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Human Immunodeficiency Virus (HIV) infection remains prevalent among the marginalized and drug using population in the United States. Testing for HIV is an important and cost-effective way to reduce HIV prevalence. Our objective was to determine if there is a difference in the number of HIV testing by injection status among users of illicit drugs and if a person's social network characteristics is a contributing factor. Using a cross-sectional design and negative binomial regression models, we assessed HIV testing behavior of people who use non-injected drugs (PWND) compared to people who use injected drugs (PWID). In an analytic sample of 539 participants, PWND tested for HIV 19% less compared to PWID, PR (95% CI) = 0.81 (0.66, 0.98), p = 0.03. Other contributing factors of testing were education, condomless sex, STIs, heroin use, and participant's sex network. The interaction term between PWND and emotional support in relation to HIV testing was significant, 1.33 (1.03, 1.69), p=0.03. These findings suggest HIV testing behavior differed by injection status, and this relationship may be dependent on emotional support. To exert a greater impact on the HIV epidemic, interventions and policies encouraging HIV testing in PWND, an understudied at-risk sub-population, are warranted.

This is the third edition of the book but apparently (Ziegel, 2001) is the 12th revision of a manual developed in 1973 to serve as a reference for graduate students. Several reviews published on th...

In the United States, heterosexual transmission is the second leading cause of HIV/AIDS, and two-thirds of all heterosexually acquired cases diagnosed between 2005 and 2008 occurred among African Americans. Few HIV prevention interventions have been designed specifically for African American heterosexual men not seeking clinical treatment. Here we report results of a single-arm intervention trial of a theory-based HIV prevention intervention designed to increase condom use, reduce concurrent partnering and increase HIV testing, among heterosexually active, African American men living in high HIV prevalence areas of New York City. We tested our hypothesis using McNemar discordant pairs exact test for binary variables and paired t-tests for continuous variables. We observed statistically significant declines in mean number of total and new female partners, unprotected sex partners and partner concurrency in both primary and non-primary sex partnerships between baseline and three months post-intervention.

The objectives of this cross-sectional study were to compare sociodemographic and risk behavior characteristics between black men who have sex with both men and women (MSMW) and those who have sex with men only (MSMO) and assess factors associated with having any unprotected vaginal and/or anal intercourse (UVAI) with women in the last 3 months. Data from 326 black men who reported recent unprotected anal intercourse with a man in an HIV behavioral intervention study in New York City were analyzed. Baseline characteristics were compared between MSMW and MSMO, and factors associated with having any UVAI in the past 3 months with women among MSMW were evaluated. In total, 26.8% reported having sex with both men and women in the last 3 months. MSMW were less likely to be HIV infected, use amyl nitrates, and have unprotected receptive anal sex with most recent male partner. MSMW were more likely to be over 40 years old and use heroin. A total of 55.6% of MSMW reported having UVAI with women in the last 3 months. Compared to MSMW having only protected sex, MSMW having any UVAI with women were less likely to be HIV infected and to disclose having sex with men to female partners; they were more likely to have greater than four male sex partners in the last 3 months. In conclusion, HIV prevention interventions among black MSMW should directly address the risk of HIV transmission to both their female and male partners. Disclosure of bisexuality to female partners may be an important component of future prevention efforts.

We conducted a randomized controlled trial of a sexual risk-reduction intervention targeting non-injection drug users (NIDUs) and members of their drug-use/sexual networks (N=270). The intervention was based primarily on the social-influencing approach, and was delivered in four sessions. Sexual risk behaviors were examined at baseline, and 3, 6, 9, and 12 months after the completion of the intervention using the vaginal equivalent episodes (VEE), a weighted sexual risk behavior index. VEE scores decreased in both the active and control conditions in the first six months post-intervention and continued to decline in the control group. However, in the active condition, VEE scores increased after the nine-month assessment and approached baseline levels by the 12-month assessment. There was no evidence of significant differences in high-risk sexual behaviors between the intervention and control conditions. Future studies are needed to improve behavioral interventions in this population.

We assessed the safety of short-term antiretroviral prophylaxis to prevent mother-to-child transmission (MTCT) of HIV by monitoring haematological changes in children up to the age of 18 months. Babies of HIV-infected women were randomised at birth to receive a single dose of nevirapine (NVP) alone or with zidovudine (ZDV) twice daily for a week. Based on the time of presentation to the labour ward, mothers of these babies might or might not have received intrapartum NVP. Complete blood counts were performed at birth and at 1.5, 3, 6, 9, 12, 15 and 18 months. Babies' HIV status was determined by HIV-1 RNA testing. A total of 1755 babies were included in the study. Age-specific mean haemoglobin levels and prevalence of anaemia (haemoglobin < 10 g/dL) were not significantly different in cases where only the babies received a single dose of NVP and cases where NVP was given to mother/infant pairs or additional ZDV to the baby. Among HIV-infected children compared with uninfected children, the age-specific frequency of anaemia was significantly greater, anaemia started earlier and recovery to normal levels was slower and prolonged. A reversible granulocytopenia was observed in all children between 1.5 and 3 months of age. HIV infection significantly increased the children's risk of death. Antiretroviral prophylaxis appeared to protect against anaemia and child death. Short regimens of antiretrovirals to prevent MTCT of HIV are not associated with long-term adverse haematological changes.

Effects of changes in physical health status and drug use, and prior social support on depressive symptoms were assessed in low income injection drug users. Data are from participants (n = 503) enrolled at baseline (1994-1995) who remained at one-year follow-up (79%), of whom 37% were HIV-positive and 36% female. Physical health was measured by HIV symptoms, AIDS, CD4 count and functional limitation (IADLs). One-third scored high on depressive symptoms (CES-Dor = 16) at one-year follow-up, representing no statistically significant change from baseline (38%). In multiple logistic regression, after controlling for baseline depression scores (OR = 6.11, p0.001) and drug use (OR = 1.20, p = 0.192), baseline functional limitation (OR = 3.28, p0.001) and declining functioning (OR = 3.60, p0.001) were positively, and quitting drug use was negatively, associated with depressive symptoms at follow-up. Low social support at baseline (OR = 0.58, p0.10) was marginally predictive of depressive symptoms. Depressive symptoms did not differ by gender. For HIV-positive respondents, functional limitation was predictive of depressive symptoms, but HIV illness and drug use were not. Facilitating drug treatment and preventive medical care may aid in reducing depression in this population. For HIV-positive drug users, drug treatment prior to AIDS may help reduce depressive symptoms, with potential implications for HIV service utilization and medical adherence.

Plasma retinol-binding protein (RBP) concentrations have been suggested as surrogate indicators for plasma retinol concentrations in the assessment of vitamin A status in less technologically developed settings. Plasma RBP was measured by radial immunodiffusion and plasma retinol by high performance liquid chromatography in a cross-sectional study of 900 pregnant women at the Queen Elizabeth Central Hospital, Blantyre, Malawi. The Spearman correlation coefficient between plasma RBP and retinol concentrations was 0.95 (p0.0001). By linear regression, 0.70 micromol l(-1) retinol was equivalent to 21.1 mg l(-1) RBP. With these cut-off points for defining vitamin A deficiency, there was high concordance between categorical descriptions of deficiency using retinol and RBP by chi-square analysis (p0.001). Measurement of plasma RBP by radial immunodiffusion is simple, inexpensive, and does not require expensive instrumentation. Plasma RBP concentrations measured by radial immunodiffusion are highly correlated with plasma retinol and can be used as a simple surrogate measure for vitamin A concentrations in large field studies.

We consider the estimation of the k + 1-dimensional nonparametric component β(t) of the varying-coefficient model Y(t) = X T (t)β(t) + e(t) based on longitudinal observations (Yij , X i (tij ), tij ), i = 1, …, n, j = 1, …, ni , where tij is the jth observed design time point t of the ith subject and Yij and X i (tij ) are the real-valued outcome and R k+1 valued covariate vectors of the ith subject at tij. The subjects are independently selected, but the repeated measurements within subject are possibly correlated. Asymptotic distributions are established for a kernel estimate of β(t) that minimizes a local least squares criterion. These asymptotic distributions are used to construct a class of approximate pointwise and simultaneous confidence regions for β(t). Applying these methods to an epidemiological study, we show that our procedures are useful for predicting CD4 (T-helper lymphocytes) cell changes among HIV (human immunodeficiency virus)-infected persons. The finite-sample properties of o...

The human immunodeficiency virus type 1 (HIV-1) epidemic continues to grow both within the United States and worldwide. Currently, HIV-1 disease is the greatest killer of American men and third greatest killer of women aged 25–44. The major routes of HIV-1 transmission are: (i) heterosexual and (ii) homosexual sex with infected partners; (iii) injection drug use (IDU) with a needle previously used by an infected person; and (iv) transmission from an infected mother to her infant. The HIV-1 epidemic in industrial countries initially occurred largely among homosexual men, but now 53% of American AIDS cases occur in IDUs and heterosexual/infant risk groups. While the risk of infection from a single unsafe sex or IDU act may be less than one per cent, the repeated practice of these activities by participants makes overall risk quite great. Cessation of risky drug use and/or sexual behavior is the only way to prevent transmission by these routes. Use of condoms in sex, while not 100% effective, dramatically re...

Secular trends in illicit drug and alcohol use among gay men may reflect behavioral changes related to concerns about HIV1. These trends may also have public health ramifications to the extent that they measure the results of education about safer sexual practices. Using data from 1984-89 in the Multicenter AIDS Cohort Study, we investigated trends in use of illicit drugs and alcohol in HIV1 - men (N = 2,319), HIV1 + men without AIDS (N = 1,118), and HIVI + men who developed AIDS (N = 426). Illicit drug use was initially common, particularly in the HIV1 + groups, but declined substantially with time. Alcohol use declined considerably in the HIV1 + groups and to a lesser extent in HIV1 - men. Moderation in illicit drug and alcohol use was not robustly associated with demographic characteristics. While self-reported illicit drug and alcohol use decreased from 1984-89, such use persisted in most of each group.

The recent literature contains theorems improving on both the standard Bonferroni inequality (Hoover (1990)) and the Sidak/Slepian inequalities (Glaz and Johnson (1984)), The application of these improved theorems to upper bounds for non coverage of simultaneous confidence intervals on multivariate normal variables is explored. The improved Bonferroni upper bounds always hold, while improved Sidak/Slepian bounds only apply to special cases. It is shown that improved Sidak/Slepian bounds will always hold for Normal Markov Processes, a commonly occuring and easily identifiable class of multivariate normal variables. The improved Sidak/Slepian upper bound, if it applies, is proven to be superior to the computationally equivalent improved Bonferroni bound. This improvement, however, is not great when both methods are used to determine upper bounds for Type I error in the range of .01 to .10.