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Biomedical subjects

J K Watters

Publications and source records attributed to J K Watters.

At least 37 records · Page 2Linked to original sources
PubMed1994

Historical perspective on the use of bleach in HIV/AIDS prevention.

In 1986, community outreach workers began distributing small bleach bottles to injection drug users (IDUs) in San Francisco as a simple means for them to reduce their risk of infection with HIV and other pathogens by quickly flushing their syringes with bleach. At inception, the intervention was based on four assumptions: (a) sole reliance on expanded drug treatment capacity could not achieve HIV prevention goals, (b) legal barriers made syringe distribution or exchange schemes unfeasible, (c) IDUs would act in their own interest if the measures offered were acceptable to them, and (d) using bleach would diminish the risk of HIV transmission from reusing injection equipment. Following successful implementation of this program in San Francisco, similar programs were developed in many locations. These programs serve as the principal means of preventing needle-borne HIV infection among IDUs not enrolled in drug abuse treatment in the United States. Needed are definitive laboratory studies to determine the effectiveness of bleach decontamination as presently used by IDUs.

Disinfection↗
PubMed1994

Sexual behavior and sexual identity in male injection drug users.

Sexual behavioral data from a survey of 396 male drug injectors showed that 301 (76%) were behavioral heterosexuals, 49 (12.45%) were bisexuals, and 46 (11.6%) were homosexuals over the previous 5 years. Among those sexually active during the 6 months before the interview, bisexuals were similar to heterosexuals and homosexuals in reporting two or more female or male partners, respectively. Overall, almost three fourths of the bisexuals had two or more sexual partners. Bisexuals were also similar to heterosexuals in reported heterosexual and intercourse (16 and 15%, respectively), and to homosexuals in reported homosexual insertive anal intercourse (33 and 54%, respectively). They were less likely than heterosexuals to engage in vaginal and insertive oral sex with women and than homosexuals to practice receptive and and oral sex with men. The three groups all practiced high levels of unprotected sex. Almost half the behavioral bisexuals identified themselves as heterosexuals. Self-identified heterosexuals in the sample were less likely than self-identified gays or bisexuals to state they reduced sexual risk; however, reported condom use was low for all three groups. With human immunodeficiency virus infection rates of 54% (21 of 39) for behavioral homosexuals, 24% (11 of 45) for bisexuals, and 9% (24 of 260) for heterosexuals, these findings indicate an urgent need for more effective sexual risk reduction among injection drug users and their partners.

Adult↗
PubMed1993

Discrepancies in tuberculin skin test results with two commercial products in a population of intravenous drug users.

Screening for tuberculosis (using the Mantoux test) and human immunodeficiency virus (HIV) was conducted among intravenous drug users (IVDUs) recruited from a San Francisco Bay Area neighborhood. Of 178 IVDUs skin-tested with one commercial purified protein derivative (PPD) preparation, a reaction of > or = 5 mm of induration occurred in 62 (47%) of 133 HIV-negative and 13 (29%) of 45 HIV-positive IVDUs (P = .037). Forty-two IVDUs with an initial PPD reaction > or = 5 mm were retested with a second commercial preparation; 11 (26%) had no reaction (0 mm) on retesting. These 11 were 5 (56%) of 9 HIV-positive and 6 (18%) of 33 HIV-negative persons (P = .038). These discrepancies may be unique to specific lots of product or may reflect more general differences. A degree of caution in evaluating unexpected tuberculin skin test results may be indicated. Response to different tuberculin products by HIV status should be further evaluated.

Acquired Immunodeficiency Syndrome↗
PubMed1993

HIV risk-related sex behaviors among injection drug users, crack smokers, and injection drug users who smoke crack.

OBJECTIVES: This study was designed to assess and compare sex risk behaviors for human immunodeficiency virus (HIV) transmission of three drug user groups: injectors who do not smoke crack, crack smokers who do not inject, and injectors who also smoke crack. METHODS: Sexual risk behaviors for HIV were assessed among 246 drug users from Denver, Miami, and San Francisco. Respondents were classified into the three drug groups based on self-report and verified through urinalysis and physical inspection. RESULTS: An increased risk for HIV through sexual transmission was associated with crack cocaine use, particularly among those who also injected. Crack smoking injectors were more likely to report sex with an injector, exchanging sex for drugs and/or money, drug use before or during sex, and unprotected sexual intercourse. They also injected more than injectors only, smoked crack as often as smokers only, and reported higher overall frequencies of drug use. CONCLUSIONS: These findings, together with the higher rates of gonorrhea and syphilis reported by smokers and injectors/smokers, are indicators of the risk crack poses for the heterosexual transmission of HIV.

Adult↗
PubMed1991

The effect of squatting on pelvic dimensions.

Lateral X-ray pelvimetry was performed on 63 women in the sitting and squatting positions on the 5th or 6th post-natal day to assess whether squatting has any effect on pelvic dimensions. Four assessors measured the inlet and outlet pelvic dimensions from 25 cases with good radiographic views in order to minimise observer bias. There was no statistically significant change in pelvic dimensions with squatting. Some possible explanations are discussed.

Female↗
PubMed1991

Sexual risk behavior among heterosexual intravenous drug users: ethnic and gender variations.

We analyzed the relationship of ethnicity and gender to high-risk sexual behavior among 457 male and female heterosexual intravenous drug users (IVDUs) interviewed in street and clinic settings in San Francisco. Over two-thirds said they never used condoms. More of the black respondents had not been enrolled in treatment. White IVDUs were more likely to report 10 or more partners, anal sex, and a steady drug-injecting partner; black respondents more often reported prostitution. More men said they never used condoms, and more women said they engaged in prostitution. These high-risk sexual behaviors were significantly and independently associated with ethnicity or gender when other sociodemographic variables were held constant. Sexual risk reduction for IVDUs, focusing on condom use, needs to be expanded to reach non-injecting partners. Intervention is critical for the black community, where a high proportion of IVDUs have steady non-injecting partners.

Adult↗
PubMed1991

Drug-use profiles, race, age, and risk of HIV infection among intravenous drug users in San Francisco.

We examined the relationship of HIV serostatus to drug use profile, high risk behavior, drug treatment status, and demographic characteristics of 505 intravenous drug users (IVDUs) in San Francisco. We found five identifiable drug-injection profiles described as Omnijector, Primarily Heroin, Primarily Heroin/Cocaine, Primarily Cocaine, and Primarily Speed which fell into "higher risk" and "lower risk" categories in relation to HIV seroprevalence of members (17.0 and 9.8%), respectively. This difference was not significant when effects of race were held constant (adjusted OR = 1.66, 95% CI = 0.91, 3.01). In logistic regression analysis, only Black race and age under 30 were significant predictors of HIV seropositivity (OR = 2.95, 95% CI = 1.57, 5.52 and OR = 2.05, 95% CI = 1.01, 4.13, respectively). Neither membership in higher risk profile nor frequency of injection (including daily or greater injection of cocaine) contributed to the model. We conclude that Black IVDUs under 30 are at greatest risk of HIV infection, that multiple patterns of drug use injection and habituation require additional resources to treat, and that the heterogeneous distribution of HIV weakens the predictive power of known behavioral risk factors in this population.

Adult↗
PubMed1990

AIDS prevention for intravenous drug users in the community: street-based education and risk behavior.

Conducted a study of behavior change associated with a street-based AIDS education project targeted to intravenous (IV) drug users in San Francisco. Two cross-sections were sampled from drug detoxification clinics and street locations in 1986 (n = 438) and 1987 (n = 623). Significant increases were reported in the percentage of IV drug users who used bleach to decontaminate syringes, who did not share needles in past year, and in condom use. A significant reduction in an index of the number of needle-sharing partners was reported. Respondents ranked treatment program as most important source of AIDS information prior to implementation of the program, and ranked outreach workers as most important after implementation. Findings suggest that this community-based outreach program had at least some impact on knowledge about AIDS and may have led to reductions in behaviors known to transmit HIV.

Acquired Immunodeficiency Syndrome↗
PubMed1990

The prevalence of high-risk sexual behavior in male intravenous drug users with steady female partners.

A sample of 149 (70 White, 79 Black) male intravenous drug users with steady female sexual partners was interviewed in 1987, in treatment and street settings, about sexual practices during the previous five years. Eighty-three percent had multiple partners, 15 percent reported male sexual contact, 38 percent reported heterosexual anal intercourse, and 73 percent never used condoms. Thirty-seven White and 30 Black subjects reported bisexuality or heterosexual and intercourse or both.

Acquired Immunodeficiency Syndrome↗
PubMed1989

Bilateral fetal uropathy: what is the outlook?

OBJECTIVE: To assess the morbidity and mortality associated with a prenatal diagnosis of bilateral fetal uropathy. DESIGN: Retrospective study. SETTING: Departments of radiology, paediatric surgery, obstetrics, and pathology in two teaching hospitals that serve as referral centres for the Yorkshire region. PATIENTS: 126 Cases of fetal uropathy were referred either prenatally or postnatally from hospitals in Yorkshire between August 1982 and December 1987. The disease was bilateral in 54 cases and unilateral in 72 cases. In 14 cases bilateral fetal uropathy was associated with coexistent disease. INTERVENTIONS: All cases were managed individually by an obstetrician after discussion with the radiologists and paediatric surgeons. Babies who survived were treated prophylactically with antibiotics after delivery and were operated on if appropriate. END POINT: Assessment of prognosis for long term renal function for each baby referred between August 1982 and December 1987: follow up ranged from six months to five years. MEASUREMENTS AND MAIN RESULTS: Of the 54 fetuses with bilateral fetal uropathy, 13 were terminated as the prenatal findings of ultrasonography were considered to be incompatible with long term survival. Ten of the liveborn babies died, five of renal or pulmonary insufficiency, or both, and five of associated congenital anomalies. Thirty one infants survived to follow up; four of these had serious coexistent disease and two had impaired renal function. Thus the overall mortality was 43% and the morbidity rate 19%. The renal anomaly was associated with other serious disease in 14 cases (26%) compared with two (3%) of the 72 cases of unilateral fetal uropathy. All but two of the 27 infants with isolated bilateral urinary tract disease had excellent prospects for survival. CONCLUSION: Although bilateral fetal uropathy is associated with a high morbidity rate and mortality, careful prenatal assessment can help to identify fetuses with a poor prognosis. The outlook for a fetus with isolated renal disease if treated promptly after delivery is excellent and compares favourably with that reported after prenatal surgical intervention.

Abnormalities, Multiple↗
PubMed1989

Human immunodeficiency virus seroprevalence in female intravenous drug users: the puzzle of black women's risk.

This study of 155 female i.v. drug users found that black women had higher HIV seroprevalence than white women (21% compared to 7%, respectively, odds ratio = 3.59, 95% CI 1.28-9.98). To attempt to explain why black female i.v. drug users were more likely to test HIV antibody positive, the ethnic distribution of a series of risk factors associated with HIV seropositivity, such as needle sharing, high risk sexual behavior and history of sexually transmitted disease, was examined. Either there was no significant difference between the two groups or white i.v. drug users were more likely than blacks to engage in specific risk behaviors. Although this study failed to identify risk factors associated with higher HIV seropositivity in black female i.v. drug users, it did uncover important trends in the data. These trends are analyzed in terms of observed or possible social and cultural differences between black and white women. It is suggested that these underlying social and cultural differences may hold the key to black female i.v. drug users' greater risk of HIV infection.

Adult↗