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A cross-sectional study of the association between severity of childhood trauma and adult prostitution behaviors was conducted among 676 heterosexual drug addicts in San Antonio, Texas. Three hundred and fifty eight women and 338 men taking part in a national multisite program for AIDS prevention research completed the Childhood Trauma Questionnaire as part of a comprehensive risk behavior assessment. Women addicts in the sample were less educated, more likely to be in a common-law relationship, living with someone of the opposite sex or separated, and had lower incomes in comparison to men addicts. Among male subjects, higher educational levels and older age were positively associated with prostitution activities. Single female subjects were three times more likely to engage in selling sex than married subjects. Single women with higher incomes were more likely to be prostituting than single women with lower incomes. Black women reporting severe degrees of emotional abuse, emotional neglect, or physical neglect were more likely to engage in prostitution behavior than Hispanic or white women with similar levels of trauma. Black men with a history of childhood physical abuse were more likely to use prostitutes than Hispanic or white men. Key Words: Prostitution; Drug abuse; AIDS; HIV; Ethnic minority groups., INTRODUCTION In the last several years, heterosexual contact has become an increasingly important factor in newly reported cases of human immunodeficiency virus (HIV). In particular, minorities and women have become [...]

Studies of accidental needlestick exposure to blood containing human immunodeficiency virus (HIV) have shown that the volume of blood in an exposure is a strong predictor of subsequent infection. Illicit drug injectors, a group at elevated risk for HIV transmission, use syringes manufactured in two styles, one of which (the integral cannula type) retains substantially less blood after intravenous use than the other (the detachable needle type). In this report, we examine some of the factors associated with use of syringes with detachable needles among drug injectors in San Antonio, Texas using data from epidemiological surveys, ethnographic studies, and historical observations. We compare personal history of syringe type use with HIV serostatus in a sample of 501 active drug injectors interviewed and screened for HIV in 1997-1998. Ninety-nine percent of these respondents reported that they currently used only integral cannula syringes, but 13% had used a syringe with a detachable needle within the past 2 years, and 37% had used one in their lifetime. Only 9% had ever used one [greater than or equal to] 20 times in a year. Hispanic (Mexican American) respondents were significantly less likely than other ethnic groups to have ever used a detachable needle syringe. HIV seroprevalence was < 1% among heterosexual injectors who had never used a detachable needle syringe compared to 4% among those who had used one (p< 0.05). Keywords: Injecting drug users; HIV; Syringes; Texas; USA

The relationships between the level of childhood maltreatment and current psychological distress were examined in a community sample of 676 substance abusing men and women using a validated self-report instrument (the Childhood Trauma Questionnaire) designed to measure physical, emotional, and sexual abuse and physical and emotional neglect. Current levels of self-reported psychological distress/symptoms were measured using a 53-item Brief Symptom Inventory. Prevalence of early trauma ranged from 44% for emotional neglect to 65% for sexual abuse. The severity of all forms of childhood maltreatment were directly associated with current psychological distress., INTRODUCTION Child abuse has been linked with several long-term psychological effects. Most reports in the literature (1-4) focus primarily on sexual abuse. Sexual abuse is associated with interpersonal difficulties such [...]

Few HIV/AIDS educational programs have been tailored specifically for women, and most have promoted methods requiring the full participation and cooperation of male partners. This study introduced drug-involved women to the .female condom - a female-controlled method of protection from HIV and other sexually transmitted diseases. The primary aim was to assess the acceptability of this new device among high-risk women in St. Louis, San Antonio, and Rio de Janeiro. All respondents participated in a female condom education program, were asked to try the condom, and to report their experiences at two points of contact. Outcome data indicated that a sizable proportion of the women followed up used the female condom during vaginal sex on one or more occasions. In addition, many women also preferred the female condom to the male condom in terms of overall satisfaction, suggesting that there is a viable role for this device in the HIV prevention field., Heterosexual contact is the fastest growing mode of HIV transmission in the United States, and as a result, women are becoming infected in increasing numbers. In 1985, for example, female [...]

This study examined characteristics of injecting drug users (IDUs) who want treatment and the features that differentiate them from IDUs who do not want treatment. Data were collected as part of a community-based HIV prevention project in San Antonio, Texas. Interviews were administered to 1,100 IDUs between February 1993 and May 1995. Interview topics included sociodemographics, drug use history, current drug use, treatment history, injection-related HIV risk behavior, sexual behavior, and previous contact related to HIV prevention. Multiple logistic regression analysis identified four factors independently associated with wanting treatment in the multivariate model. These were: (1) 30 or more injections per month; (2) being eligible for methadone maintenance; (3) 2 or more previous treatment admissions; and (4) being recruited after the first year of the project. Implications of these findings are discussed., INTRODUCTION Substance abuse treatment is an important component of the effort to limit the spread of human immunodeficiency virus (HIV) among injecting drug users (IDUs) (1-3). In contrast to interventions [...]

The authors followed a cohort of 610 opioid users for 1 year after admission to methadone maintenance. At the end of the year, 52% were on methadone and 48% were off methadone. Among subjects on methadone, days of intravenous drug use, crime, and needle-sharing decreased markedly from the month preceding admission to the month preceding the first anniversary of admission. Among subjects off methadone, days of these activities also decreased, but the decreases appeared in large part to be an effect of increased days of incarceration. Among those on methadone, days of productive activity increased markedly. Subjects with more years of intravenous drug use were more likely to be on methadone at the end of the year, and subjects under compulsory supervision were less likely to be on methadone. The findings confirm previous reports of decreased illicit opioid use, decreased crime, and decreased needle risk for infection with the human immunodeficiency virus among opioid users who remain on methadone.

The relation of ethnic matching of caseworker and patient to treatment outcomes was evaluated in a cohort of 610 opioid users admitted to methadone maintenance. At admission, the subjects were assigned to caseworkers in rotation. Thirty-seven percent of the Anglo subjects, 11% of the African-American subjects, and 60% of the Hispanic subjects were matched with caseworkers of their own ethnic group. In all ethnic groups, the matched and nonmatched subgroups did not differ significantly on 11 pre-treatment characteristics. The subgroups also did not differ significantly on 3 treatment variables, with the exception of methadone dose in the Anglo group. The Anglo-matched subgroup had a slightly higher mean dose (61 mg) than did the not matched subgroup (52 mg). In all ethnic groups, the matched and nonmatched subgroups did not differ significantly on 12 outcome variables. No relation was found between ethnic matching and treatment outcomes. Keywords-ethnic matching; methadone maintenance; counseling; outcomes.

Treatment outcomes of 296 subjects admitted to methadone maintenance while on probation or parole are compared to those of 314 subjects admitted without such compulsory supervision. Equivalent treatment services were offered to both groups. The pretreatment differences between groups were small except for time incarcerated. All subjects were followed for one year. The compulsory supervision group had worse outcomes with respect to retention, productive activity, .and incarceration. The differences were small except for incarceration. The mean number of months incarcerated was 2.1 for the compulsory supervision group and 0.7 for the voluntary group. Of subjects discharged from treatment, a higher percentage of the compulsory supervision group was discharged because of incarceration, but a higher percentage of the voluntary group was discharged for noncompliance with program requirements. The findings do not support a policy of exclusion of opioid users from methadone maintenance because they are on probation or parole. Keywords - probation; parole; methadone maintenance; opioid dependence.

An open clinical trial was conducted to compare the effects of rapid (1-day) admission with slow (14-day) admission to methadone maintenance on pretreatment attrition, retention during treatment, and other outcomes. One hundred eighty-six illicit opioid users eligible for methadone maintenance were randomly assigned to rapid admission or slow admission, with 93 subjects assigned to each group. The random assignment produced two groups that were similar on 22 personal variables. All subjects admitted to treatment were followed for 1 year. Follow-up interviews were obtained with 155 (98%) of the 158 subjects admitted to treatment. During the period from initial contact to medication, only 4% of the rapid admission subjects but 26% of the slow admission subjects dropped out. The risk of dropout during slow admission was 6 times that during rapid admission. A higher percentage of rapid admission subjects, 43%, than of slow admission subjects, 39%, remained continuously in treatment for 1 year, but the difference was not significant. The two subgroups that remained in treatment for 1 year did about equally well on measures of illicit drug use and social performance. The findings indicate that pretreatment attrition can be markedly reduced by prompt medication, and that prompt medication does not adversely affect retention during treatment or other outcomes., Key words. Methadone maintenance; Rapid admission INTRODUCTION Opioid users seeking methadone maintenance treatment often drop out during the waiting period from application to start of medication. The waiting period may [...]

The authors report the inter-interviewer reliability of two brief questionnaires developed to measure the effects of innovations in methadone maintenance. The instruments were designed to answer the research questions, but to intrude only minimally into the clinical assessment and treatment processes. The Initial Interview, completed at the time of admission, yielded information on 23 variables, and the Followup Interview, completed as soon as possible after the first anniversary of admission, yielded information on 20 variables. To assess reliability, a repeat interview was conducted by a different interviewer immediately after the first interview was completed. Repeat interviews were conducted with 19 subjects who completed the Initial Interview and 30 who completed the Followup Interview. Exact agreement was found in all the pairs of responses from the Initial Interview for 5 of the 6 categorical variables and 6 of the 17 quantitative variables. For the remaining 11 quantitative variables, the intraclass correlation coefficients ranged from .700 to .999. Exact agreement was found in all pairs of responses from the Followup Interview for 2 of the 4 categorical variables and 8 of the 16 quantitative variables. For each of the remaining categorical variables, the kappa statistic was significant (.73 and .49). For the remaining 8 quantitative variables, the intraclass correlation coefficients ranged from .750 to .999. The findings signify satisfactory inter-interviewer reliability of the instruments. These brief instruments could easily be adapted for use in other treatment evaluation studies where brevity in data collection is considered desirable., INTRODUCTION During the last 25 years many instruments have been developed and used in drug abuse treatment evaluation research. In the interest of promoting comparability of research findings, Rounsaville et [...]

Several reports have suggested that required treatment fees impair retention on methadone maintenance. In a controlled study, 152 illicit opioid users admitted to methadone maintenance were randomly assigned to fee or no-fee status. The fee subjects were required to pay a fee of $2.50 per day and the no-fee subjects were required to pay nothing. Elimination of fees significantly increased retention. Only 34% of the fee subjects but 54% of the no-fee subjects were retained for one year. Of those retained for one year, the fee subjects and the no-fee subjects showed only small and nonsignificant differences on urine test results and measures of social performance. Interviews per month with caseworker were inversely related to retention. Increased interviews and decreased retention may both have reflected treatment problems of subjects.

The decrease in patient retention in the methadone maintenance program of the Center for Health Care Services in San Antonio, TX, can be related to the changes in the program. Increased treatment fees and decreased methadone dose are believed to have adversely affected retention. Program developments such as provision of takehome methadone and outpatient induction procedure may have enhanced retention, but their effect was concealed by the negative effects of the other program changes.

To assess the long-term effects of methadone maintenance, we compared the 10-year outcomes of 95 chronic opioid users who spent at least one cumulative year on methadone with those of 77 chronic opioid users who spent less than one cumulative year on methadone. All subjects were men and 90% were Mexican-American. The two groups were similar on 12 of 15 background variables. During the 10-year period, the methadone group had a cumulative mean of 54 months on methadone, while the comparison group had a cumulative mean of only 2 months on methadone. On social performance, as measured by months employed and months institutionalized, the methadone group did significantly better than did the comparison group. On months of voluntary abstinence, however, the comparison group did significantly better than did the methadone group. The mean of the comparison group, 36 months, was three times greater than that, 12 months, of the methadone group. At the end of the 10-year period, 26% of the comparison group but only 7% of the methadone group had been in continuous voluntary abstinence for 3 years or longer. Methadone maintenance for 1 year or longer was inversely related to abstinence during and at the end of the 10 years. This finding seems consistent with the hypothesis that methadone maintenance for 1 year or longer impedes eventual recovery from opioid dependence. For many patients, however, the benefits of prolonged maintenance could outweigh the possible cost of diminished likelihood of eventual recovery., INTRODUCTION In a recent review [1] of 5-year or longer follow-up studies of opioid users admitted to methadone maintenance or to drug-free treatment, we attempted to assess the effect of [...]

While maintained on methadone, heroin users reduce their heroin use and related criminal activity and increase their legitimate employment. These benefits are obtained at the cost of continued opioid dependence. Furthermore, as a consequence of neural adaptation and conditioning, methadone maintenance may impede eventual recovery from opioid dependence. The authors attempt to assess such a possible effect by comparing long-term outcomes after methadone maintenance with those after drug-free treatment. In five long-term follow-up studies of methadone maintenance, the percentages found voluntarily abstinent ranged from 9 to 21. In six long-term follow-up studies of drug-free treatment, the percentages found voluntarily abstinent ranged from 10 to 19. These rates seem remarkably similar. They do not suggest that methadone maintenance impedes eventual recovery from opioid dependence, but they do not clearly exclude such an effect., INTRODUCTION The spread of the acquired immunodeficiency syndrome among intravenous heroin users has increased the need for expansion and improvement of methadone maintenance programs [1]. While maintained on methadone, heroin [...]

Examined activity patterns of college students living in residence halls (N=117) using time budget methodology. Found differences among four college classes (freshmen, sophomores, juniors, and seniors) which seemed to form a developmental pattern. Found considerable differences among individual students. Found women spent more time in employment and grooming than did men. (Author/ABL)

A prospective study of 823 injecting drug users (IDUs) was made to identify baseline variables differentiating those who entered treatment during the study from those who did not enter. Variables independently associated with entering treatment in a multiple logistic regression model included (a) expressed desire for treatment, (b) being eligible for methadone maintenance, (c) two or more previous treatment admissions, (d) frequency of injection, (e) heroin use in the past 30 days, (e) being human immunodeficiency virus (HIV) positive, (f) giving money or drugs for sex, and (g) level of injection-related risk for HIV infection. Key Words. Human immunodeficiency virus; Injecting drug users; Substance abuse treatment, INTRODUCTION Treatment for drug dependence is an important component of public health strategies to limit the spread of human immunodeficiency virus (HIV) (1-5). In contrast to interventions that emphasize safer [...]

A cross-sectional study was conducted to examine the association between childhood trauma and current human immunodeficiency virus (HIV) risk behaviors of 181 active illicit-drug-using women in San Antonio, Texas. We found very few statistically significant associations, which could be explained by (a) childhood trauma subtypes not being mutually exclusive, (b) clustering of mild-to-severe forms of abuse, and (c) childhood trauma having an indirect, rather than direct, effect on HIV risk behavior. Public health implications from this study are that prevention programs need to consider past and current individual and environmental factors that influence HIV sexual risk behaviors in women drug users., INTRODUCTION Acquired immunodeficiency syndrome (AIDS) is a chronic, progressive disease caused by the human immunodeficiency virus (HIV), for which no vaccine or cure is presently available. As of December 31, [...]

The purpose of this study was to estimate the prevalence of positive trauma histories in a community sample of intravenous drug using (IVDU) women for five subsets of childhood trauma (emotional abuse or neglect, physical abuse or neglect, and sexual abuse) and to compare demographic variables between the abused versus nonabused groups. Of the 181 women who completed the Childhood Trauma Questionnaire (CTQ), 109 (60.2%) were sexually abused, 100 (55.2%) were physically abused, 83 (45.9%) were emotionally abused, 151 (83.4%) were emotionally neglected, and 108 (59.7%) were physically neglected. There were no statistically significant findings for age, ethnicity, and educational level. Those subjects that were physically neglected were more likely not to be in a current relationship compared to those subjects that were not abused (p = .036). The findings suggest that the prevalence of all five childhood traumas was higher than what has been reported in the general population, and that physical neglect of individuals may predict lack of current significant relationships., INTRODUCTION Disproportionate numbers of women with substance dependence disorders have a history of childhood trauma (CT). The impact of CT may be severe and long lasting, with deviant behavior, psychological [...]

Drug injection and other practices affecting the risk of human immunodeficiency virus (HIV) infection were studied among 154 heroin users and 45 methamphetamine users in San Antonio, Texas. Amphetamine users were younger, mostly white, and had less-severe drug dependence. Heroin users had significantly higher levels of needle risk, as indicated by frequency of injection, number of persons sharing equipment, and place of injection. Methamphetamine users tended to buy syringes in lots of 10 or more from pharmacies and to use a syringe less than 5 times before discarding it. Heroin users tended to buy 1 needle at a time from an illicit source and to use it more than 20 times. Of methamphetamine users, 71% had more than one sex partner, compared to 39% of heroin users. Partners of methamphetamine users were more likely to be drug injectors than were partners of heroin users. Fewer methamphetamine users reported a behavior change in response to the acquired immunodeficiency syndrome (AIDS) epidemic, and fewer had been contacted by AIDS Education/Outreach. We suggest that efforts to promote risk reduction among methamphetamine users be stepped up because this population has been underserved and because less-sweeping behavior changes are needed to reduce needle-related risks to acceptable levels., INTRODUCTION Behavioral studies of human immunodeficiency virus (HIV) transmission among drug injectors have reported significant association between type of drug used and presence of infection (1-4). Most of the studies [...]