Correlates of consistent condom use with main partners by partnership patterns among young adult male injection drug users from five US cities

This paper examined correlates of consistent condom use with a main partner among heterosexual male injection drug users (IDUs). Using data from a multi-site sample of young IDUs, we identified 1770 sexually active men of whom 24% (429/1770) reported an exclusive main female sex partner and 49% (862/1770) reported both main and casual female sex partners. Consistent condom use with a main partner was low among men with an exclusive main partner and those with multiple partners (12% and 17%, respectively). In multivariate analysis, consistent condom use with a main partner across partnership patterns was directly associated with anticipating a positive response to requests for condom use and by partner support of condom use; consistent condom use was inversely associated with a main partner's pregnancy desires. Among men with an exclusive main partner, consistent condom use was also inversely associated with needle sharing with a main partner. Among men with multiple partners, consistent condom use with a main partner was inversely associated with injecting with a used needle and intimate partner violence. The low prevalence of consistent condom use with main female partners among heterosexually active male IDUs indicates an increased risk for HIV transmission between men and their primary sex partners. Interventions for heterosexual males that are geared toward increasing condom use in primary relationships are warranted.     

Student and school characteristics associated with use of nicotine replacement therapy: a multilevel analysis among Canadian youth

BackgroundResearch indicates that it is common for youths to use nicotine replacement therapy (NRT) despite limited empirical evidence for its effectiveness within this population. Since very little is known about the characteristics associated with NRT use by youth, the current study examined the association between ever and current use of NRT as a function of student characteristics and the characteristics of the schools they attend.MethodsThis study used nationally representative student-level data from 29,296 grade 9 to 12 students who participated in the 2008–2009 Canadian Youth Smoking Survey (YSS). School-level data on the built environment surrounding schools were provided by DMTI-Spatial, and data on school location were provided by the Canadian Census. Two multilevel logistic regression models were used to predict ever use of NRT and current use of NRT as a function of student and school characteristics among current smokers.ResultsOverall, 21.1% of youth smokers in Canada had ever used NRT and 5.1% were currently using NRT. Odds of ever and current NRT use were highest among daily smokers and boys, while youths who had made multiple quit attempts or participated in a quit and win contest were more likely to be ever NRT users. Attending a school located within an urban area increased youths' odds of ever and current NRT use, whereas higher density of pharmacies surrounding a school was inversely associated with current NRT use.ConclusionsCharacteristics of students and the schools they attend were associated with the likelihood of youth smokers using NRT. Significant between-school differences in NRT use exist, however further research is needed to identify which school characteristics account for these differences and understand how youth are accessing NRT.     

Factors associated with recent-onset injection drug use among drug users in Pakistan

Seventy-two recent-onset injection drug users and 241 non-injection drug users were recruited in Quetta and Lahore, Pakistan, in 2003. Trained interviewers administered questionnaires regarding drug use behaviors and perceived changes in drug cost/supply. Logistic regression identified independent correlates of recent-onset injection. In Lahore, a perceived increase in drug cost was associated with higher odds of recent-onset injection, with no association in Quetta. Recent-onset injection was also associated with family history of drug use, group drug use, and sharing snorting/chasing tools. Changes in perception of the drug supply may be associated with recent-onset injection drug use. Familial/social influences were also associated with recent-onset injection, suggesting peer-led interventions could discourage transition to injection drug use.     

Factors associated with readiness to change drug use among needle-exchange users

To determine if frequent needle-exchange program (NEP) use is associated with lower readiness to change drug use, NEP clients in Providence, RI were interviewed regarding their drug use, HIV risk, health, and past use of drug treatment services in 1997-1998. Readiness to change drug use was assessed using a nine-step decision ladder. Based on this assessment, 14.3% of the sample were classified as precontemplators (24/168), 29.2% were in the contemplation stage (49/168), and 56.5% were in the determination or ready to change stage (95/168). We found that mean number of NEP visits was 25.5 among precontemplators, 28.7 among contemplators, and 22.5 among those in the determination stage. In multivariate analysis, an inverse relationship between having ever been in alcohol treatment and higher readiness to change drug use was the only significant association. In this exploratory study, we found that more frequent NEP participation did not impact readiness to change drug use among intravenous drug users. Given the high proportion of NEP clients ready to change drug use, improving linkages between NEPs and substance abuse treatment appears warranted.     

Alcohol, drugs, and condom use among drug offenders: an event-based analysis

BACKGROUND: Studies of the association between substance use and condom use in specific sexual encounters often do not separate the effects of alcohol and different types of drugs. Because the pharmacological effects and social settings of various substances differ, their effects on unprotected intercourse may vary as well. GOAL: This study examined the relationship between alcohol and drug use and the use of condoms in sexual encounters with casual partners in a high-risk population of drug offenders. DESIGN: Participants in court-ordered drug diversion programs (n=536; 26% female) completed a questionnaire in which they reported on the circumstances of their most recent sexual encounter with a casual partner. RESULTS: In multivariate logistic models, alcohol use in conjunction with sex was not related to decreased condom use in either men or women. Amphetamines (smoked or injected) were associated with decreased condom use, while cocaine, marijuana, and orally-administered amphetamines were not significantly associated with condom use. CONCLUSIONS: In this high-risk sample, links between substance use and unprotected sex differ with type of drug used.     

The relationship between attitudes toward pregnancy and contraception use among drug users

Use of alcohol and drugs during pregnancy is regarded as a serious problem in the medical field. The current study explored gender and ethnic differences in attitudes and behaviors related to sexuality and contraceptive use among European American, Mexican American and Native American female and male clients in drug recovery programs. The study also examined the relationship between sexual abuse, concern for pregnancy, concern for contracting sexually transmitted diseases and contraception use among women drug users. Results showed gender and ethnic differences in attitudes toward pregnancy, abortion and contraceptive use. In addition, both Mexican American and Native American women who had a high concern for pregnancy were more likely to use birth control when they reported sexual abuse than when they reported no abuse. In contrast, European American women with a high concern for pregnancy showed a tendency to use birth control less when they reported abuse than when they did not. The observed attitudinal and behavioral differences between genders and ethnic groups are discussed in relation to design of treatment program components to increase contraceptive use and decrease unwanted pregnancies among drug users.     

Adversity among drug users: relationship to impulsivity

Illicit substance users experience adverse life events, but few studies have examined the role of impulsivity in these events. The present investigation sought to establish a link between negative life experiences and a trait measure of impulsivity and demonstrate that this association remains even accounting for potential confounds. Participants were 330 heroin and cocaine users recruited from the community for a health service research study. Participants completed a structured interview that assessed topics including drug and alcohol use, impulsivity, and negative life events. This group of drug users reported high rates of adverse life events in the 6 months prior to the assessment. No specific substance abuse/dependence diagnosis or combination of diagnoses was associated with adversity. Number of substance-related diagnoses was associated with adverse life events, but not when adjusting for impulsivity. Experience of these events was significantly associated with impulsivity (p<.001), above and beyond the shared relation with demographic variables, substance abuse and dependence, and number of substance-related diagnoses. These findings document the high frequencies of recent adverse life events among illicit drug users and indicate that trait impulsivity is associated with increased risk of these life events.     

Predictors of increased condom use following HIV intervention with heterosexually active drug users

Research with injection drug users (IDUs), at risk for acquiring and transmitting HIV, has focused primarily on their risky drug practices, with far less attention paid to their risky sex behaviors. The purpose of this study was to determine what variables were associated with an increase in condom use following an HIV intervention with 3357 IDUs in nine cities. Participants reported using condoms during 15% of their sexual encounters prior to the HIV intervention, and during 22% of their sexual encounters six months later. A logistic regression analysis indicated that individuals who increased their condom use were likely to be HIV seropositive (odds ratio OR = 2.49), to have received AIDS information prior to the intervention (OR = 1.28), to have multiple sex partners (OR = 2.14), to be single with multiple sex partners (OR = 1.34), or to have exchanged drugs or money for sex (OR = 1.33). Discussion focuses on the generally low incidence of condom use and the need for increased intervention, particularly among drug users in monogamous relationships and sex workers.     

Factors associated with employment among a cohort of injection drug users

Introduction and Aims. One of the most substantial costs of drug use is lost productivity and social functioning, including holding of a regular job. However, little is known about employment patterns of injection drug users (IDU). We sought to identify factors that were associated with legal employment among IDU. Design and Methods. We describe the employment patterns of participants of a longitudinal cohort study of IDU in Vancouver, Canada. We then use generalised estimating equations (GEE) to determine statistical associations between legal employment and various intrinsic, acquired, behavioural and circumstantial factors. Results. From 1 June 1999 to 30 November 2003, 330 (27.7%) of 1190 participants reported having a job at some point during follow up. Employment rates remain somewhat stable throughout the study period (9–12.4%). Factors positively and significantly associated with legal employment in multivariate analysis were male gender (adjusted odds ratio [AOR] = 2.78) and living outside the Downtown Eastside (AOR = 1.85). Factors negatively and significantly associated with legal employment included older age (AOR = 0.97); Aboriginal ethnicity (AOR = 0.72); HIV‐positive serostatus (AOR = 0.32); HCV‐positive serostatus (AOR = 0.46); daily heroin injection (AOR = 0.73); daily crack use (AOR = 0.77); public injecting (AOR = 0.50); sex trade involvement (AOR = 0.49); recent incarceration (AOR = 0.56); and unstable housing (AOR = 0.57). Discussion and Conclusions. Our results suggest a stabilising effect of employment for IDU and socio‐demographic, drug use and risk‐related barriers to employment. There is a strong case to address these barriers and to develop innovative employment programming for high‐risk drug users.[Richardson L, Wood E, Li K, Kerr T. Factors associated with employment among a cohort of injection drug users. Drug Alcohol Rev 2010]     

Factors associated with suicide attempts among injection drug users

Injection drug users (IDUs) entering an urban low-threshold opiate detoxification unit in Munich, Germany, between 1991 and 1997 were asked for lifetime suicide attempts and administered a questionnaire, including sociodemographic, IDU-related, and drug user treatment related variables. Among 1,049 participants, 20% had ever tried to commit suicide. In the logistic regression, female gender, older age, drug user treatment experience, lack of drug user counseling, and emergency treatment were associated with attempted suicide. Regular screening for suicidal behavior in IDUs should be undertaken with a special focus to mention risk factors. The study's limitations are noted. This study was partially sponsored by the German Ministry of Health.     

High-risk behaviors associated with transition from illicit non-injection to injection drug use among adolescent and young adult drug users: a case-control study

OBJECTIVE: The goal of our study was to elucidate characteristics of persons likely to transition into injection drug use so that an identifiable group with high-risk for blood-borne infection may be targeted for interventions. METHODS: An age-matched case-control analysis was performed from a cohort study in Baltimore, 1997-1999, of street-recruited non-injection and injection drug users (IDUs), aged 15-30. Cases were IDUs injecting < or = 2 years and controls were age-matched persons who used non-injection heroin, cocaine or crack. At baseline, all were interviewed about prior year-by-year behaviors; analysis using conditional logistic regression was based on information for the year prior to injection onset for the case and the same calendar time for the controls as well as recent behaviors for both groups. RESULTS: Of 270 participants, most were African American (78%), female (61%), and HIV seroprevalence was 7% at baseline. IDUs were significantly more likely than controls to be non-African American (adjusted odds ratio (AOR)=0.09) and report high school dropout (AOR=2.32), early sex-trading (AOR=2.72), and recent violence victimization (AOR=9.28). CONCLUSION: Given that new injectors are at high-risk for HIV and hepatitis yet difficult to reach for prevention efforts, our data suggest some categories to use to target non-injectors who are likely to transition into injection use.     

The effects of victimization on drug use: a multilevel analysis

Agnew's general strain theory suggests that negative life experiences constitute stress that may lead to deviance, unless effective coping strategies are forthcoming. In the present study, the principles of general strain theory were employed to examine the age-varying effects of three types of victimization on drug-using behavior: sexual victimization, physical victimization, or other victimization. Study data came from seven waves of the National Youth Survey, a longitudinal survey of youth ages 11 to 17 years when the study began in 1976. The broad hypotheses of general strain theory were supported, by the data, with some qualifications. Results of the data analysis also showed that victimization's impact on drug use is type-specific and/or drug-specific. Further studies with more sophisticated measures of drug use should clarify the role of victimization (by type) in various drug-using behaviors. The study's limitations are noted.     

Intra-couple communication dynamics of HIV risk behavior among injecting drug users and their sexual partners in Northern Vietnam

This paper elucidates the social context of HIV risk behavior and intra-couple risk communication among injecting drug users (IDUs) and their main sex partner. Data on shared injection equipment, unprotected sex with multiple partners, unprotected sex with a main partner and couples' dynamics and risk communication were gathered through separate in-depth interviews with 11 active male IDUs and 11 of their primary female sex partners in Northern Vietnam. The majority of IDUs' sex partners does not inject drugs and is monogamous. In contrast, most IDUs reported a wide range of risky practices including needle sharing and unprotected sex with multiple, often concurrent, sex partners. Men rarely used condoms with primary partners. Many IDUs worried about their HIV-status, but none disclosed their injecting or sexual practices to their sex partners, leaving their partners unaware of their HIV risk. Among women who worried about HIV/AIDS, the vast majority was unable to influence their partner's needle sharing or extramarital affairs and most would not initiate condom use because they feared their partner's reaction. Couple-based interventions to facilitate risk communication combined with programs to promote condom use among male IDUs, may help to reduce HIV transmission from IDUs to their primary partners.     

Sexual and drug use behaviors among female crack users: a multi-site sample

The purpose of this paper was to compare female crack users who report exchanging sex for drugs and/or money with female crack users who did not report exchanging sex for drugs and/or money. A multi-site sample of (n = 4667) female crack users who participated in the National Institute of Drug Abuse (NIDA) AIDS Cooperative Agreement Project from 20 sites were interviewed. Statistical analysis compared two groups on selected variables of interest: women crack users who reported exchanging sex for drugs and/or money (n = 2658) and women crack users who did not report exchanging sex (n = 2009). Results indicated that both groups of women had frequent unprotected sex. However, women who exchanged sex had more sexual partners, had sex more often, used drugs before and during sex more often, and had a higher rate of STDs than women who did not exchange sex. In addition, African-American women, homeless women, and women who reported past substance abuse treatment were about twice as likely to exchange sex. Regional differences were also examined.     

Factors associated with methadone maintenance therapy use among a cohort of polysubstance using injection drug users in Vancouver

We identified methadone maintenance therapy (MMT) use during follow-up interviews and examined associations between MMT use and socio-demographic and drug-related variables using generalized estimating equations (GEE). Of the 1587 participants recruited into this cohort, 170 (11%) were enrolled in MMT at baseline and additional 498 (31%) initiated MMT during follow-up. Of those ever enrolled in MMT, 406 (61%) ceased MMT and re-initiated MMT on more than one occasion. The median treatment duration was 14.4 months. Factors that were negatively and significantly associated with MMT use in multivariate analyses included: Aboriginal ethnicity (adjusted odds ratio [AOR] = 0.40); recent incarceration (AOR = 0.79); sex trade involvement (AOR = 0.87); syringe lending (AOR = 0.72); heroin injection (AOR = 0.64), whereas female gender (AOR = 2.47), HIV positivity (AOR = 1.57), and crack cocaine smoking (AOR = 1.23) were positively and significantly associated with being on MMT. Unstable housing, syringe borrowing, non-fatal overdose, cocaine injection, and residence in Vancouver's Downtown Eastside were not associated with MMT use in multivariate analyses. Our study demonstrates high rates of initiation of and retention in MMT among local IDUs. While the use of MMT was associated with reductions in heroin use and HIV risk behavior, barriers to Aboriginal IDUs were evident, and the association with increased crack cocaine use deserves further study.     

Knowledge and perception of risk for HIV and condom use among male injecting drug users in Cebu City,Philippines

Injecting drug users (IDU) represent a small fraction of the HIV and AIDS cases in the Philippines. To determine if these people are engaging in behaviors that put them at risk for HIV, interviews were conducted with 360 male IDUs in Cebu City, Philippines, from 1997 to 1999, as part of a national surveillance system. The interviews assessed knowledge about HIV transmission, sources of information about HIV/AIDS, perceived risks of contracting HIV, needle-sharing practices, condom use, self-reported signs and symptoms of STDs and number of sex partners. Although most of the men were able to recognize behaviors accurately that put them at risk for HIV, more than two-thirds claimed that they shared needles and almost two-thirds of those who were sexually active claimed that they never used condoms. Intervention strategies must be developed for this population if the nation is to avoid the dramatic increase in HIV infection among IDUs that has been witnessed in neighboring Southeast Asian nations such as Malaysia and Vietnam.     

Social and structural determinants of health associated with drug use patterns among female sex workers in Iran: A latent class analysis

BackgroundFemale sex workers (FSWs) experience adversities regarding social determinants of health (SDH) and behavioural factors including illicit drug use. This study aimed to assess the clustered impact of SDH on illicit drug use among FSWs in Iran.MethodsWe surveyed 1,347 FSWs in 13 major cities in 2015. Latent class analysis was conducted to identify distinct classes of five measured SDH including low education, unemployment, unstable housing, last-year incarceration and sexual violence. We examined the association of these classes with five illicit drug use patterns using multivariable generalized linear model with Poisson family and log link, and reported adjusted prevalence ratios (aPR) and their 95% confidence intervals (CI).ResultsWe identified five SDH classes: Class 1: no SDH adversities; Class 2: mainly unemployment; Class 3: low education and unemployment; Class 4: sexual violence and unemployment; and Class 5: multiple SDH adversities. The prevalence of last-month drug use ranged from 7.0% in Class 1 to 53.3% in Class 5. Compared to FSWs in Class 1, those in Class 2 (aPR: 2.47, 95% CI: 1.15, 5.27), Class 3 (aPR: 3.69, 95% CI: 1.62, 8.36), Class 4 (aPR: 4.49, 95% CI: 1.71, 11.78) and Class 5 (aPR: 6.35, 95% CI: 2.42, 16.69) were more likely to report last-month drug use. The same patterns were observed for specific drugs of opium use, crystal methamphetamine use, and heroin-crack use, as well as poly-drug use.ConclusionSocio-structural determinants are clustered together and elevate the likelihood of illicit drug use among FSWs. Our findings highlighted the significance of assessing and addressing such key determinants of health in drug use harm reduction programs targeting FSWs.     

Factors associated with drug treatment dropout among injection drug users in Puerto Rico

This study examined factors associated with drug treatment dropout among injection drug users (IDUs) in Puerto Rico, a group that has contributed significantly to the self-sustaining AIDS epidemic in the island since the mid-1980s. A total of 557 IDUs were recruited from communities in a semirural region of Puerto Rico, as part of a longitudinal study testing the efficacy of a two-facet intervention model, based on motivational interviewing. Of 124 IDUs who had entered drug treatment at follow-up, 33 (26.6%) dropped out before completing all recommended sessions. Multiple logistic regression analysis showed that age, homelessness, and speedball use were significantly associated with drug treatment dropout. Conversely, participants who received the two-facet intervention were significantly less likely to drop out of drug treatment. Receiving psychiatric services also reduced the odds of treatment dropout. Improving adherence to drug treatment and reducing dropout rates are complex processes that need to be addressed at the individual behavioral and social support levels, as well as the program process and resource levels.