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Numerous interventions have been developed and implemented to decrease risk behaviors which lead to HIV infection and transmission. These interventions have been differentially successful in reducing high risk behaviors in various populations. Testing and evaluation of the interventions have been subject to various degrees of rigor. The CDC recommends the use of interventions which have been rigorously tested and meet the standards for evidence based intervention rather than the continuation of the development of new interventions. Project RESPECT is an evidence based intervention that proved efficacious in increasing condom use among patients of STD clinics. We tested the efficacy of the RESPECT intervention against the NIDA standard intervention to determine if the RESPECT intervention was more effective in reducing high risk behaviors among drug users. Both interventions showed changes from baseline to follow-up; RESPECT was more effective than the NIDA standard intervention in reducing high risk sex behaviors.

This study reports on the role of cocaine as effect modifier of the association of CD4+ cell counts and RNA viral load. HIV-1 seropositive (n = 80) and seronegative (n = 42) African American women (AAW) crack cocaine smokers were recruited. Increasing cocaine use, based on self-reports and laboratory values, significantly exacerbates the immunopathology of HIV-1 in a dose-response manner, confirmed by a non-linear drop in CD4+ cell number for a given viral load in HIV+ AAW. This report supports a view of deleterious effects due to cocaine use in humans.

Purpose: This study investigated the sexual risk behaviors among injection drug users. (IDUs) in order to inform the development of sexual risk reduction interventions for IDUs., Methods: A cross-sectional survey of IDUs (n=141) was conducted in an in-patient detoxification treatment center in Shanghai, China, to collect information on demographics; drug use history; sexual risk behavior; HIV/AIDS knowledge, attitudes, and other psychosocial variables; and HIV, HBV, and HCV seroprevalence. Factors associated with HIV sexual risk behaviors and HBV and/or HCV infection were analyzed., Results: Sexual risk behaviors among IDUs were common: the majority (77%) of the participants had not used a condon consistently in the previous 3 months, 25.5% had multiple partners, 48.2% had IDU partners, and 75.9% did not know their partner's HIV status. IDUs who were married (OR=4.83, p<0.05) or did not intent to use condoms in the future (OR=0.21, p<0.05) were more likely to have unprotected sex. The prevalence of HBV and HCV infection was 31.9% and 51.8%, respectively, but no one tested positive for HIV.IDUs with an injection history of 3 years or more (OR=5.86, p<0.05) and with an overdose history (OR=3.21, p<0.05) were more likely to be infected with HBV and/or HCV., Conclusions: Sexual risk behaviors among IDUs in Shanghai are common, and many IDUs are vulnerable for transmission of disease. Prevention efforts with IDUs should address sexual risk behaviors in addition to needle-sharing behaviors.

We estimated seroincidence of HIV, hepatitis B virus (HBV) and hepatitis C virus (HCV), and the prevalence of risk behaviors among injection drug users (IDUs) who accepted inpatient detoxification by 14-day methadone tapering treatment in the Shanghai Drug Abuse Treatment Center. We also evaluated the effect of an HIV/AIDS prevention education intervention on those IDUs. Data including demographic characteristics, HIV, HBV and HCV seroincidence, sexual and injection-related risk behaviors were collected from 101 IDUs. All subjects received HIV/AIDS prevention education during inpatient detoxification treatment. An HIV-knowledge questionnaire was used to evaluate the effects of this intervention. We found that risk behaviors, including unsafe sex and unclean injection practices, were common among the subjects. The seroincidence of HBV and HCV infection rates was 56.4% and 46.5%, respectively, but no HIV-infected case was found among the subjects. After participating in the HIV/AIDS prevention intervention, subjects' scores (M+/-SD) on the HIV-knowledge questionnaire were significantly improved from baseline (97.29+/-7.42 vs. 31.1+/-12.1). Our study confirmed that IDUs in Shanghai are a high-risk population for blood borne diseases such as hepatitis B and hepatitis C and HIV. HIV/AIDS prevention education increased HIV knowledge, improved understanding of HIV prevention methods and changed attitudes toward HIV/AIDS. Therefore, HIV/AIDS prevention education should to be an important component of drug treatment.

In order to estimate the prevalence of human immunodeficiency virus type 1 (HIV-1) and hepatitis C virus (HCV) co-infection in hard-to-reach intravenous drug users, 199 subjects from high-risk inner-city locales, the so called "shooting galleries", were consented, interviewed, and tested in Miami, FL, US. Positive HIV-1 status was based on repeatedly reactive ELISA and confirmatory Western Blot. Positive HCV status was based on reactive ELISA and confirmatory polymerase chain reaction techniques. Overall, 50 (25%) were not infected with either virus, 61 (31%) were HIV-1/HCV co-infected, 17 (8%) infected by HIV-1 only, and 71 (36%) infected by HCV only. The results of the multivariable analyses showed that more years using heroin was the only significant risk factor for HCV only infection (odds ratio = 1.15; 95% confidence interval = 1.07, 1.24) and for HIV-1/HCV co-infection (odds ratio = 1.17; 95% confidence interval = 1.09, 1.26). This paper demonstrates that HIV-1/HCV co-infection is highly prevalent among so called "shooting galleries".

Purpose: Previous studies have examined the practices of injecting drugs or smoking crack cocaine as high-risk, but independent, factors for HIV transmission. To explore the independent and dual risks of injection practices and crack smoking, this study examined HIV seroprevalence rates among distinct drug user groups, based on patterns of daily administration., Methods: A sample of 3,555 drug users and neighborhood controls in urban Miami, FL and rural Belle Glade and Immokalee, FL were partitioned into four mutually-exclusive groups: 1) injection drug users (IDUs); 2) crack-cocaine smokers; 3) dual users who both smoked crack and injected drugs; and 4) non-drug-user controls., Results: HIV seroprevalence rates were 45.1% for IDUs, 30.5% for dual users, 20.1% for crack smokers and 7.3% for controls. Multivariate logistic regression analysis found that when compared with controls odds ratios for HIV seropositivity were 9.81 for IDUs, 5.27 for dual users, and 2.24 for crack smokers., Conclusions: These findings provide evidence of: 1) behavioral and structural co-factors that influence HIV exposure patterns among drug users; and 2) the substantially higher risk of HIV infection among IDUs compared with other drug users. Intervention strategies must be tailored for the specific drug use subpopulations to optimize efficacy.

Drug injectors and crack users (526) in South Florida responded to a survey questionnaire that was designed to examine belief in the effectiveness of various strategies, other than condom use, employed to reduce personal risk of contracting HIV during sexual acts. Each strategy was believed to be effective by at least one quarter of the study participants. Factor analysis was used to group these strategies. Subsequent multivariate analysis indicated that the participants who believed in the effectiveness of HIV prevention strategies other than condom use were also less likely to report using condoms. These findings highlight the need for prevention interventions to elicit prevention myths and the full range of risk reduction strategies practiced.

A cohort of 111 injection drug users (IDUs) and their sex partners was assessed in 1988 concerning risk behaviors for HIV and knowledge of HIV/AIDS. Ten years later, in 1998, the cohort was reassessed using the same instrument. All who were HIV negative in 1988 were retested by blood draw for antibodies to HIV. A paired analysis was utilized to determine individual changes in risk behaviors for three serostatus groups-those who remained HIV negative (long-term HIV negatives), seroconverters, and those positive in 1988 (long-term HIV positives). Incidence was twice as high for sex partners (37.5%) as for IDUs (18.0%). Drug and needle use risk behaviors, except crack use, showed decreases; sexual risk behaviors were less amenable to change. Knowledge significantly increased among the long-term HIV negatives and seroconverters but not among those HIV positive in 1988. This analysis demonstrates the need for continued intervention among IDUs and their sex partners. [ABSTRACT FROM AUTHOR]

The Yunnan Province in China may be experiencing the highest incidence of heroin use in China, in part because of its proximity to the Golden Triangle. This high incidence, as elsewhere, threatens to increase associated problems in China, including the spread of HIV. Furthermore, the high purity of heroin used in this Province leads to rapid addiction and increased difficulties in treating the symptoms of withdrawal. One response to this epidemic is the development and implementation of the Kunming Drug Rehabilitation Center. The Center, with a capacity for 620 addicts, is grounded in a recovery-oriented perspective that is based on the Therapeutic Community model and modified for the Yunnan Province and China. It is referred to as the Kunming Model and is known for the development of its own medicine for detoxification and its individualized psychological, psychiatric, medical, and biosocial program. Similarities and differences between the Kunming Center and treatment programs in the United States are discussed and implications for universal approaches to drug treatment are addressed. [ABSTRACT FROM AUTHOR]

A demonstration project, currently in progress in Miami, is using an experimental research design to evaluate an AIDS intervention program among IV drug users and the sexual partners of IV drug users. At the time of the initial assessment, which includes a blood test to determine HIV serostatus and an extensive interview, study participants are randomized into either a standard or an enhanced intervention protocol. The enhanced intervention group receives more intensive counseling, including individual as well as group sessions. Follow-up assessments of both groups are made at six-month intervals. The before/after comparisons will assess whether frequency of risk behaviors have changed and whether observed changes are greater in the enhanced group than the standard group. Randomization to two alternative intervention groups allows for the control of many potential biases that plague other types of before/after research designs. [ABSTRACT FROM AUTHOR]

Presents a cohort study on women involved in chronic injecting and crack cocaine drug use. Methodology used in the study; Demographic characteristics of women who participated in the study; Differences between standard and innovative groups; Implication of the design of future HIV prevention interventions for drug using women; Results of the study.

Objectives. A nested case-control study was conducted in Miami, Fla, to determine risk factors associated with human immunodeficiency virus type 1 (HIV-1) seroconversion among injection drug users. Methods. The study identified 21 incident cases of HIV-1 infection and 76 unmatched controls from two longitudinal cohorts of injection drug users. One cohort consisted of individuals who originally had been recruited from treatment centers; a second cohort was recruited from the "street." Logistic regression analyses that adjusted for age, gender, and race were performed. Results. The final model determined that the primary independent risk factor that best explained the risk for seroconversion was sharing injection equipment in the year prior to conversion; a marginal risk factor was presence of sexually transmitted disease during this same period. Conclusions. Both an injection component and a sexual component play a role in seroconversion among injection drug users, although the injection component is much stronger. [ABSTRACT FROM AUTHOR]

Presents a study which compared drug use and HIV infection in women in East Harlem, New York City and Miami, Florida, based on sociodemographic variables and risk behaviors. Methodology used in the study; Identification of significant, independent predictors of HIV Infection in each city; Differences in sociodemographic characteristics and drug use observed; Indication of intensified intervention efforts with women who exchange sex.

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

A response by Brian R. Edin, Sairus Faruque, Clyde B. McCoy and Carl O. Word to letters to the editor concerning their article "Intersecting epidemics: crack cocaine use and HIV infections among inner-city young adults" that was published in the November 24, 1994 issue is presented.