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Director's Report to the National Advisory Council on Drug Abuse
September, 1995

Research Findings

AIDS Research

Comparison of Education Versus Behavioral Skills Training Interventions in Lowering Sexual HIV-Risk Behavior of Substance-Dependent Adolescents:

The training based on cognitive-behavioral principles may be effective in lowering high-risk adolescents' vulnerability to HIV infection. Substance-dependent adolescents (n=34) in a residential drug treatment facility received either a 6-session behavior skills training HIV-risk reduction intervention or standard HIV education. After the intervention, adolescents who received behavior skills training exhibited increased knowledge about HIV-AIDS, more favorable attitudes toward prevention and condom use, more internal locus of control, increased self-efficacy, increased recognition of HIV risk, and decreases in high-risk sexual activity. Self-report data were corroborated by records for the treatment of sexually transmitted diseases (St.Lawrence JS, Jefferson KW, Alleyne E, Brasfield TL, Journal of Consulting and Clinical Psychology 63(1):154-157, 1995).

Not-in-treatment Male and Female IDUs and Crack Smokers:

Sherry Deren and colleagues examined data from a national sample of not-in-treatment male and female IDUs and crack smokers to determine relative risks of HIV positive serostatus by sexual orientation. Data were collected on sexual orientation from 11,956 respondents in 16 cities participating in NIDA's Cooperative Agreement for AIDS Outreach/Intervention Research Program from 1990 to 1993. There were 8,423 men (70%), 47% of whom were IDUs, 31% crack smokers, and 21% both IDUs and crack smokers, and 3,533 women (30%), 37% of whom were IDUs, 44% crack smokers, and 18% both. Significant differences were found in drug use by sexual orientation for both males and females. Gay and bisexual males were more likely to be crack smokers and heterosexual males were more likely to be IDUs; gay and bisexual females were more likely to be both injectors and crack smokers. HIV positive serostatus among males was highest among gay men, followed by bisexuals; there was no significant difference in seropositivity within risk category by sexual orientation among females. The paper discusses the implications of relative HIV risks among not-in-treatment drug users by sexual orientation for improving targeted outreach and prevention interventions. Sexual Orientation and HIV Risk Behaviors in a National Sample of Injection Drug Users and Crack Smokers. Drugs and Society (in press).

Behavior Change Among a Cohort of Men

Sally M. Blower and colleagues examined the process of risk behavior change among a cohort of men who have sex with other men in Amsterdam through the use of time series data. Their analyses demonstrate how risk behavior change in this cohort may be viewed as a homogeneous one-step Markovian process. The authors discuss the implications of their findings for long-term prediction of HIV seroconversion rates, for design and evaluation of HIV behavioral intervention studies and vaccine trials, and for understanding and interpreting relapse behavior. An Analysis of the Process of Human Immunodeficiency Virus Sexual Risk Behavior Change. Epidemiology. 1995;6;238-242.

Drug Use and AIDS Risk Behavior Among Homeless Women:

A causal model consisting of personal and social resources, threat appraisal processes, coping styles, and barriers to risk reduction as predictors of general AIDS risk and specific drug use behaviors was investigated among homeless African American (N=714) and Latina (N=691) women aged 18 to 69 years (mean age 32). The model, which was based on a stress and coping framework, supported many of the hypothesized relationships. Active coping was associated with fewer general AIDS risk behaviors for both groups and less specific drug use behavior among African American women. Specific drug use behavior was predicted by high threat appraisal and more avoidant coping for both groups. Behavioral differences between the two ethnic groups were found, especially on the risky AIDS and drug use behavioral measures. Furthermore, less self-esteem predicted more barriers to condom use among the African American women whereas more social resources predicted more barriers among the Latinas. Thus, culture-specific strategies may be necessary to increase condom use among such high risk populations. Nyamathi A, Stein JA & Brecht M. Psychosocial Predictors of AIDS Risk Behavior and Drug Use Behavior in Homeless and Drug Addicted Women of Color. Health Psychology, 14:1995:265-273.

Barriers to Condom Use and Needle Cleaning Among Impoverished Minority Female IDUs and Their IDU Partners:

Based on a study of women recruited primarily from homeless shelters and drug recovery programs, the most commonly cited barriers to condom use were belief that partners did not have acquired immunodeficiency syndrome (AIDS), lack of knowledge about where to get and how to use condoms, and discomfort discussing condom use with partners. African-American women were more likely to report having multiple partners and unprotected sex, and more likely to report barriers in using, discussing and obtaining condoms. Latina women were more likely to report partners' dislike of condoms. African- American and highly acculturated Latina women were more likely to be IDUs than less acculturated Latina women. The more pervasive barriers for needle cleaning were not having personal needles, being high and not interested in needle cleaning, and not having disinfectant available. In a multiple logistic regression analysis for engaging in unprotected sex and cleaning needles, no ethnic or acculturation differences were found after controlling for selected demographic characteristics and risk factors. The data indicate a need to increase the supply of free or low cost condoms, to provide easily accessible sites for obtaining condoms, and to focus counseling for women on negotiating condom use with partners and the skillful and correct placement of the condoms. Nyamathi, A., Lewis, C., Leake, B., Flaskerud, J., Bennett, C. Barriers to Condom Use and Needle Cleaning Among Impoverished Minority Female Injection Drug Users and Partners of Injection Drug Users. Public Health Reports, 110:1995:166-172.

Knowledge, Beliefs, and Attitudes About AIDS, Drug Use, and Sexual Behavior Among Young Children:

AIDS education for children and adolescents is the ultimate goal of the Children's Health Awareness Project conducted by Drs. Elizabeth Wells and her colleagues at the University of Washington, Seattle. This longitudinal study which began in 1991-92 involves annual surveys of children then in grades 3, 4, 5 and 6 (N=1,173; 51% female; 47% white, 24% African American, 20% Asian American, 9% other ethnic groups). Analysis at time one demonstrated a high level of recognition of the three primary routes of HIV transmission (sex, drug use, and in utero exposure). However, children who knew about these routes also had misconceptions about the mechanisms involved in acquiring HIV through these routes and about behaviors through which HIV in not transmitted. Older children had fewer misconceptions than younger children, and children of higher socioeconomic status (SES) had fewer misconceptions than those of lower SES. Ethnic differences in knowledge about the primary routes of HIV transmission were not evident. Hoope, M.J., Wells, E.A., Morrison, D.M., Gillmore, M.R. & Wilsdon, A. Misconceptions About AIDS Among Children Who Can Identify the Major Routes of HIV Transmission. Journal of Pediatric Psychology, 20(50):1995:671- 686.

IDU Networks in Three Cities

Mark L. Williams and colleagues investigated the structures of IDU networks in three cities with varying HIV infection rates among IDUs (Rio Piedras, Puerto Rico, with an HIV positive rate among IDUs of 60% or higher; Houston, Texas, with an HIV positive rate among IDUs of 6%; and Dayton/Columbus, Ohio, with an HIV positive rate among IDUs of 1%). They found that network size did not vary among the sites, ranging from as small as two IDUs to as large as six or more IDUs, nor did the length of time respondents reported using drugs with their network counterparts. However, there were significant differences in the frequencies of drug use within a network, with the majority of networks in Rio Piedras reporting drug use together two or more times daily and the majority of networks in Houston and Dayton/Columbus reporting drug use together weekly or less than weekly. The networks in Puerto Rico were significantly more homogeneous than those in Houston and Dayton, being predominately single gender injectors only. Houston and Dayton/Columbus networks were mixed gender and mixed IDUs and crack smokers. An Investigation of the HIV Risk Behaviors of Drug Use Networks. Connections. Vol 18; 1; April 1995; pp. 58-72.

Paradigm Shift:

Robert Trotter and collaborators Richard B. Rothenberg and Susan Coyle have written a recent article about a paradigm shift in social research on HIV transmission, drug abuse, and risk reduction. They provide an environmental-epidemiological rationale for the use of social network analysis to explore facilitating factors or barriers to the transmission of HIV infection in drug using populations. The authors present an overview of the theoretical, empirical, and practical conditions that have led to the paradigm shift in social research, including a discussion of research trends and support for social network analysis in the HIV and drug risk field. Drug Abuse and HIV Prevention Research: Expanding Paradigms and Network Contributions to Risk Reduction. Connections. Vol 18; 1; April 1995; pp. 29-45.

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