI: 10.1080/09540121003615111] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Howard Newville
- a Ferkauf Graduate School of Psychology , Yeshiva University , 1165 Morris Park Avenue, Bronx , NY , 10461 , USA
- b St. Luke's-Roosevelt Hospital , New York , NY , USA
| | - Deborah L. Haller
- b St. Luke's-Roosevelt Hospital , New York , NY , USA
- c Columbia University College of Physicians and Surgeons , New York , NY , USA
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111
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Vlahov D, Robertson AM, Strathdee SA. Prevention of HIV infection among injection drug users in resource-limited settings. Clin Infect Dis 2010; 50 Suppl 3:S114-21. [PMID: 20397939 PMCID: PMC3114556 DOI: 10.1086/651482] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Injection drug use contributes to considerable global morbidity and mortality associated with human immunodeficiency virus (HIV) infection and AIDS and other infections due to blood-borne pathogens through the direct sharing of needles, syringes, and other injection equipment. Of approximately 16 million injection drug users (IDUs) worldwide, an estimated 3 million are HIV infected. The prevalence of HIV infection among IDUs is high in many countries in Asia and eastern Europe and could exacerbate the HIV epidemic in sub-Saharan Africa. This review summarizes important components of a comprehensive program for prevention of HIV infection in IDUs, including unrestricted legal access to sterile syringes through needle exchange programs and enhanced pharmacy services, treatment for opioid dependence (ie, methadone and buprenorphine treatment), behavioral interventions, and identification and treatment of noninjection drug and alcohol use, which accounts for increased sexual transmission of HIV. Evidence supports the effectiveness of harm-reduction programs over punitive drug-control policies.
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Affiliation(s)
- David Vlahov
- Center for Urban Epidemiologic Studies, New York Academy of Medicine, New York, New York 10029, USA.
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112
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Milloy MJ, Fairbairn N, Hayashi K, Suwannawong P, Kaplan K, Wood E, Kerr T. Overdose experiences among injection drug users in Bangkok, Thailand. Harm Reduct J 2010; 7:9. [PMID: 20465842 PMCID: PMC2880311 DOI: 10.1186/1477-7517-7-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2009] [Accepted: 05/13/2010] [Indexed: 12/02/2022] Open
Abstract
Background Although previous studies have identified high levels of drug-related harm in Thailand, little is known about illicit drug overdose experiences among Thai drug users. We sought to investigate non-fatal overdose experiences and responses to overdose among a community-recruited sample of injection drug users (IDU) in Bangkok, Thailand. Methods Data for these analyses came from IDU participating in the Mit Sampan Community Research Project. The primary outcome of interest was a self-reported history of non-fatal overdose. We calculated the prevalence of past overdose and estimated its relationship with individual, drug-using, social, and structural factors using multivariate logistic regression. We also assessed the prevalence of ever witnessing an overdose and patterns of response to overdose. Results These analyses included 252 individuals; their median age was 36.5 years (IQR: 29.0 - 44.0) and 66 (26.2%) were female. A history of non-fatal overdose was reported by 75 (29.8%) participants. In a multivariate model, reporting a history of overdose was independently associated with a history of incarceration (Adjusted Odds Ratio [AOR] = 3.83, 95% Confidence Interval [CI]: 1.52 - 9.65, p = 0.004) and reporting use of drugs in combination (AOR = 2.48, 95% CI: 1.16 - 5.33, p = 0.019). A majority (67.9%) reported a history of witnessing an overdose; most reported responding to the most recent overdose using first aid (79.5%). Conclusions Experiencing and witnessing an overdose were common in this sample of Thai IDU. These findings support the need for increased provision of evidence-based responses to overdose including peer-based overdose interventions.
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Affiliation(s)
- M-J Milloy
- British Columbia Centre for Excellence in HIV/AIDS, St, Paul's Hospital, 667-1081 Burrard Street, Vancouver, British Columbia, V6Z 1Y6, Canada.
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113
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Kidorf M, King VL, Peirce J, Burke C, Kolodner K, Brooner RK. Psychiatric distress, risk behavior, and treatment enrollment among syringe exchange participants. Addict Behav 2010; 35:499-503. [PMID: 20079972 DOI: 10.1016/j.addbeh.2009.12.033] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2009] [Revised: 12/09/2009] [Accepted: 12/23/2009] [Indexed: 10/20/2022]
Abstract
The present study evaluated psychiatric distress as a predictor of treatment enrollment in out-of-treatment injection opioid users newly registered at the Baltimore Needle Exchange Program (BNEP). Study participants (n=281) completed the Addiction Severity Index (ASI), the Risk Assessment Battery (RAB), and the Symptom Checklist-90 (SCL-90-R), and were randomly assigned to one of three different conditions for 4 months that evaluated referral strategies designed to promote treatment interest and enrollment. The Global Severity Index (GSI) of the SCL-90 was used as a measure of psychiatric distress. A logistic regression showed that higher GSI scores predicted more treatment enrollment (Adjusted OR=2.15, CI=1.10-4.23, p<0.05), after controlling for study condition, demographic variables, syringe exchange site, and severity of drug use. The results suggest that the data from the assessment of psychiatric distress in syringe exchange settings can be used to support motivational strategies for encouraging syringe exchangers to seek substance abuse treatment.
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114
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Chaudhury R, Jones HE, Wechsberg W, O'Grady KE, Tuten M, Chisolm MS. Addiction severity index composite scores as predictors for sexual-risk behaviors and drug-use behaviors in drug-using pregnant patients. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2010; 36:25-30. [PMID: 20141393 DOI: 10.3109/00952990903544810] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND HIV sexual-risk and drug-use behavior predictors have been studied in non-pregnant but not pregnant drug-dependent populations. OBJECTIVE Examine the ability of the ASI composite scores to predict HIV sexual- and drug-risk scores as well as the individual items of a modified version of the Risk Assessment Battery in drug-using pregnant women. METHODS Pregnant women (N = 76) completing pretreatment ASI and HIV-risk questionnaires. RESULTS The Legal composite score was the sole significant predictor of the sexual-risk score, with a 1 SD increase in the Legal composite score resulting in a 24% increase in sexual-risk, p < .001. The Medical, Drug, and Legal composite scores were each significant predictors of the drug-risk score, with a 1 SD increase resulting in a 31% decrease, and 121% and 73% increases, respectively, in drug-risk, all ps < .05. CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE Drug-using pregnant women and their fetuses are vulnerable to the consequences of both sexual-risk behaviors and drug-use. The ASI may help screen such patients for HIV sexual-risk and drug-use behaviors as a first step in tailoring treatment to address these issues.
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Affiliation(s)
- R Chaudhury
- Johns Hopkins University, Baltimore, Maryland, USA
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115
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Abstract
HIV is an increasingly critical and costly health problem for American women. Substance use plays a major role in human immunodeficiency virus (HIV) infection in women. There are several plausible explanations for the association between substance use and HIV risk behavior. Pregnant substance abusers are a population deserving special attention given the prevalence of risk behavior in this population and the added risk of perinatal transmission of HIV. Current guidelines for the screening and treatment of HIV among pregnant women and their infants are delineated. Substance abuse treatment has a limited impact on HIV risk behavior in female substance abusers. Similarly, traditional knowledge-based and skill-based HIV risk reduction interventions have modest efficacy in this population. Hence, there is a need to develop new interventions that directly target sex-related and drug-related HIV risk behavior among female substance abusers. Recent work suggests that the incorporation of motivational interviewing components into traditional HIV risk reduction interventions may be a promising new direction for the field.
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Affiliation(s)
- Susan E Ramsey
- The Warren Alpert Medical School of Brown University, Providence, RI, USA.
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116
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Epperson MW, Khan MR, Miller DP, Perron BE, El-Bassel N, Gilbert L. Assessing criminal justice involvement as an indicator of human immunodeficiency virus risk among women in methadone treatment. J Subst Abuse Treat 2010; 38:375-83. [PMID: 20356702 DOI: 10.1016/j.jsat.2010.03.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2009] [Revised: 02/26/2010] [Accepted: 03/02/2010] [Indexed: 11/27/2022]
Abstract
This study examines the relationship between criminal justice involvement and high-risk sexual partnerships among a random sample of 416 women in methadone treatment in New York City. Logistic regression models were used to estimate the associations between recent criminal justice involvement (arrest or incarceration in the past 6 months) and recent high-risk partnerships (multiple sex partners, sex trading, or sex with a risky partner in the past 6 months) when adjusting for sociodemographic factors and recent regular drug use. Women with recent criminal justice involvement demonstrated higher odds of engaging in high-risk sex partnerships. Although regular drug use was a significant confounder of several of these relationships, recent arrest or incarceration remained significantly associated with multiple sex partnerships, sex with a risky partner, and engaging in unprotected sex and a high-risk partnership even after controlling for regular drug use and other social stressors. This study highlights the vulnerability of drug-involved women offenders to human immunodeficiency virus (HIV) risk and points to the need for investigation into the role of arrest and incarceration as factors that may contribute to HIV infection.
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Affiliation(s)
- Matthew W Epperson
- Center for Behavioral Health Services and Criminal Justice Research, Rutgers University, New Brunswick, NJ 08901, USA.
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117
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Knudsen HK, Oser CB. Availability of HIV-related health services in adolescent substance abuse treatment programs. AIDS Care 2010; 21:1238-46. [PMID: 20024699 DOI: 10.1080/09540120902803182] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Given that alcohol and drug abuse heightens the risk of adolescents acquiring HIV, substance abuse treatment programs for youths may represent an important site of HIV prevention. In this research, we explored the adoption of three HIV-related health services: risk assessment during intake, HIV prevention programing, and HIV testing. Data were collection through telephone interviews with 149 managers of adolescent-only substance abuse treatment programs in the USA. About half of these programs had adopted HIV risk assessment and HIV prevention. On-site HIV testing was less widely adopted, with only one in four programs offering this service. At the bivariate level, the availability of on-site primary medical care and the availability of an overnight level of care were positively associated with these three types of services. The association for the measure of an overnight level of care was no longer significant once medical services were controlled. However, in a separate analysis, it was found that programs offering an overnight level of care were much more likely to offer on-site medical care than outpatient-only facilities. There was also evidence that publicly funded treatment programs were more likely to offer HIV prevention and on-site HIV testing, after controlling for other organizational characteristics. Much more research about the adoption of HIV-related services in adolescent substance abuse treatment is needed, particularly to offer greater insight into why certain types of organizations are more likely to adopt these health services.
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Affiliation(s)
- H K Knudsen
- Department of Behavioral Science and Center on Drug & Alcohol Research, University of Kentucky, KY, USA.
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118
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Canfield KM, Smyth E, Batki SL. Methadone maintenance patients' knowledge, attitudes, beliefs, and experiences concerning treatment for hepatitis C virus infection. Subst Use Misuse 2010; 45:496-514. [PMID: 20141461 DOI: 10.3109/10826080903452538] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Hepatitis C virus (HCV) knowledge, attitudes, beliefs, and experiences (KABE) of 64 HCV antibody positive methadone maintenance treatment (MMT) patients were assessed in conjunction with acceptability of an on-site semi-structured HCV education session, HCV RNA diagnostic testing, HCV treatment motivational assessment, and initiation of HCV treatment. The KABE interviews were conducted in 2006 and 2007 in an urban New York State MMT clinic in affiliation with a NIDA-funded HCV research project. The majority had basic knowledge of HCV disease, but poor understanding of HCV testing and treatment. While the majority of participants expressed fear of HCV treatment side effects, 88% accepted HCV RNA testing and 78% expressed willingness to start HCV treatment with the majority of chronically infected choosing to start HCV treatment medications. Study limitations and implications are discussed.
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Affiliation(s)
- Kelly M Canfield
- Department of Psychiatry, SUNY Upstate Medical University, Syracuse, New York 13210, USA.
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119
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CHE YANHUA, ASSANANGKORNCHAI SAWITRI, MCNEIL EDWARD, CHONGSUVIVATWONG VIRASAKDI, LI JIANHUA, GEATER ALAN, YOU JING. Predictors of early dropout in methadone maintenance treatment program in Yunnan province, China. Drug Alcohol Rev 2010; 29:263-70. [DOI: 10.1111/j.1465-3362.2009.00157.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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120
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Abstract
Drug use and HIV/AIDS remain serious public health issues in the US. The intersection of the twin epidemics of HIV and drug/alcohol use, results in difficult medical management issues for the healthcare providers who work in the HIV prevention and treatment fields. Access to care and treatment, medication adherence to multiple therapeutic regimens and concomitant drug-drug interactions of prescribed treatments are difficult barriers for drug users to overcome without directed interventions. Injection drug users are frequently disenfranchised from medical care and suffer stigma and discrimination creating additional barriers to care and treatment for their substance use disorders as well as HIV infection. Controlling the transmission of HIV will require access to care and treatment of individuals who abuse illicit drugs and alcohol. Improving health outcomes (e.g. access to and adherence to antiretroviral therapy) among HIV-infected substance users will also require access to evidenced-based pharmacological therapies for the treatment of drug abuse and dependence. The current review presents an overview of issues regarding the use of medication-assisted treatments for substance abuse and dependence among HIV-infected individuals, providing medical management paradigms for their care and treatment.
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121
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Calsyn DA, Crits-Christoph P, Hatch-Maillette MA, Doyle SR, Song YS, Coyer S, Pelta S. Reducing sex under the influence of drugs or alcohol for patients in substance abuse treatment. Addiction 2010; 105:100-8. [PMID: 20078464 PMCID: PMC2808629 DOI: 10.1111/j.1360-0443.2009.02812.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIMS In a previous report, the effectiveness of the Real Men Are Safe (REMAS) intervention in reducing the number of unprotected sexual occasions among male drug abuse treatment patients was demonstrated. A secondary aim of REMAS was to reduce the frequency with which men engage in sex under the influence (SUI) of drugs or alcohol. DESIGN Men in methadone maintenance (n = 173) or out-patient psychosocial treatment (n = 104) completed assessments at baseline, 3 and 6 months post-intervention. PARTICIPANTS The participants were assigned randomly to attend either REMAS (five sessions containing information, motivational exercises and skills training, including one session specifically targeting reducing SUI) or human immunodeficiency virus (HIV) education (HIV-Ed; one session containing HIV prevention information). SUI during the most recent sexual event served as the primary outcome in a repeated measures logistic regression model. FINDINGS Men assigned to the REMAS condition reporting SUI at the most recent sexual event decreased from 36.8% at baseline to 25.7% at 3 months compared to a increase from 36.9% to 38.3% in the HIV-Ed condition (t(intervention) = -2.16, P = 0.032). No difference between the treatment groups was evident at 6-month follow-up. At each assessment time-point, sex with a casual partner versus a regular partner, and being in methadone maintenance versus psychosocial out-patient treatment, were associated with engaging in SUI. CONCLUSIONS Overall, a motivational and skills training HIV prevention intervention designed for men was associated with greater reduction in SUI than standard HIV education at the 3-month follow-up.
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Affiliation(s)
- Donald A. Calsyn
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine
,Alcohol and Drug Abuse Institute, University of Washington
| | | | - Mary A. Hatch-Maillette
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine
,Alcohol and Drug Abuse Institute, University of Washington
| | | | - Yong S. Song
- Department of Psychiatry, University of California San Francisco and San Francisco General Hospital, San Francisco, CA
| | - Susan Coyer
- Prestera Center for Mental Health Services Inc., Huntington, WV
| | - Sara Pelta
- Department of Psychiatry, University of California San Francisco and San Francisco General Hospital, San Francisco, CA
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Lauby JL, Batson H, Milnamow M. Effects of drug use on sexual risk behavior: results of an HIV outreach and education program. JOURNAL OF EVIDENCE-BASED SOCIAL WORK 2010; 7:88-102. [PMID: 20178027 DOI: 10.1080/15433710903175965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
We evaluated the effects on drug use and sexual risk of an HIV intervention for out-of-treatment drug users, and assessed the effect of drug use on unprotected sex with main and non-main partners. The intervention significantly reduced unprotected sex with a main partner, but did not affect drug use or unprotected sex with non-main partners. Participants who stopped using drugs by follow-up were less likely to have unprotected sex with both main and other partners.
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Affiliation(s)
- Jennifer L Lauby
- Philadelphia Health Management Corporation, Philadelphia, Pennsylvania 19102, USA.
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123
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Affiliation(s)
- Julia Dickson-Gomez
- Psychiatry and Behavioral Medicine, Center for AIDS Intervention Research, Medical College of Wisconsin, Milwaukee, Wisconsin 53202, USA.
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124
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Rash CJ, Petry NM. Alcohol use and gender effects on HIV risk behaviors in cocaine-using methadone patients. ACTA ACUST UNITED AC 2009; 2009:25-32. [PMID: 20700471 DOI: 10.2147/nbhiv.s6871] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Injection drug users engage in behaviors that increase the spread of human immunodeficiency virus (HIV) and other infectious diseases. Although methadone maintenance (MM) is highly effective in decreasing heroin use and the spread of HIV, polydrug use, especially the combined use of cocaine and alcohol, is common in MM patients. Alcohol use is independently associated with HIV risk behaviors, and the effects of alcohol use on risk behaviors may vary by gender. This study evaluated the effects of recent heavy alcohol use and gender with respect to HIV risk behaviors in 118 cocaine-abusing methadone patients. Both lifetime and past month injection and sexual risk behaviors were examined. Recent heavy drinkers (n = 46) were more likely to be male than nonheavy drinkers (n = 72). Recent heavy drinkers reported more risky sexual behaviors over their lifetimes than nonheavy drinkers. Gender effects were also present for lifetime risk behaviors, with females demonstrating more sexual and injection risk behaviors than men. In terms of recent injection risk behaviors, there was a significant alcohol use by gender effect. Heavy drinking females reported significantly more drug-sharing behaviors and less frequent needle cleaning than nonheavy drinking females. Recent sexual behaviors did not differ based on alcohol use status or gender. These findings may inform HIV prevention strategies in cocaine-abusing MM patients, and they suggest that cocaine-abusing women who drink heavily are a particularly high risk group who should be counseled about risky injection drug use practices.
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Affiliation(s)
- Carla J Rash
- Department of Psychiatry, University of Connecticut Health Center, Farmington, CT, USA
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125
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Song YS, Calsyn DA, Doyle SR, Dierst-Davies R, Chen T, Sorensen JL. Predictors of condom use among men enrolled in drug treatment programs. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2009; 21:460-473. [PMID: 19842829 PMCID: PMC3689147 DOI: 10.1521/aeap.2009.21.5.460] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
This study identified predictors of condom use and developed a model of condom use in a sample of men (n = 324) enrolled in drug treatment. Utilizing a series of logistic regression analyses reported condom use was predicted by possession of condoms, future intention to use condoms, future intention to increase condom use, having a high-risk partner, low Condom Barriers Scale scores, being unmarried and ethnic minority status. A probit path analysis revealed the following model of condom use among men in drug treatment: Taking condoms from clinic stocks was the best predictor of condom possession, which in turn was the best predictor of condom use. These study findings identify condom availability in treatment programs as an important risk reduction intervention. Treatment programs can apply these predictors of condom use to better identify individuals at risk for HIV and sexually transmitted infections to better target prevention interventions.
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Affiliation(s)
- Yong S Song
- Department of Psychiatry, University of California at San Francisco at San Francisco General Hospital, USA.
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126
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Campbell BK, Fuller BE, Lee ES, Tillotson C, Woelfel T, Jenkins L, Robinson J, Booth RE, McCarty D. Facilitating outpatient treatment entry following detoxification for injection drug use: a multisite test of three interventions. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2009; 23:260-70. [PMID: 19586142 DOI: 10.1037/a0014205] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
A multisite, randomized trial within the National Drug Abuse Treatment Clinical Trials Network (CTN) was conducted to test 3 interventions to enhance treatment initiation following detoxification: (a) a single session, therapeutic alliance intervention (TA) added to usual treatment; (b) a 2-session, counseling and education, HIV/HCV risk reduction intervention (C&E), added to usual treatment; and (c) treatment as usual (TAU) only. Injection drug users (n=632) enrolled in residential detoxification at 8 community treatment programs were randomized to 1 of the 3 study conditions. TA participants reported entering outpatient treatment sooner and in greater numbers than TAU participants. Reported treatment entry for C&E fell between TA and TAU with no significant differences between C&E and the other conditions. There were no differences among the interventions in retention, as measured by weeks of outpatient treatment for all participants who reported treatment entry. Alliance building interventions appear to be effective in facilitating transfer from detoxification to outpatient treatment, but additional treatment engagement interventions may be necessary to improve retention.
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Affiliation(s)
- Barbara K Campbell
- Department of Public Health and Preventive Medicine, Oregon Health & Science University, Portland, OR 97209, USA.
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127
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Beyrer C, Patel Z, Stachowiak JA, Tishkova FK, Stibich MA, Eyzaguirre LM, Carr JK, Mogilnii V, Peryshkina A, Latypov A, Strathdee SA. Characterization of the emerging HIV type 1 and HCV epidemics among injecting drug users in Dushanbe, Tajikistan. AIDS Res Hum Retroviruses 2009; 25:853-60. [PMID: 19689193 DOI: 10.1089/aid.2008.0206] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
This study aimed to determine HIV, HCV, and syphilis prevalence and correlates, and to characterize the molecular epidemiology of HIV-1 among injecting drug users (IDUs) in Dushanbe, Tajikistan. A cross-sectional study assessing risk factors for HIV and HCV through an interview administered survey was conducted. A total of 491 active adult IDUs were recruited from May to November 2004 in Dushanbe, Tajikistan. HIV-1 antibody status was determined with rapid testing and confirmed with ELISA. HCV antibody testing was conducted using a BIOELISA HCV kit. HIV-1 subtyping was done on a subset with full-length sequencing. Correlates of HIV and HCV infection were assessed using logistic regression. Overall prevalence of HIV was 12.1%, HCV was 61.3%, and syphilis was 15.7%. In a multivariate logistic regression model controlling for gender and ethnicity, daily injection of narcotics [odds ratio (OR) OR 3.22] and Tajik nationality (OR 7.06) were significantly associated with HIV status. Tajik nationality (OR 1.91), history of arrest (OR 2.37), living/working outside Tajikistan in the past 10 years (OR 2.43), and daily injection of narcotics (OR 3.26) were significantly associated with HCV infection whereas being female (OR 0.53) and always using a sterile needle (OR 0.47) were inversely associated with HCV infection. Among 20 HIV-1-positive IDU with specimens available for typing, 10 were subtype A, 9 were CRF02_AG, and one was an A-CRF02_AG recombinant. Epidemics of HIV-1, HCV, and drug use are underway in Dushanbe. The molecular epidemiology is distinctive, with West African variants accounting for roughly 50% of prevalent infections. Targeted prevention programs offering both needle exchange programs and opiate substitution therapies are urgently called for to prevent the further spread of HIV and HCV in Tajikistan.
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Affiliation(s)
- Chris Beyrer
- Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, Baltimore, Maryland 21205
| | - Zeenat Patel
- Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, Baltimore, Maryland 21205
| | - Julie A. Stachowiak
- Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, Baltimore, Maryland 21205
| | - Farida K. Tishkova
- Tajik Scientific and Research Institute of Prevention Medicine, Federal Virology Laboratory, Dushanbe, Tajikistan
| | - Mark A. Stibich
- AIDS infoshare Russia, Dorozhny Proezd, dom 9/10, Moscow 113545, Russia
| | | | - Jean K. Carr
- Henry M. Jackson Foundation, 1401 Rockville Pike, Rockville, Maryland 20852
| | - Vladimir Mogilnii
- AIDS infoshare Russia, Dorozhny Proezd, dom 9/10, Moscow 113545, Russia
| | - Alena Peryshkina
- AIDS infoshare Russia, Dorozhny Proezd, dom 9/10, Moscow 113545, Russia
| | - Alisher Latypov
- Tajik Scientific and Research Institute of Prevention Medicine, Federal Virology Laboratory, Dushanbe, Tajikistan
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128
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Calsyn DA, Hatch-Maillette M, Tross S, Doyle SR, Crits-Christoph P, Song YS, Harrer JM, Lalos G, Berns SB. Motivational and skills training HIV/sexually transmitted infection sexual risk reduction groups for men. J Subst Abuse Treat 2009; 37:138-50. [PMID: 19150206 PMCID: PMC2749552 DOI: 10.1016/j.jsat.2008.11.008] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2008] [Revised: 10/17/2008] [Accepted: 11/24/2008] [Indexed: 10/21/2022]
Abstract
The effectiveness of a motivational and skills training HIV/AIDS group intervention designed for men in substance abuse treatment was evaluated. Men in methadone maintenance (n = 288) or outpatient psychosocial treatment (n = 302) completed assessments at baseline, 2 weeks, 3 months, and 6 months postintervention. Participants were randomly assigned to attend either Real Men Are Safe (REMAS; five sessions containing information, motivational exercises, and skills training) or HIV education (HIV-Ed; one session containing HIV prevention information). REMAS participants engaged in significantly fewer unprotected vaginal and anal sexual intercourse occasions (USO) during the 90 days prior to the 3- and 6-month follow-ups than HIV-Ed participants. Completing REMAS resulted in an even stronger effect: Completers reduced their number of USO by 21% from baseline to 6-month follow-up. In contrast, HIV-Ed completers increased the number of USO by 2%. A motivational and skills training HIV prevention intervention designed for men was associated with greater sexual risk reduction over standard HIV-Ed. Substance abuse treatment programs can therefore help reduce sexual risk among their clientele by providing a more intensive intervention than what is traditionally provided.
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Affiliation(s)
- Donald A Calsyn
- Alcohol and Drug Abuse Institute, University of Washington, Seattle, WA 98105, USA.
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129
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Cao D, Marsh JC, Shin HC. Gender and Racial/Ethnic Disparities in the Impact of HIV Prevention Programming in Substance Abuse Treatment. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2009; 34:730-40. [DOI: 10.1080/00952990802311209] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Dingcai Cao
- Departments of Health Studies and Ophthalmology and Visual Science, University of Chicago, Illinois, USA
| | - Jeanne C. Marsh
- School of Social Service Administration, University of Chicago, Chicago, Illinois, USA
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130
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Brown LS, Kritz S, Muhammad A, Bini EJ, Goldsmith RJ, Robinson J, Alderson D, Hasin DS, Rotrosen J. Disparities in Health Services for HIV/AIDS, Hepatitis C Virus, and Sexually Transmitted Infections: Role of Substance Abuse Treatment Programs. J Addict Med 2009; 3:95-102. [PMID: 20161081 PMCID: PMC2743506 DOI: 10.1097/adm.0b013e318190f0e7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES This report focused upon the availability of infection-related health services in substance abuse treatment programs with and without addiction services tailored for special populations (women and non-white populations). METHODS In a cross-sectional, descriptive design, treatment program administrators across the United States within the National Drug Abuse Treatment Clinical Trials Network provided information on program characteristics, the availability of infection-related services (four medical services and three non-medical services for HIV, HCV, and STI), and barriers to providing infection-related services. RESULTS Of 319 programs, 269 submitted surveys (84% response rate). Of these, 80% provided addiction services for special populations. Programs providing addiction services designed for at least one special population, were more likely to provide infection-related health services, especially HIV-related education (94% versus 85%, p = 0.05) and patient counseling (76% versus 60%, p = 0.03) and were more likely to include outpatient addiction services (86% versus 57%, p<0.001) and outreach and support services (92% versus 70%, p=0.01). Barriers to providing infection-related services included funding (cited by 48.3% to 74.7% of programs), health insurance (cited by 28.9% to 60.8% of programs), and patient acceptance (cited by 23.2% to 54.3% of programs). CONCLUSIONS Despite many barriers, infection-related healthcare is available in programs with addiction treatment services tailored for special populations, especially for African Americans and Latino Americans. Tailoring substance abuse treatment along with reducing barriers to infection-related care represent public health interventions with potential to reduce the burdens and disparities associated with these infections.
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Affiliation(s)
- Lawrence S. Brown
- Addiction Research and Treatment Corporation, Brooklyn, NY
- Department of Public Health, Weill Medical College, Cornell University, New York, NY
| | - Steven Kritz
- Addiction Research and Treatment Corporation, Brooklyn, NY
| | | | - Edmund J. Bini
- Department of Gastroenterology, VA New York Harbor Healthcare System and New York University School of Medicine, New York, NY
| | - R. Jeffrey Goldsmith
- Department of Psychiatry, Cincinnati VA Medical Center, University of Cincinnati, Cincinnati, OH
| | | | | | - Deborah S Hasin
- Mailman School of Public Health and Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY
| | - John Rotrosen
- Department of Psychiatry, New York University School of Medicine and VA New York Harbor Healthcare System, New York, NY
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131
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Kidorf M, King VL, Neufeld K, Peirce J, Kolodner K, Brooner RK. Improving substance abuse treatment enrollment in community syringe exchangers. Addiction 2009; 104:786-95. [PMID: 19413790 DOI: 10.1111/j.1360-0443.2009.02560.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM The present study evaluated the effectiveness of an intervention combining motivational enhancement and treatment readiness groups, with and without monetary incentives for attendance and treatment enrollment, on enhancing rates of substance abuse treatment entry among new registrants at the Baltimore Needle Exchange Program (BNEP). DESIGN Opioid-dependent study participants (n = 281) referred by the BNEP were assigned randomly to one of three referral interventions: (i) eight individual motivational enhancement sessions and 16 treatment readiness group sessions (motivated referral condition--MRC); (ii) the MRC intervention with monetary incentives for attending sessions and enrolling in treatment--MRC+I); or (iii) a standard referral condition which directed participants back to the BNEP for referral (standard referral-SRC). Participants were followed for 4 months. FINDINGS MRC+I participants were more likely to enroll in any type of treatment than MRC or SRC participants (52.1% versus 31.9% versus 35.5%; chi(2) = 9.12, P = 0.01), and more likely to enroll in treatment including methadone than MRC or SRC participants (40.4% versus 20.2% versus 16.1%; chi(2) = 16.65, P < 0.001). MRC+I participants also reported less heroin and injection use than MRC and SRC participants. CONCLUSIONS Syringe exchange sites can be effective platforms to motivate opioid users to enroll in substance abuse treatment and ultimately reduce drug use and number of drug injections.
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Affiliation(s)
- Michael Kidorf
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA.
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132
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Zanini B, Lanzini A. Antiviral Treatment for Chronic Hepatitis C in Illicit drug Users: A Systematic Review. Antivir Ther 2009. [DOI: 10.1177/135965350901400410] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
According to recent World Health Organization data, approximately 170–200 million people worldwide are infected with hepatitis C virus (HCV). At present, illicit drug users (IDUs) constitute the largest group of individuals infected with HCV in industrial countries. Between 50% and 90% of IDUs are estimated to be positive for anti-HCV antibodies and most of the new infections occur in IDUs. The aim of our review is to focus on tertiary prevention of HCV infection among IDUs. We review strategies to prevent HCV infection and disease progression, attitude to antiviral treatment, access to specific HCV therapy and data of efficacy and safety of antiviral treatment among IDUs.
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Affiliation(s)
- Barbara Zanini
- Gastroenterology Unit, University and Spedali Civili of Brescia, Brescia, Italy
| | - Alberto Lanzini
- Gastroenterology Unit, University and Spedali Civili of Brescia, Brescia, Italy
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133
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Kivelä PS, Krol A, Partanen ALA, Ristola MA. High prevalence of unprotected sex among Finnish HIV-positive and HIV-negative injecting drug users. Scand J Public Health 2009; 37:357-63. [PMID: 19372233 DOI: 10.1177/1403494809105290] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIMS To study the prevalence of sexual risk behaviour and to identify factors associated with inconsistent condom use of Finnish injecting drug users (IDUs), and thus to examine the potential of sexual transmission of HIV within and from this population. METHODS HIV-positive (n = 89) and HIV-negative (n = 207) IDUs from the Helsinki metropolitan area were interviewed using a standardized questionnaire. Determinants of inconsistent condom use in the past 6 months were analyzed with logistic regression. RESULTS Inconsistent condom use was reported by 63% (39) of HIV-positive and 80% (144) of HIV-negative sexually active IDUs. Unprotected sex was more common in steady relationships (OR 5.6, CI 2.4-13.4). Inconsistent condom use was also associated with recent inpatient addiction treatment especially in the HIV-positive group (OR 15.7, 95% CI 1.7-143.0). Inpatient or outpatient addiction treatment was reported by 72% of the participants. Inconsistent condom use was not associated with age, gender, drug use frequency or markers of marginalization (unstable living, unemployment). CONCLUSIONS Inconsistent condom use allows for the spread of HIV and other sexually transmitted infections among Finnish IDUs. Addiction treatment programmes should include interventions focused on sexual behaviour to all of their clients. Partners of IDUs should be actively offered HIV counselling and testing.
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Affiliation(s)
- Pia S Kivelä
- Division of Infectious Diseases, Helsinki University Central Hospital, Helsinki, Finland.
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134
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Predictors of opiate agonist treatment retention among injection drug users referred from a needle exchange program. J Subst Abuse Treat 2009; 36:306-12. [DOI: 10.1016/j.jsat.2008.07.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2008] [Revised: 06/24/2008] [Accepted: 07/17/2008] [Indexed: 10/21/2022]
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135
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Corsi KF, Lehman WK, Booth RE. The effect of methadone maintenance on positive outcomes for opiate injection drug users. J Subst Abuse Treat 2009; 37:120-6. [PMID: 19150202 DOI: 10.1016/j.jsat.2008.11.004] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2008] [Revised: 09/25/2008] [Accepted: 11/24/2008] [Indexed: 10/21/2022]
Abstract
This study examined outcome variables for 160 opiate injection drug users (IDUs) who entered methadone maintenance between baseline and 6-month follow-up. Outcome variables of interest included drug use, productivity, and HIV risk behaviors. Participants were recruited through street outreach in Denver, CO, from 2000 through 2004 using targeted sampling. The sample was primarily men, White (48%), averaged 39 years of age, and had been injecting drugs for an average of nearly 20 years. Significant improvements were found in univariate tests. Logistic regression revealed that spending more time in treatment was a significant predictor of positive outcomes on drug use and HIV risk behaviors. The results underscore the importance of retaining IDUs in methadone maintenance to maximize their treatment success. Results from this study show that time in treatment can affect many aspects of the participant's life in a positive way, including reduction of HIV risk.
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Affiliation(s)
- Karen F Corsi
- Department of Psychiatry, University of Colorado Denver School of Medicine, Denver, CO, USA.
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136
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Barry D, Weinstock J, Petry NM. Ethnic differences in HIV risk behaviors among methadone-maintained women receiving contingency management for cocaine use disorders. Drug Alcohol Depend 2008; 98:144-53. [PMID: 18684571 PMCID: PMC2614896 DOI: 10.1016/j.drugalcdep.2008.06.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2008] [Revised: 06/12/2008] [Accepted: 06/14/2008] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To identify ethnic differences in HIV risk behaviors among cocaine using women receiving methadone maintenance for opioid dependence, and to evaluate the efficacy of contingency management (CM) for cocaine use disorders in reducing HIV risk behaviors. METHODS African American (N=47), Hispanic (N=47), and White women (N=29) were randomized to standard methadone treatment or standard methadone treatment plus a CM intervention. They completed the HIV Risk Behavior Scale (HRBS) indicating frequency of drug use and sexual behaviors across the lifetime, in the month before baseline, and in the 3 months following clinical trial participation. Ethnic group differences and the effect of CM on change in HIV risk behaviors between baseline and follow-up were evaluated. RESULTS White women reported significantly higher lifetime rates of risky drug use and sexual behaviors on the HRBS than African American women; neither group differed significantly from Hispanic women. No ethnic group differences in HIV risk behaviors were identified in the month prior to baseline. At follow-up, African American women reported fewer high-risk drug use behaviors than White or Hispanic women, and Hispanic women reported more high-risk sexual behaviors than White or African American women. CM was associated with reduction in high-risk drug use behaviors regardless of ethnicity, but did not affect high-risk sexual behaviors. CONCLUSIONS White women receiving methadone maintenance engage in more lifetime HIV risk behaviors than African American women. CM for cocaine use reduces risky drug use behaviors, but certain ethnic groups may benefit from additional targeted HIV prevention efforts.
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Affiliation(s)
- Danielle Barry
- Department of Psychiatry, University of Connecticut Health Center, Farmington, CT 06030, United States
| | - Jeremiah Weinstock
- Department of Psychiatry, University of Connecticut Health Center, Farmington, CT 06030, United States
| | - Nancy M. Petry
- Department of Psychiatry, University of Connecticut Health Center, Farmington, CT 06030, United States
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137
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Effectiveness of HIV/STD sexual risk reduction groups for women in substance abuse treatment programs: results of NIDA Clinical Trials Network Trial. J Acquir Immune Defic Syndr 2008; 48:581-9. [PMID: 18645513 DOI: 10.1097/qai.0b013e31817efb6e] [Citation(s) in RCA: 93] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
CONTEXT Because drug-involved women are among the fastest growing groups with AIDS, sexual risk reduction intervention for them is a public health imperative. OBJECTIVE To test effectiveness of HIV/STD safer sex skills building (SSB) groups for women in community drug treatment. DESIGN Randomized trial of SSB versus standard HIV/STD Education (HE); assessments at baseline, 3 and 6 months. PARTICIPANTS Women recruited from 12 methadone or psychosocial treatment programs in Clinical Trials Network of National Institute on Drug Abuse. Five hundred fifteen women with >or=1 unprotected vaginal or anal sex occasion (USO) with a male partner in the past 6 months were randomized. INTERVENTIONS In SSB, five 90-minute groups used problem solving and skills rehearsal to increase HIV/STD risk awareness, condom use, and partner negotiation skills. In HE, one 60-minute group covered HIV/STD disease, testing, treatment, and prevention information. MAIN OUTCOME Number of USOs at follow-up. RESULTS A significant difference in mean USOs was obtained between SSB and HE over time (F = 67.2, P < 0.0001). At 3 months, significant decrements were observed in both conditions. At 6 months, SSB maintained the decrease and HE returned to baseline (P < 0.0377). Women in SSB had 29% fewer USOs than those in HE. CONCLUSIONS Skills building interventions can produce ongoing sexual risk reduction in women in community drug treatment.
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138
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Ghitza UE, Epstein DH, Preston KL. Self-report of illicit benzodiazepine use on the Addiction Severity Index predicts treatment outcome. Drug Alcohol Depend 2008; 97:150-7. [PMID: 18499354 PMCID: PMC2553754 DOI: 10.1016/j.drugalcdep.2008.04.003] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2008] [Revised: 04/07/2008] [Accepted: 04/07/2008] [Indexed: 10/22/2022]
Abstract
The relationship between pre-treatment illicit benzodiazepine use (days of use in the last 30) assessed on the Addiction Severity Index (ASI) and treatment outcome was investigated by retrospective analysis of data from two controlled clinical trials in 361 methadone maintained cocaine/opiate users randomly assigned to 12-week voucher- or prize-based contingency management (CM) or control interventions. Based on screening ASI, participants were identified as non-users (BZD-N; 0 days of use) or users (BZD-U; >0 days of use). Outcome measures were: urine drug screens (thrice weekly); quality of life and self-reported HIV-risk behaviors (every 2 weeks); and current DSM-IV diagnosis of cocaine and heroin dependence (study exit). In the CM group, BZD-U had significantly worse outcomes on in-treatment cocaine use, quality-of-life scores, needle-sharing behaviors, and current heroin dependence diagnoses at study exit compared to BZD-N. In the control group, BZD-U had significantly higher in-treatment cocaine use but did not differ from BZD-N on psychosocial measures. Thus, in a sample of non-dependent BZD users, self-reported illicit BZD use on the ASI, even at low levels, predicted worse outcome on cocaine use and blunted response to CM.
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139
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A comparison of 1-year substance abuse treatment outcomes in community syringe exchange participants versus other referrals. Drug Alcohol Depend 2008; 97:122-9. [PMID: 18486360 PMCID: PMC2601705 DOI: 10.1016/j.drugalcdep.2008.03.026] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2007] [Revised: 03/26/2008] [Accepted: 03/26/2008] [Indexed: 02/07/2023]
Abstract
This longitudinal cohort study of 324 consecutive admissions to methadone maintenance treatment between 08/1994 and 09/1997 compared 1-year outcomes of opioid-dependent patients referred from a syringe exchange program (SEP; n=81) versus other sources (n=243). All participants received stepped-based counseling. The Addiction Severity Index was completed upon admission. Treatment outcomes were assessed using weekly urine testing and days in treatment. GEE regression models were used to evaluate the association between baseline variables and treatment outcomes. SEP referrals were older, included more males and African Americans, reported greater unemployment and heavier heroin, cocaine, and injection drug use at admission. During treatment, SEP referrals used more opioids (OR 2.57; 95% CI 1.86-3.56) and cocaine (OR 2.77; 95% CI 1.93-3.95), and were less likely to complete 1 year (35%) compared to other referrals (56%; hazard ratio 1.88; 95% CI 1.35-2.62). Nevertheless, referral source was not significantly associated with outcome when adjusted for baseline characteristics. Greater baseline frequency of substance and injection drug use, and younger age were positively associated with ongoing opioid and cocaine use. African American race and baseline unemployment were also associated with ongoing cocaine use. Younger age and greater baseline cocaine use were associated with poorer retention at 1 year. The poorer treatment response of SEP referrals is likely due to higher baseline problem severity. Specialized interventions may be required to reduce drug use and improve retention in this population.
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140
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Doyle SR, Calsyn DA, Ball SA. Factor structure of the Condoms Barriers Scale with a sample of men at high risk for HIV. Assessment 2008; 16:3-15. [PMID: 18689777 DOI: 10.1177/1073191108322259] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study assesses the psychometric properties of the Condom Barriers Scale (CBS), an instrument originally designed to measure women's perceptions and attitudes regarding male condom use, with a sample of men at high risk for human immunodeficiency virus (HIV). Participants include 590 male patients in drug abuse treatment involved in a gender-specific HIV prevention intervention for teaching safer sex skills. Second-order confirmatory factor analysis generally supported the underlying four-factor subscale structure of the CBS. However, exploratory factor analysis revealed a few specific discrepancies in the factor structure between men and women. Internal consistency and test-retest reliability estimates were moderate to high in value. CBS scores correlated with use of condoms for men with high-risk sexual partners, supporting criterion-related validity. Overall, the analysis indicates that the CBS is a potentially valid and reliable instrument and has utility for assessing barriers to condom use with men, but may need some item content modifications to allow appropriate assessment of gender differences and comparisons across studies.
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Affiliation(s)
- Suzanne R Doyle
- Alcohol and Drug Abuse Institute, University of Washington, Seattle, WA 98105-4631, USA.
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141
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Kidorf M, King VL. Expanding the public health benefits of syringe exchange programs. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2008; 53:487-95. [PMID: 18801210 DOI: 10.1177/070674370805300803] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To provide a brief history of community syringe exchange programs (SEPs), describe the clinical profile of those who attend them, identify factors interfering with the transition of SEP participants to more comprehensive substance abuse treatment services, review studies designed to improve rates of treatment seeking, and offer practical suggestions to facilitate links between SEPs and substance abuse treatment. METHOD Relevant articles were identified using a PubMed literature search of English-language journals from 1997 to 2007. Studies were included that evaluated the effectiveness of SEPs or methods for increasing treatment enrolment in SEP participants or other out-of-treatment intravenous drug users. Relevant articles prior to 1997 were identified using reference lists of identified articles. RESULTS SEPs have little impact on rates of drug use or injections. Substance abuse treatment reduces human immunodeficiency virus transmission through drug use reduction and psychosocial functioning improvement, yet SEP participants only infrequently engage in treatment. Psychological and pharmacological interventions delivered at the SEP setting can improve treatment seeking in SEP participants. Use of SEPs by substance abuse treatment programs can improve harm-reduction efforts at these settings. CONCLUSIONS Efforts to improve the link between SEPs and substance abuse treatment should include interventions to enhance cooperation across programs, motivate treatment enrolment and SEP use, and expand access to treatment. A more fluent and bidirectional continuum of services can enhance the public health benefits of both of these health care delivery settings.
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Affiliation(s)
- Michael Kidorf
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
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142
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Willner-Reid J, Belendiuk KA, Epstein DH, Schmittner J, Preston KL. Hepatitis C and human immunodeficiency virus risk behaviors in polydrug users on methadone maintenance. J Subst Abuse Treat 2008; 35:78-86. [PMID: 17931826 PMCID: PMC2600879 DOI: 10.1016/j.jsat.2007.08.011] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2007] [Revised: 07/11/2007] [Accepted: 08/08/2007] [Indexed: 11/22/2022]
Abstract
We examined the impact of methadone maintenance treatment (MMT) on risk behaviors for transmission of blood-borne diseases in polydrug users who had tested positive or negative for hepatitis C virus (HCV). At intake, HCV-positive participants (n=362) engaged in more human immunodeficiency virus (HIV) risk behaviors (as measured by the HIV Risk-Taking Behavior Scale) than HCV-negative participants (n=297; p< .001). This difference was specific to injection-related behaviors and decreased significantly within the first few weeks of MMT (p< .0001). Where needles continued to be used, HCV-positive participants became more likely over time to engage in safer injecting practices. Furthermore, HCV-positive participants became more likely to use condoms than HCV-negative participants. These findings demonstrate that both drug- and sex-related risk behaviors decrease during MMT and emphasize the benefits of methadone programs for public health and HIV/HCV prevention.
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143
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Hanson T, Alessi SM, Petry NM. Contingency management reduces drug-related human immunodeficiency virus risk behaviors in cocaine-abusing methadone patients. Addiction 2008; 103:1187-97. [PMID: 18494842 DOI: 10.1111/j.1360-0443.2008.02216.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM Contingency management (CM) is efficacious in reducing drug use. This study examined whether CM also reduces human immunodeficiency virus (HIV) risk behaviors and if these effects are mediated by longest duration of abstinence achieved during treatment. DESIGN Data were analyzed from a subset of participants in a combined data set of three published randomized controlled trials of CM treatments. SETTING A community-based methadone maintenance clinic. PARTICIPANTS One-hundred and sixty-five cocaine-abusing methadone maintenance patients. INTERVENTION Participants received either standard methadone treatment or standard methadone treatment with CM for 3 months. MEASUREMENTS The HIV Risk Behavior Scale (HRBS) was administered prior to randomization to a study condition and 3 months after the study treatments ended. The primary objective indicator of drug use was longest duration of cocaine and opioid abstinence achieved during treatment. FINDINGS Relative to those assigned to standard care, participants receiving CM significantly decreased overall HIV risk behaviors and injection drug use risk behaviors. CM participants also achieved longer durations of consecutive cocaine and opioid abstinence during treatment. Duration of abstinence achieved mediated the relationship between treatment condition and HRBS difference scores. CONCLUSIONS These results suggest that CM treatment reduces HIV drug use risk behaviors in cocaine-abusing methadone maintenance patients.
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Affiliation(s)
- Tressa Hanson
- University of Connecticut Health Center, 263 Farmington Avenue, Farmington, CT 06030-3944, USA
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144
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Abstract
During the last three decades, both the injection of illicit psychoactive drugs and HIV infection among injecting drug users (IDUs) have spread throughout industrialized and developing countries. Extremely rapid transmission of HIV has occurred in IDU populations with incidence rates of 10 to 50/100 person-years. In sharp contrast, there are many examples of very effective HIV risk reduction for IDUs, both in preventing initial epidemics and in bringing existing epidemics under control. IDUs are capable of learning basic information about HIV/AIDS and modifying their behavior to protect both themselves and their peers. Effective HIV prevention for IDUs requires programs that treat IDUs with dignity and respect, provide accurate information and the means for behavior change-access to sterile injection equipment, condoms, and drug abuse treatment. Programs that provide these services need to be implemented on a public health scale for IDU populations at risk for HIV infection.
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145
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Qian HZ, Hao C, Ruan Y, Cassell HM, Chen K, Qin G, Yin L, Schumacher JE, Liang S, Shao Y. Impact of methadone on drug use and risky sex in China. J Subst Abuse Treat 2008; 34:391-7. [PMID: 17869049 DOI: 10.1016/j.jsat.2007.07.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2007] [Revised: 06/08/2007] [Accepted: 07/01/2007] [Indexed: 10/22/2022]
Abstract
This study examined the impact of methadone on drug-using and risky sexual behaviors among 557 heroin injection drug users in one of the first methadone programs in China. Structured questionnaires were administered to collect data on methadone utilization, drug use, and risky sexual behaviors. Blood samples were tested for blood-borne infections. Multivariate logistic analyses revealed that, among opioid-addicted individuals, methadone participants were less likely to use or inject drugs and share needles than nonparticipants. They also were less likely to have multiple sexual partners or have unprotected sex. Those currently enrolled in methadone maintenance had lower risk of using and injecting drugs than those who were no longer receiving methadone. Data suggest positive, short-term impact on these important behaviors, but further studies are needed to examine the long-term impact of methadone treatment on disease rates.
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Affiliation(s)
- Han-Zhu Qian
- Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
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146
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Contingency management reduces injection-related HIV risk behaviors in heroin and cocaine using outpatients. Addict Behav 2008; 33:593-604. [PMID: 18068905 DOI: 10.1016/j.addbeh.2007.11.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2007] [Revised: 11/01/2007] [Accepted: 11/07/2007] [Indexed: 11/20/2022]
Abstract
Intravenous drug use is a major vector of HIV transmission. We assessed whether contingency management (CM), in which participants earn reinforcers for drug abstinence, reduces HIV risk behaviors in methadone-maintained opiate- and cocaine-using outpatients. Participants (n=116) were randomly assigned to prize-based CM or to receipt of prize draws noncontingently on a schedule yoked to the CM group. Both groups received methadone and individual counseling throughout treatment. The HIV-Risk Taking Behaviour Scale was administered in written questionnaire form at 2-week intervals (HRBS; [Darke, S., Hall, W., Heather, N., Ward, J., & Wodak, A. (1991). The reliability and validity of a scale to measure HIV risk-taking behaviour among intravenous drug users. AIDS, 5, 181-185]). A mediation analysis was conducted to determine whether abstinence from opiates and cocaine mediated the effect of CM on HRBS scores. Changes in HRBS scores over time differed significantly by treatment (F(9,334)=2.4, p<0.05), with HRBS scores decreasing over time in the CM group to a greater extent than in the noncontingent control group. Participants in the CM group had significantly lower rates of simultaneous cocaine/opiate-positive urine specimens than those in the noncontingent control group during CM treatment (F(1,111)=6.8, p=0.01). The relationship between treatment condition and HRBS scores was mediated by abstinence. CM targeted toward cocaine and heroin use produces significant reductions in injection-related drug-taking behaviors associated with heightened risk for getting or transmitting HIV.
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147
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Holmes L, Monjok E, Ward D, Garrison OM, Toney ED, Ogungbade G, Essien EJ. Racial variance in rationale for HIV testing in community-based setting in the United States: evidence from the National Health Interview Survey. JOURNAL OF THE INTERNATIONAL ASSOCIATION OF PHYSICIANS IN AIDS CARE (CHICAGO, ILL. : 2002) 2008; 7:61-8. [PMID: 18319512 PMCID: PMC2391243 DOI: 10.1177/1545109708315327] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND HIV testing varies across racial/ethnic groups in the United States, but it is unclear whether the rationale for testing differs as well racially. The authors aimed to assess the rationale for HIV testing and the racial/ethnic variation therein. METHODS Using the National Health Interview Survey 2003 (n = 29 753), the authors examined the association between rationale for HIV testing and race. Chi-square statistic and multinomial logistic regression analyses were used to test for racial differences and the effect of race/ethnicity on the rationale for HIV testing. RESULTS There was a statistically significant racial difference with respect to HIV testing rationale, chi(2) = (24, N = 10,481) = 808.9, P < .001. After adjustment for relevant covariates, compared with Caucasians, African Americans were 37% less likely to be tested due to exposure to sex/drugs, whereas Hispanics were not (prevalence risk ratio [PRR], 0.63, 95% confidence interval [CI] = 0.47-0.84, respectively). Likewise African Americans and Hispanics were less likely to be tested if they were sick or had a medical problem (PRR = 0.66, 95% CI = 0.44-0.99 and PRR = 0.65, 95% CI = 0.43-0.98). CONCLUSIONS Substantial racial variation occurred in the reasons for being tested for HIV in the United States, indicative of the need to understand such rationale for effective HIV screening and testing.
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Affiliation(s)
- Laurens Holmes
- Institute of Community Health, University of Houston, Texas Medical Center, Houston, TX 77030, USA.
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148
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Bobrova N, Rughnikov U, Neifeld E, Rhodes T, Alcorn R, Kirichenko S, Power R. Challenges in providing drug user treatment services in Russia: providers' views. Subst Use Misuse 2008; 43:1770-84. [PMID: 19016164 DOI: 10.1080/10826080802289291] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The estimated number of opiate users in Russia is 2,000,000 and heroin consumption is continuing to increase. The Russian government is discussing the initiation of compulsory treatment to bring illegal drug users to the treatment services. At the same time, there is no access to the evidence-based treatment for opiate addiction such as methadone and buprenorphine maintenance programs. Qualitative interviews were conducted with drug user treatment service providers (N = 35) in Barnaul, Volgograd, and Yekaterinburg, Russia, in 2003-2004 to examine their views on drug user treatment services in Russia. The framework approach was used in data collection and analysis. Study participants identified major challenges in service provision for drug using population, including lack of resources, rehabilitation programs, and social support. It also depicted ambivalent attitudes toward compulsory treatment and clients' registration. The Russian drug user treatment system desperately needs resources allocation to provide quality care and diversify in its services in order to achieve long-term recovery. At this stage, it seems unreasonable to initiate compulsory treatment as is advocated by some government officials.
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Affiliation(s)
- Natalia Bobrova
- Department of Epidemiology and Public Health, University College London, London, UK.
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149
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Stallwitz A, Stöver H. The impact of substitution treatment in prisons—A literature review. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2007; 18:464-74. [DOI: 10.1016/j.drugpo.2006.11.015] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2006] [Revised: 11/27/2006] [Accepted: 11/29/2006] [Indexed: 10/23/2022]
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150
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Sullivan LE, Moore BA, Chawarski MC, Pantalon MV, Barry D, O'Connor PG, Schottenfeld RS, Fiellin DA. Buprenorphine/naloxone treatment in primary care is associated with decreased human immunodeficiency virus risk behaviors. J Subst Abuse Treat 2007; 35:87-92. [PMID: 17933486 DOI: 10.1016/j.jsat.2007.08.004] [Citation(s) in RCA: 80] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2007] [Revised: 07/31/2007] [Accepted: 08/08/2007] [Indexed: 10/22/2022]
Abstract
Methadone treatment reduces human immunodeficiency virus (HIV) risk, but the effects of primary-care-based buprenorphine/naloxone on HIV risk are unknown. The purpose of this study was to determine whether primary-care-based buprenorphine/naloxone was associated with decreased HIV risk behavior. We conducted a longitudinal analysis of 166 opioid-dependent persons (129 men and 37 women) receiving buprenorphine/naloxone treatment in a primary care clinic. We compared baseline and 12- and 24-week overall, drug-related, and sex-related HIV risk behaviors using the AIDS/HIV Risk Inventory (ARI). Buprenorphine/naloxone treatment was associated with significant reductions in overall and drug-related ARI scores from baseline to 12 and 24 weeks. Intravenous drug use in the past 3 months was endorsed by 37%, 12%, and 7% of patients at baseline and at 12 and 24 weeks, respectively (p< .001). Sex while you or your partner were "high" was endorsed by 64%, 13%, and 15% of patients at baseline and at 12 and 24 weeks, respectively (p< .001). Inconsistent condom use during sex with a steady partner was high at baseline and did not change over time. We conclude that primary-care-based buprenorphine/naloxone treatment is associated with decreased drug-related HIV risk, but additional efforts may be needed to address sex-related HIV risk when present.
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Affiliation(s)
- Lynn E Sullivan
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA.
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