Safer sex strategies for women: the hierarchical model in methadone treatment clinics.
Women clients of a methadone maintenance treatment clinic were targeted for an intervention aimed to reduce unsafe sex. The hierarchical model was the basis of the single intervention session, tested among 63 volunteers. This model requires the educator to discuss and demonstrate a full range of barriers that women might use for protection, ranking these in the order of their known efficacy. The model stresses that no one should go without protection. Two objections, both untested, have been voiced against the model. One is that, because of its complexity, women will have difficulty comprehending the message. The second is that, by demonstrating alternative strategies to the male condom, the educator is offering women a way out from persisting with the male condom, so that instead they will use an easier, but less effective, method of protection. The present research aimed at testing both objections in a high-risk and disadvantaged group of women. By comparing before and after performance on a knowledge test, it was established that, at least among these women, the complex message was well understood. By comparing baseline and follow-up reports of barriers used by sexually active women before and after intervention, a reduction in reports of unsafe sexual encounters was demonstrated. The reduction could be attributed directly to adoption of the female condom. Although some women who had used male condoms previously adopted the female condom, most of those who did so had not used the male condom previously. Since neither theoretical objection to the hierarchical model is sustained in this population, fresh weight is given to emphasizing choice of barriers, especially to women who are at high risk and relatively disempowered. As experience with the female condom grows and its unfamiliarity decreases, it would seem appropriate to encourage women who do not succeed with the male condom to try to use the female condom, over which they have more control. (+info)
Weekly patterns of drug treatment attendance.
OBJECTIVES: This study examined weekly patterns of drug treatment attendance in relation to date of welfare payment receipt and reason for treatment absence. METHODS: Treatment attendance by Medicaid-eligible pregnant women who were drug dependent was examined by calendar week over a 29-month period. RESULTS: Time series analyses showed that attendance was lower during week 1 than week 4. Drug use was the most frequently reported reason for treatment absence during week 1 (25%) but was not reported as a reason during week 3. CONCLUSIONS: Drug-dependent outpatients had increased absences associated with illicit drug use during the first week of the month when welfare payments were received. The generalizability of the findings is unknown. (+info)
Trend of HIV incidence rates among drug users in an HIV epicenter in northern Thailand (1989-1997).
OBJECTIVES: To determine trends and associated risk factors of HIV incidence (1989-1997) in a drug abuse treatment clinic in northern Thailand where HIV is epidemic. DESIGN: Retrospective cohort study. METHODS: Nine-years (1989-1997) of data (excluding names) from the logbook of drug abusers seeking treatments in Mae Chan Hospital in Chiangrai Thailand, were transcribed and double-entered into separate computer files which were later validated against each other. For each patient, the dates of the first HIV negative, the last HIV negative, and the first HIV positive were determined. A retrospective cohort of drug users who were initially HIV-negative and treated for more than once was constructed. HIV seroconversion was assumed to follow a uniform distribution between the last negative and the first positive HIV tests. The incidence rates and their 95% confidence intervals (CI) were calculated. RESULTS: Of the 378 repeat patients, 16 (4.2%) HIV seroconverted. This is equivalent to 5.11 per 100 person-years of observation (PYO) (95% CI = 3.13-8.35). The incidence remained relatively stable over the study period while the prevalence was on the decline. The younger, Thai lowlanders, drug injectors had higher incidence rates than the older, ethnic minorities and drug smokers, respectively. CONCLUSION: Prevalence can give illusional results. It is necessary to know baseline HIV incidence to monitor and evaluate an HIV intervention program. (+info)
Human immunodeficiency virus (HIV) infection in parenteral drug users: evolution of the epidemic over 10 years. Valencian Epidemiology and Prevention of HIV Disease Study Group.
BACKGROUND: Evaluation of acquired immunodeficiency syndrome (AIDS) prevention strategies requires an on-going follow up of the frequency of human immunodeficiency virus (HIV-1) infection. The aim of this study was to examine the trends in prevalence and incidence of HIV-1 infection among injecting drug users (IDU) during the period 1987-1996. METHODS: Transversal and cohort studies were designed which included a consecutive sample of 7132 IDU who attended three AIDS Prevention and Information Centres in the Region of Valencia (Spain) and voluntarily asked to be tested for HIV antibodies. The prevalence was estimated for each year based on the serological status of HIV-1 when the patient first visited the centre. The annual incidence rates were calculated based on the seronegative patients in which a new determination of HIV-1 was done. In order to control the possible effects on the estimations of age, sex and duration of addiction of the people studied, Poisson and logistic regression models were adjusted. RESULTS: Prevalence and incidence rates of HIV-1 infection showed parallel trends over time. The overall prevalence found was 43.6% (95% confidence intervals [CI]: 42.4-44.7%). Of the 4023 seronegative individuals, 1746 were followed up over the whole of the study period. The incidence rate observed was 6.85 x 100 persons/year (95% CI : 6.04-7.66). The prevalence figures show a decrease, which is most marked from 1990 onwards and then they tend to stabilize over the past few years. The incidence rates increase slightly up to 1991 (9.8 x 100 persons/year), and then begin to decrease. CONCLUSION: Trends of prevalence of HIV-1 infection approximate trends of subjacent incidence rate. Despite decrease in HIV-1 infection frequency observed over 10 years, both the prevalence and incidence figures continue to be high in absolute terms. It is necessary to intensify and adapt preventive measures to each subgroup at risk of infection and in the case of heterosexual transmission ensure that the failure observed in the case of IDU is not repeated. (+info)
Validation of the University of Manchester Drug Misuse Database.
OBJECTIVE: The study was conducted to assess the validity and quality of data held by one of the UK regional drug misuse databases (DMD). DESIGN: The research was multi-centred and used retrospective analysis to assess the validity of data held on the database. SETTING: The Regional Database is managed at the University of Manchester Drug Misuse Research Unit and uses data returned by medical and non-medical services within the UK's former North Western Regional Health Authority. MATERIAL: The research was largely based on analysis of the reporting or non-reporting to DMD of 1526 presentations by drug users to four community drug teams (CDTs) during the course of 1993. Two datasets were used: the DMD dataset, based on returns to the regional database from the agencies in question; and agency client records. Additionally the data included on a random sample of 300 database forms returned by these CDTs were compared with information contained in client records. MAIN OUTCOME MEASURES: The study reports on how well DMD is functioning in relation to the correct reporting of episodes of problem drug use and the quality of data held. RESULTS: A very high level of agreement (0.875 +/- 0.017, 95% CI, kappa coefficient 0.728) was established between reports sent in to the database and those expected by examination of agency records. The database figures underestimated the total number of episodes that should have been reported by a factor of 0.008. It was also established that 0.906 (+/- 0.018, 95% CI) of the reports made to the database were made correctly, that 0.178 (+/- 0.030, 95% CI) of eligible presentations were not reported, and that 0.166 (+/- 0.030, 95% CI) of ineligible presentations were mistakenly reported. Lastly, it was established that data were unnecessarily missing or inaccurately recorded in 0.027 of cases and that data entry errors occurred in 0.015 of cases. CONCLUSIONS: The validation project showed that the DMD system is very reliable, providing accurate measures of the extent and nature of presenting problem drug use in the region under study. (+info)
Psychiatric comorbidity measures as predictors of retention in drug abuse treatment programs.
OBJECTIVE: To examine lifetime and current psychiatric comorbidity measures as predictors of drug abuse treatment retention, and to test the generalizability of results across treatment agencies in diverse settings and with varying practices. DATA SOURCES/STUDY SETTING: The national Drug Abuse Treatment Outcome Studies (DATOS), a longitudinal study of clients from 96 treatment agencies in 11 U.S. cities. STUDY DESIGN: The design is naturalistic and uses longitudinal analysis of treatment retention in long-term residential, outpatient drug-free, and outpatient methadone treatment modalities; client background (including psychiatric comorbidity) and program service provision are predictors. Clinical thresholds for adequate treatment retention were 90 days for long-term residential and outpatient drug-free, and 360 days for outpatient methadone. Psychiatric indicators included lifetime DSM-III-R diagnoses of depression/anxiety and antisocial personality, and dimensional measures of current symptoms for depression and hostility. DATA COLLECTION/EXTRACTION METHODS: Data include structured interviews with clients, a survey of treatment program administrators, and program discharge records. PRINCIPAL FINDINGS: Dimensional measures of current psychiatric symptoms emerged as better predictors than lifetime DSM-III-R diagnoses. In addition, the predictive association of hostility with retention varied significantly across treatment agencies, both in the long-term residential and outpatient drug-free modalities. Other notable findings were that on-site mental health services in long-term residential programs were associated with better retention for clients with symptoms of hostility. CONCLUSIONS: Assessment issues and stability of results across programs are important considerations for treatment research and practice. (+info)
Surveillance of problem drug use in the UK: a review of a Regional Drug Misuse Database.
BACKGROUND: We report detailed findings of the first systematic validation of a Regional Drug Misuse Database (RDMD); such databases constitute the main investment in routine drug statistics in the UK by the Department of Health. METHODS: A retrospective case-finding study in a stratified random sample of one in three specialist drug agencies was carried out. Agency records of clients attending during 1994 were matched with reports (episodes) to the North Thames RDMD to assess the level of under-reporting, and the relationship between RDMD reports (episodes) and the number of problem drug users in contact with agencies. Under-ascertainment of cases was estimated using two-sample capture-recapture. RESULTS: Under-reporting was associated with agency records missing full date of birth or initials (attributers), and agency type. Compared with drug dependency units (DDU) the odds of under-reporting were 3-18 times higher by the other specialist drug agencies. Even after excluding episodes with missing attributers the odds ratio (OR) of not being reported was significantly higher among needle exchanges (OR 2.7), non-statutory community based drug teams (OR 3.2), statutory community based drug teams (OR 4.9) and residential rehabilitation units (OR 8.7) compared with DDUs. Overall database episodes represented 60 per cent of the number of clients attending specialist agencies as a result of a mixture of under-reporting and the proportion of clients retained in treatment, which also varied by agency type. A total of 727 individuals (16 per cent) had never been reported. CONCLUSIONS: Surveillance of drug misuse through RDMDs does not yet fulfil its objectives. It is essential that a system of following up reports is introduced to improve their utility, and to contribute to the monitoring of the UK Government's new drugs strategy, and wider European surveillance. (+info)
Project neighborhoods in action: an HIV-related intervention project targeting drug abusers in Washington, DC.
Project Neighborhoods in Action was a human immunodeficiency virus (HIV) outreach and intervention program that was conducted with injection drug users and crack users in several inner-city neighborhoods in the District of Columbia. Study participants were placed randomly in either a standard intervention or an enhanced intervention condition, with more than 800 persons being assigned to each group. Drug use frequency dropped from 15.2 days to 12.4 for alcohol (P<.0001), 2.1 days to 1.6 for marijuana (P<.003), 13.0 days to 8.8 days for crack (P<.0001), 2.4 days to 1.5 days for cocaine (P<.0001), 19.7 days to 15.6 for heroin (P<.0001), and 5.2 days to 3.4 for speedball (P<.0001). Drug injecting decreased from an average of 90.8 times to 66.9 (P<.0001), with both direct sharing and indirect sharing rates decreasing significantly as well (from 2.4 to 1.1 times for the former [P<.002] and from 12.0 to 8.1 times for the latter [P<.0004]). The number of sexual partners dropped from a mean of 1.6 to 1.1 (P<.0001). The number of drug-injecting sexual partners went from 0.3 to 0.2 (P<.01). Having sex while high decreased from 11.2 times to 7.9 (P<.0001). Trading sex for drugs and/or money declined from 1.9 times to 1.3 (P<.001). Protected sex increased from 29.5% to 63.7% (P<.0001), and the number of unprotected sexual acts dropped from 9.6 to 7.2 (P<.0001). Only a few differences were observed for standard versus enhanced intervention respondents, with no particular pattern formed. We were left with the impression that the standard intervention and enhanced intervention used in this program were about equally effective at reducing the involvement of drug abusers in HIV-related risky behaviors. (+info)