Faculty Bibliography

Illicit drug injection is a major component of the AIDS epidemic in the United States, Europe and some developing countries. Prevention of illicit drug injection would not only reduce HIV transmission but would also reduce the other health, psychological and social problems associated with illicit drug injection. One hundred and four subjects who were using heroin intranasally ('sniffing') were recruited for a study of the transition to drug injection. Eligibility criteria included sniffing as the most frequent route of administration and no more than 60 injections in the past 2 years. All subjects received thorough basic information about AIDS, including HIV antibody test counseling. Subjects were then randomly assigned to a four-session social learning based AIDS/drug injection prevention program or a control condition. Eighty-three subjects were successfully followed at a mean time of 8.9 months. Twenty (24%) of the followed subjects reported injecting illicit drugs during the follow-up period. Drug injection during follow-up was associated with being in the control group, intensity of non-injected drug use, prior injection, and having close personal relationships with current intravenous (IV) drug users.

Many drug injectors continue to engage in behaviors that lead them to become infected with HIV in spite of a wide variety of public health programs. In addition, many persons have begun to inject drugs in spite of knowing the risks of AIDS. The inadequacy of current efforts to prevent these behaviors suggests that additional forms of intervention should be attempted. We suggest that social interventions be tried to complement current programs (almost all of which have an individual focus). Evidence that social factors such as peer pressure and the social relations of race affect risk behavior is presented. Social interventions that are discussed include organizing drug injectors against AIDS in ways analogous to those in which gays organized against the epidemic, and finding ways to change large-scale social relationships that predispose people to inject drugs.

We examined crack use in a cohort of methadone patients originally enrolled in 1984-86. Crack use questions were added to the study in 1987. Of the 494 methadone patients originally enrolled, 228 subjects remained in methadone and were re-interviewed in 1987-88, and 234 remained in methadone and were re-interviewed in 1988-89. Approximately one-quarter of the subjects were using crack at each of the 1987-88 and 1988-89 data collection points, and only 3% of the subjects were using crack at daily or greater frequencies at each of the 1987-88 and 1988-89 interviews. Concurrent crack use was associated with (a) the number of noninjected drugs being used; (b) the number of IV drug-using sexual partners; (c) drug injection; and (d) the use of nonheroin opiates. Persistent crack use, defined as use in both 1987-88 and 1988-89, was associated with previous noninjected drug use and previous suicide attempts. While the potential problem of crack use among methadone patients should not be minimized, it appears that, compared to illicit drug injectors not in treatment, being in methadone maintenance may offer a protective effect against crack use

AIDS outreach workers operate at the frontlines of the AIDS epidemic to provide information and education to high-risk individuals. Recent reports indicate that these workers have been effective in helping to reduce high-risk behaviors. However, a review of retention data for 62 outreach workers employed from 1986 to 1988 at a private nonprofit research institute indicated a high rate of turnover, especially among males. The literature provides little information regarding the demographic characteristics of outreach workers and their sources of job satisfaction and dissatisfaction. This exploratory investigation was undertaken to address these topics. Structured interviews were conducted with 20 currently active outreach workers. Results indicate that altruistic motives were most frequently cited as reasons why people became outreach workers and also provided the primary source of satisfaction. Stress was most frequently mentioned as a source of dissatisfaction and also as a reason previous workers had left outreach work. Conclusions focus on the outreach workers' suggestions for job improvements. These included: improvement in the terms of employment (e.g., salary, benefits); more education and training opportunities; and more support groups or help with recovery.