Director's Report to the National Advisory Council on Drug Abuse
Drug Use, Ethnicity, and the Course of HIV Infection
A ongoing study of progression of HIV infection compared a seroprevalent cohort of predominantly African-American, active IDUs with a cohort of predominantly white homosexual and bisexual men. Comparisons of changes in T-lymphocyte subsets following seroconversion indicated that prior to seroconversion the predominantly African-American IDUs had lower CD4% and higher CD8% as compared with the homosexual men. In the first two years after seroconversion, larger changes for both CD4% and CD8% were observed in the cohort of homosexual men as compared with the IDU cohort. After two years, the CD4% levels of the two cohorts converged and then declined at similar rates. These results suggest that drug use and ethnicity do not appreciably alter the course of HIV infection, at least through four years of post-seroconversion follow-up, and that observed differences between the two risk groups prior to seroconversion greatly diminish following seroconversion (Galai, Vlahov, Margolick, Chen, Graham & Munoz, JAIDS, 1994; 8:66-74). Furthermore, it was found that membership in either cohort risk group was not a factor in the relationship between clinical outcome and CD4 level. Subgroups in both cohorts who remained asymptomatic had similarly high levels of CD4 at baseline and identically slow rates of CD4 decline. Those in both cohorts who developed thrush or clinically defined AIDS had lower levels of CD4 at baseline and higher rates of CD4 decline. Distributions of these variables were similar in both cohorts (Margolick, Munoz, Vlahov, Astemborski, Solomon, He, Nelson & Saah, Arch Int Med, 154:869-875, 1994).
Effects of HIV on Immune Function in Humans
Researchers at the Cornell University Medical College have demonstrated that the HIV-1 envelope glycoprotein gp160 significantly reduced the mitogen-induced secretion of interferon- gamma and interleukin-2 but augmented secretion of interleukin-4 by peripheral blood mononuclear cells in vitro. These effects were not observed, however, when target cells were depleted of either CD4- or CD2-positive cells or were incubated with CD4-immunoglobulin chimeric molecules, suggesting that interaction between CD4 and gp160 molecules is necessary for the observed effects. Studies are in progress to further characterize these effects and their significance in HIV infection (Hu, R., Oyaizu, N., Kalyanaraman, V.S., and Pahwa, S. HIV-1 gp160 as a Modifier of Th1 and Th3 Cytokine Response: gp160 Suppresses Interferon-gamma and Interleukin-2 Production invitro. Clin. Immunol. Immunopathol. 73:245-251, 1994).
HIV Infection in Women with Injection Drug Using Partners
Dr. Stephanie Tortu and colleagues at the National Development and Research Institute examined the risk of HIV infection among a national sample of 5,162 heterosexual women with IDU partners recruited through street outreach and local networks of drug users. Three groups of women were distinguished and compared: those that had single sex partners, those with multiple partners, and those with multiple partners who also exchanged sex for drugs and/or money. Women with multiple partners who exchanged sex for drugs and/or money were at the highest risk for HIV, even when demographic variables were controlled. Tortu, S., Beardsley, M., Deren, S., and Davis, W. The Risk of HIV Infection in a National Sample of Women with Injection Drug-Using Partners. Am J Public Health. 84:1243-1249, 1994.
HIV Risk Behaviors Among Injection Drug Users in San Juan, Puerto Rico
In a study investigating the effects of a community outreach program in reducing HIV risk behaviors among IDUs in San Juan, Puerto Rico, Dr. Colon of the Puerto Rico Department of Anti-Addiction Services, and colleagues at the University of Puerto Rico School of Public Health modeled pre- and post-intervention trends in risk behavior levels from successive cohorts of IDUs. While major portions of reported risk reductions were accounted for by secular trends, the outreach intervention was found to have significant partial effects in lowering risk behaviors related to the shared use of cookers and needle disinfectant practices. However, the intervention did not have an effect on high risk sexual behaviors which underscores the importance of focusing on these behaviors in HIV prevention interventions. Colon, H., Sahai, H., Robles, R., and Matos, T. Effects of a Community Outreach Program in HIV Risk Behaviors Among Injection Drug Users in San Juan, Puerto Rico: An Analysis of Trends. AIDS Education and Prevention. 7(3):192-209, May/June 1995.
Women at High Risk for HIV
Dr. Sherry Deren and colleagues in the AIDS Research Consortium evaluated data on behavioral change among women IDUs and sexual partners of IDUs relative to pregnancy. Baseline and follow-up data were analyzed from a national sample of women who were pregnant at baseline, became pregnant between baseline and follow-up, or who were not pregnant at all during the study. Both pregnant and not pregnant high risk women reported significant levels of risk reductions at follow-up. IDUs who were pregnant or became pregnant reported greater reductions in drug injection rates, were more likely to report entering drug treatment, and reported the greatest reduction in sex risks compared to IDUs who remained non-pregnant. The findings indicate that the period of pregnancy provides an opportunity for changes in risk behaviors of women. Deren, S., Davis, W., Tortu, S., Beardsley, M., Ahluwalia, I., and the National AIDS Research Consortium. Women at High Risk for HIV: Pregnancy and Risk Behaviors. Journal of Drug Issues. 25(1):57-71, 1995.
Cognitive Readiness of Drug Injectors to Reduce AIDS Risks
Dr. Camacho and others from the Institute of Behavioral Research at Texas Christian University examined the impact of motivational factors on AIDS high risk behavior after participation in an AIDS intervention program. As part of NIDA's research program to educate out-of-treatment IDUs and their sexual partners about HIV, the researchers developed measures of motivation to predict which IDUs would alter their risk behaviors following AIDS intervention and to what extent. They found that concern about AIDS was not related to risk levels at the start of an intervention, but that not having concerns about AIDS was a significant barrier to behavioral change at a 6-month follow-up. Further, the rate of risk reduction was greater for individuals reporting high risk and motivation baseline levels, particularly on measures of use of dirty works and injections. Risky sexual behaviors were found to be more resistant to change than drug-related risks. The findings indicate that psychoeducational AIDS interventions will be most effective with persons who have sufficient cognitive readiness to address AIDS-related issues at the personal level. Camacho, L., Williams, M., Vogtsberger, K., and Simpson, D. Cognitive Readiness of Drug Injectors to Reduce AIDS Risks. Am J on Addictions. 4:49-55, 1995.
Injection Drug Users' Needle-Cleaning Practices
Dr. Harvey Siegel and associates at Wright State University observed the needle cleaning practices of 77 injection drug users as part of the Community-Based Outreach/Intervention research project operating in Columbus, Ohio. They observed how, when, and where IDUs cleaned their needles at baseline and 3 weeks later, at a postintervention follow-up session. The intervention included instruction on needle cleaning practices, with emphasis on exposing needles to bleach for at least 30 seconds in the rinsing process. The researchers conclude that prevention messages that target IDUs about their disinfection practices must contain explicit instructions on minimum bleach exposure times. Siegel, H., Carlson, R., Falck, R., and Wang, J. Injection Drug Users' Needle-Cleaning Practices. Am J Public Health. 84:1523-1524, 1994.
Effectiveness of HIV/AIDS Risk Reduction Interventions Targeting IDUs
Drs. Booth and Watters reviewed published studies for the years 1987 to 1994 to examine the effectiveness of HIV/AIDS risk reduction interventions that target IDUs. The authors identify several major weaknesses that researchers should address when conducting evaluations of risk reduction interventions: a need to control for historic or temporal effects with pretest-posttest control group designs; a need to measure and incorporate intervention dose into the analysis; a need to disentangle exposure effects due to research setting (e.g., treatment clinic vs. street outreach) from intervention effects; and a need to improve problems with small sample sizes, differential attrition, and confounding factors like group differences in years of injection. The authors note that most of the studies they reviewed were implemented and evaluated under adverse conditions which do not lend themselves to more elegant and controlled research designs. Booth, R. and Watters J. How Effective Are Risk-Reduction Interventions Targeting Injecting Drug Users? AIDS. 8:1515-1524, 1994.
Needle Use Practices and HIV Risk-Reduction Among IDUs in the Midwest
Dr. Carlson and colleagues at Wright State University conducted a 2-year ethnographic study of needle use patterns among IDUs in Dayton and Columbus, Ohio. The researchers assert that the term "needle sharing" implies a social bonding or altruistic motive among IDUs who share their needles. They argue that a more appropriate term would be "needle transfer or circulation" because IDUs share works out of economic necessity, from a relative scarcity of syringes. In fact, the researchers found that IDUs were reluctant to use needles previously used by others. This practice was viewed as unhygienic and subordinating because it meant "shooting up behind someone." IDUs who had to wait to use another's needle were more likely to rinse the needle quickly and skip the second bleaching/rinse cycle in their hurry to take the drug. Carlson, R., Siegel, H., and Falck, R. Ethnography, Epidemiology, and Public Policy: Needle Use Practices and HIV-1 Risk Reduction Among Injecting Drug Users in the Midwest. In: Feldman, D. (ed.) Global AIDS Policy. Westport, CT: Greenwood Publishing Group, Inc., pp. 185-214, 1994.
Psychosocial Risk Factors and Condom Use in Intravenous Drug Abusers
A study of psychosocial risk and protective factors in HIV transmission among male intravenous drug abusers (N=300 patients in AIDS or methadone clinics in a large city hospital) indicates parental and peer factors and coping measures were associated with more condom use (Brook et al.). Family factors were associated with good coping skills and with selection of friends who support condom use. The findings supported a mediational model for planning to use and actually using condoms. (Brook, DW, Brook, JS, Whiteman, M, Masci, JR, de Catalogne, J, Amundsen, F, Wynn, PS, & Roberto, J. Psychosocial Risk Factors and Condom Use in Intravenous Drug Abusers. American Journal on Addictions 3:106-114, 1994).
Effects of Personality Factors and Social Support on Patterns of Coping With AIDS. Psychological and social measures were used to study the effects of personality factors and social support on patterns of coping with AIDS or the threat of AIDS by male intravenous drug abusers. The pathways by which psychosocial factors affected coping differed in HIV-positive and HIVnegative subjects. A mediational model best depicted the interrelation of personality, family, and peer factors among HIV-positive subjects. Anger and rebelliousness interfered with coping among HIV-negative subjects but not among HIV-positive subjects. This provides insight into the interplay of inner personality factors and external support factors and their effects on coping ability. (Brook, JS, Brook, DW, Wynn, PS, Whiteman, M, Masci, JR, de Catalogne, J, Roberto, J, and Amundsen, F. Coping with AIDS and the Threat of AIDS in Intravenous Drug Abusers. Journal of Genetic Psychology 155(2):147-159, 1994).
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