Faculty Bibliography

Preventing illicit drug injection would be the ideal point for preventing HIV infection and AIDS among illicit drug injectors. This paper reports on clinical issues that arose in a program for intranasal ("sniffer") heroin users who were at high risk of injecting drugs. Extensive field notes were kept by the staff of the project. A generalized mistrust of authorities, denial of problems associated with non-injected drug use, and ambivalence about injecting were the major issues that arose during subject recruitment and the group sessions. The staff underwent trial and error learning, both becoming more confident in working with heroin sniffers, and finding better results for later participants in the study.

Gauging the impact of AIDS on intravenous drug users requires analysis of the cultural, political, and racial contexts of American society in which drug use is embedded. Considerable variation in behavior among drug injectors and noninjectors in different cities over time further complicates an understanding of the dynamics of drug use. AIDS has prompted many IV drug users to change their behavior, though not all users have reduced the risks of transmitting HIV infection. While expanded harm-reduction strategies and drug abuse treatment systems may help limit the epidemic's spread, weak federal support, constrained hospital resources, and racial stigma inhibit more direct action needed to stem the negative social and personal consequences of drug use.

In 1984 as part of a New York City study to examine the prevalence of HIV infection in a substance-abusing population and to test the validity of HIV screening kits, 94 patients at the New York VAMC were tested. Results were made available to 50 (35 seronegative, 15 seropositive) patients in January 1986. Psychological and behavioral impact of learning test results was assessed using standardized psychiatric rating scales. A comparison group of 31 nontested subjects were also evaluated. Ratings were done preresults, approximately 1-2 weeks after results, and 8-10 weeks after informing patients of their HIV status. No major stress reactions were observed. Seropositives experienced a higher level of anxiety 1-2 weeks after learning results but anxiety generally diminished; they made significant behavior changes which were maintained. Seronegatives experienced relief and maintained IV drug risk reduction behavior. Anxiety about contracting AIDS increased in nontested subjects as the study progressed