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This paper investigates whether the time period during which retrospective behavioral data are collected affects the results of studies of HIV risk factors. In particular, we address the concern that questionnaires probing behaviors in the recent past may not isolate the risk behaviors involved at the time of actual HIV infection. During 1987 and 1988, 278 street-recruited injecting drug users (IDUs) in New York City were interviewed about their sexual behaviors, medical history, drug-injection behaviors in the prior ten years, and specific needle-use behaviors during 1985-86 and thereafter. Among the 278 subjects, 52% were HIV-seropositive. In univariate analysis, serostatus was significantly related to: a) total drug-injection frequency during 1983-84 and 1985-86; b) mean monthly total drug-injection frequency during 1977 to 1987; c)cocaine injection frequencies during 1983-84 and 1985-86, and during the last thirty days, and d) injecting in shooting galleries and using previously used cookers during 1985-86. Significant predictors of seroprevalence in stepwise logistic regression were total drug and cocaine injection frequencies during; 1983-84, years of injection, residence in the Bronx, not being Hispanic and history of any sexually transmitted disease, The data confirm previous reports on behavioral risk factors for HIV serostatus. Re-analysis using drug;injection frequency data for different time periods indicates that in the context of an ''older'' HIV epidemic like that in New York City, analysis of risk factors may be less sensitive to time periods than had previously been feared, although it may be true that data for behaviors in ''the last thirty days'' cover a sufficiently atypical period as to produce misleading results.
Objectives. This case-control study examined the association between syringe e
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Total Results:
1305
Syringe exchange: HIV prevention, key findings, and future directions
HIV among injecting drug users (IDUs) has now been documented in over 60 countries in the world, and there are an additional 40 countries where injecting drug use has been reported including widespread epidemics in Southeast and southern Asia and in Latin America. At present HIV infection is almost always fatal, and there is no promise that a preventive vaccine will become available soon. Given the enormity of the HIV epidemic among IDUs and the critical need to reduce the spread of HIV transmission to and from IDUs, prevention efforts are essential. Syringe-exchange programs have become a major component of HIV prevention strategies in most developed countries and work within the philosophy of harm reduction. Increasing access to sterile syringes has been met with considerable controversy. Opponents of syringe exchange have generally argued that increasing access to sterile syringes would simultaneously increase the number of injecting drug users, increase the frequency of injection for already active IDUs, and appear to "condone" an illegal behavior. To date many research studies and four major reviews of syringe exchange literature have been conducted. All studies thus far have shown no increase in illicit drug injection associated with syringe exchanges, and significant decrease in drug risk behaviors.
PMID: 8557411
ISSN: 0020-773x
CID: 3602822
USING RETROSPECTIVE BEHAVIORAL-DATA TO DETERMINE HIV RISK FACTORS AMONG STREET-RECRUITED DRUG INJECTORS
ISI:A1995QM27800011
ISSN: 0022-0426
CID: 3606442
SYRINGE EXCHANGE PROGRAMS - UNITED-STATES, 1994-1995 (REPRINTED FROM MMWR, VOL 44, PG 684-685, 1995) [Reprint]
ISI:A1995TA10400003
ISSN: 0098-7484
CID: 3608942
REDUCED RISK OF HEPATITIS-B AND HEPATITIS-C AMONG INJECTION-DRUG USERS IN THE TACOMA SYRINGE EXCHANGE PROGRAM
ISI:A1995TB49300011
ISSN: 0090-0036
CID: 3608962
Risk factors for human immunodeficiency virus seroconversion among out-of-treatment drug injectors in high and low seroprevalence cities. The National AIDS Research Consortium
From 1988 to 1991, 6,882 drug injectors in 15 US cities were interviewed and had serum samples collected. The interviews and samples were analyzed for determination of significant predictors of human immunodeficiency virus (HIV) seroconversion in the 10 low seroprevalence cities and the five high seroprevalence cities. The unit of analysis was the period of observation between consecutive paired interviews/blood samples. In Cox proportional hazards regression, significant predictors of seroconversion in the low seroprevalence cities were: not being in drug treatment, injecting in outdoor settings or abandoned buildings, using crack cocaine weekly or more frequently, engaging in woman-to-woman sex, being of non-Latino race/ethnicity, and city seroprevalence. Predictors in high seroprevalence cities were: injecting with potentially infected syringes, not being in drug treatment, and having a sex partner who injected drugs. These findings suggest that HIV may be concentrated in sociobehavioral pockets of infection in low seroprevalence cities. For reducing HIV transmission, these results suggest: 1) in low seroprevalence cities, localized monitoring to detect specific emerging sociobehavioral pockets of infection, and quick implementation of appropriate targeted interventions if necessary; 2) in high seroprevalence cities, relatively more emphasis on locality-wide outreach and syringe-exchange projects to reduce risky behavior; and 3) in both types of cities, considerable expansion of drug treatment programs.
PMID: 7572963
ISSN: 0002-9262
CID: 1577382
Maintaining low HIV seroprevalence in populations of injecting drug users
OBJECTIVES: To describe prevention activities and risk behavior in cities where human immunodeficiency virus (HIV) was introduced into the local population of injecting drug users (IDUs), but where seroprevalence has nevertheless remained low (< 5%) during at least 5 years. DESIGN AND SETTING: A literature search identified five such cities: Glasgow, Scotland; Lund, Sweden; Sydney, New South Wales, Australia; Tacoma, Wash; and Toronto, Ontario. Case histories were prepared for each city, including data on prevention activities and current levels of risk behavior among IDUs. PARTICIPANTS: Injecting drug users recruited from both drug treatment and non-treatment settings in each city. INTERVENTIONS: A variety of HIV prevention activities for IDUs had been implemented in each of the five cities. RESULTS: There were three common prevention components present in all five cities: (1) implementation of prevention activities when HIV seroprevalence was still low, (2) provision of sterile injection equipment, and (3) community outreach to IDUs. Moderate levels of risk behavior continued with one third or more of the IDUs reporting recent unsafe injections. CONCLUSIONS: In low-seroprevalence areas, it appears possible to severely limit transmission of HIV among populations of IDUs, despite continuing risk behavior among a substantial proportion of the population. Pending further studies, the common prevention components (beginning early, community outreach, and access to sterile injection equipment) should be implemented wherever populations of IDUs are at risk for rapid spread of HIV.
PMID: 7563513
ISSN: 0098-7484
CID: 171193
A COMPARISON OF SEVERITY OF ILLNESS SCORING SYSTEMS FOR INTENSIVE-CARE UNIT PATIENTS - RESULTS OF A MULTICENTER, MULTINATIONAL STUDY
Objective: To compare the performance of three severity of illness scoring systems used commonly for intensive care unit (ICU) patients in a large international data set. The systems analyzed were versions II and III of the Acute Physiology and Chronic Health Evaluation (APACHE) system, versions I and II of the Simplified Acute Physiology Score (SAPS), and versions I and II of the Mortality Probability Model (MPM), computed at admission and after 24 hrs in the ICU. Design: A multicenter, multinational cohort study. Setting: One hundred thirty-seven ICUs in 12 European and North American countries. Patients: During a 3-month period, 14, 745 patients were consecutively admitted to 137 ICUs enrolled in the study. Interventions: Collection of information necessary to compute the APACHE II and APACHE III scores, SAPS I and SAPS II, and MPM I and MPM II scores. Patients were followed until hospital discharge. Statistical comparison, including indices of calibration (goodness-of-fit) and discrimination (are!a under the receiver operating characteristic curve). Measurements and Main Results: Despite having acceptable receiver operating characteristic areas, the older versions of the systems analyzed (APACHE II, SAPS, and MPM I computed at admission-MPM I computed after 24 hrs in the ICU) demonstrated poor calibration for the whole database. The new versions of the systems (SAPS II and MPM II) were superior to their older counterparts. This superiority is reflected by larger receiver operating characteristic areas and better fit. The APACHE III system improved its receiver operating characteristic area compared with the APACHE II system, which showed the best fit of the old systems analyzed. Conclusions: The new versions of the severity systems analyzed (APACHE III, SAPS II, MPM II) perform better than their older counterparts (APACHE II, SAPS I, and MPM I). APACHE II, SAPS II, and MPM II show good discrimination and calibration in this international database. $$:
ISI:A1995RN41400005
ISSN: 0090-3493
CID: 109619
Multi-city study on drug injecting and risk of HIV infection : a report prepared on behalf of the WHO International Collaborative Group
[Geneva?] : World Health Organization, Programme on Substance Abuse, 1994
Extent: vi, 231 p.
ISBN: n/a
CID: 4856482
New injectors and HIV risk
[Geneva?] : World Health Organization, Programme on Substance Abuse, 1994
pp. ?-?
ISBN: n/a
CID: 4856462
Prevencao de AIDS entre os usuarios de drogas injetaveis nos paises em desenvolvimento
Sao Paulo : Editora HUCITEC, 1994
pp. 13-18
ISBN: 9788527102742
CID: 4848572
