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Biomedical subjects

S R Friedman

Publications and source records attributed to S R Friedman.

At least 73 records · Page 4Linked to original sources
PubMed1994

Continuity and change within an HIV epidemic. Injecting drug users in New York City, 1984 through 1992.

OBJECTIVES: To examine trends in acquired immunodeficiency syndrome (AIDS) risk behavior and human immunodeficiency virus (HIV) seroprevalence among injecting drug users (IDUs) in New York City from 1984 through 1992. DESIGN AND SETTING: Comparisons were made between two surveys of IDUs at the same hospital-based New York City drug abuse detoxification program: 141 IDUs in 1984 and 974 IDUs in 1990 through 1992. National Death Registry, New York City Health Department, and drug treatment program records were also used. PARTICIPANTS: Persons attending detoxification program randomly selected for participation. Eligibility was based on injection within previous 2 months; 99% acceptance rates were obtained. Participants in the 1984 and 1990 through 1992 surveys were 66% and 79% men, 21% and 19% white, 33% and 34% African American, and 45% and 46% Latin American, respectively. INTERVENTIONS: Community-based AIDS prevention programs, including underground syringe exchanges. MAIN OUTCOME MEASURES: Acquired immunodeficiency syndrome risk behaviors; HIV serostatus; CD4+ cell counts; death rates among 1984 subjects; and injection and intranasal routes of drug administration. RESULTS: The HIV seroprevalence remained stable at slightly more than 50%. Mean CD4+ cell counts declined from 0.716 x 10(9)/L (716/microL) to 0.575 x 10(9)/L (P < .009). Annual death rate among 1984 subjects was 3%, with a significantly higher rate among HIV-seropositive subjects (relative risk, 2.57; 95% exact binomial confidence interval, 1.12 to 6.61). Large-scale declines were observed in AIDS risk behaviors, eg, use of potentially contaminated syringes declined from 51% to 7% of injections (P < .001). Recent additional risk reduction was associated with use of the underground syringe exchanges. Intranasal heroin use was the primary route of drug administration for 46% of heroin admissions to New York City drug treatment programs. CONCLUSIONS: The HIV seroprevalence has remained stable among this population of New York City IDUs for almost a decade. Continuation of current trends should lead to further reduction in HIV transmission, although reversal of the trend to intranasal use could lead to substantially increased transmission.

Adult↗
PubMed1994

The relevance of drug injectors' social and risk networks for understanding and preventing HIV infection.

Focusing on the social environment as well as the individual should both enhance our understanding of HIV transmission and assist in the development of more effective prevention programs. Networks are an important aspect of drug injectors' social environment. We distinguish between (1) risk networks (the people among whom HIV risk behaviors occur) as vectors of disease transmission, and (2) social networks (the people among whom there are social interactions with a mutual orientation to one another) as generators and disseminators of social influence. These concepts are applied to analyses of data from interviews with drug injectors in two studies. In the first study drug injectors' risk networks converge with their social networks: 70% inject or share syringes with a spouse or sex partner, a running partner, or with friends or others whom they know. Qualitative data from interviews with injectors in the second study also show that the social relationships between drug injectors and members of their risk network are often based on long-standing and multiplex relationships, such as those based on kinship, friendship, marital and sexual ties, and economic activity. In the first study the vast majority of injectors, over 90%, have social ties with non-injectors. Injectors with more frequent social contacts with non-injectors engage in lower levels of injecting risk behavior. Risk settings may function as risk networks: injectors in this study who inject at shooting galleries are more likely than those who do not to rent used syringes, borrow used syringes and inject with strangers. Since the adoption of a network approach is relatively new, a number of issues require further attention. These include: how to utilize social networks among drug injectors to reduce risk through peer pressure; how to promote risk reduction by encouraging ties between injectors and non-injectors; and how to integrate biographical and historical change into understanding network processes. Appropriate methodologies to study drug injectors' networks should be developed, including techniques to reach hidden populations, computer software for managing and analyzing network data bases, and statistical methods for drawing inferences from data gathered through dependent sampling designs.

Adult↗
PubMed1994

Consistent condom use in relationships between seropositive injecting drug users and sex partners who do not inject drugs.

OBJECTIVES: To study how condom use in injecting drug users' (IDU) relationships differs according to whether they are HIV-infected, and to whether their sex partner is an IDU. DESIGN AND METHODS: A total of 317 street-recruited IDU were HIV-antibody tested and interviewed about 421 relationships with particular sex partners. RESULTS: Condoms were consistently (100%) used in sex between partners (during the previous 30 days) in 33% of these relationships, and their use was significantly more frequent in relationships of seropositive IDU and in relationships with non-IDU partners. In relationships between seropositive IDU and non-IDU, consistent condom use was reported to be high (68%); this remained unchanged under multivariate controls. CONCLUSIONS: Self-reported condom use by IDU in New York, with its relatively mature epidemic, appears to be concentrated where it may most reduce the spread of HIV to non-IDU heterosexuals, i.e., in relationships between infected IDU and non-IDU partners. Differential condom use by serostatus and by partners' drug injection should be incorporated into mathematical models of the HIV epidemic. Causes of the high level of condom use in this subset of relationships may include drug injector altruism and pressure by sex partners; prevention programs should develop ways to use both of these factors to motivate increased condom use.

Adult↗
PubMed1994

Risk factors for HIV-1 seroprevalence among drug injectors in the cocaine-using environment of Rio de Janeiro.

To determine risk factors for HIV-1 among drug injectors in Rio de Janeiro, where cocaine is the dominant drug of injection, subjects were recruited using the criteria and interview instrument of the World Health Organization's Cross-National Study of HIV infection and risk behaviour in injecting drug users. HIV antibody test results were derived both from serum tests and from self-reports of previous tests (documented evidence of self-reported seropositivity was required). The analytical sample consists of 123 subjects, recruited both at drug abuse treatment sites and at street locations. Of 27 subjects with both serological and self-reported antibody status data, 20 reported previous negative tests; of these three had positive sera and may have seroconverted. Seven subjects reporting prior positive serostatus all tested positive. For the 123 subjects, seroprevalence was 34%. Independent significant risk factors in multivariate logistic regression with backwards elimination are: years of injection greater than 5; being a male who has had sex with men in the previous 5 years; and not having taken deliberate steps to protect oneself against AIDS. These findings indicate that homosexual/bisexual male drug injectors may be a bridge group through which HIV is entering drug-injecting networks in Rio de Janeiro. Efforts by drug injectors to reduce their risk of infection seem to have protective effects. This underscores the importance of HIV prevention efforts aimed at drug injectors.

Brazil↗
PubMed1994

AIDS risk reduction and reduced HIV seroconversion among injection drug users in Bangkok.

Human immunodeficiency virus (HIV) seroconversion was studied in a group of 173 injection drug users in Bangkok, Thailand, who had been previously tested for HIV and were interviewed and retested in the fall of 1989. Ten percent of the group had seroconverted. Two factors protected against HIV seroconversion: having stopped sharing injection equipment in response to the acquired immunodeficiency syndrome (AIDS) and having a regular sexual partner. The association between self-reported deliberate risk reduction and reduced HIV seroconversion among persons continuing to inject illicit drugs indicates that injection drug users can change their behavior in response to AIDS and will accurately report on the behavior change, and that the changes can protect against HIV infection.

Acquired Immunodeficiency Syndrome↗
PubMed1993

Condom use with primary partners among injecting drug users in Bangkok, Thailand and New York City, United States.

OBJECTIVE: To determine factors associated with likelihood or failure to use condoms with primary sexual partners among injecting drug users (IDU) in two cities. DESIGN AND METHODS: Interviews were conducted with 601 IDU in Bangkok in 1989 and with 957 IDU in New York City in 1990-1991. Subjects were recruited from drug-use treatment programs and a research storefront. Informed consent was obtained and a World Health Organization standardized questionnaire about AIDS risk behaviors administered by a trained interviewer. RESULTS: A substantial minority (37%) of IDU in Bangkok and a majority (55%) of IDU in New York City reported penetrative intercourse (vaginal, anal or oral) with a primary partner in the 6 months before the interview. Of those reporting penetrative intercourse with a primary partner, only 12% in Bangkok and 20% in New York reported that they always used condoms. Parallel bivariate and multiple logistic regression analyses were conducted to distinguish between subjects who reported always using condoms and subjects who reported unsafe sexual activity with primary partners. The same two factor--knowing that one is HIV-seropositive and talking about AIDS with sexual partners--were most strongly associated with always using condoms with primary partners in both cities. CONCLUSIONS: Programs to prevent sexual transmission of HIV among IDU should provide voluntary and confidential/anonymous HIV counseling and testing, and should facilitate discussions of AIDS and sexual transmission of HIV between IDU and their sexual partners. That the same two factors were associated with always using condoms with primary partners among IDU in these two cities suggests that these factors may also be important in other groups at high risk for HIV.

Adult↗
PubMed1993

Syringe-mediated drug-sharing (backloading): a new risk factor for HIV among injecting drug users.

BACKGROUND: In syringe-mediated drug-sharing (backloading), injecting drug users (IDU) use their syringes to mix drugs and to give measured shares to other IDU by squirting drug solution into the syringes of other IDU. Backloading has been discussed as a potential HIV risk factor, but its role as an HIV transmission route has not been established empirically. METHODS: Six hundred and sixty IDU who had injected drugs in the previous 2 years were street-recruited from Bushwick, New York City through chain referral, tested for HIV antibody and interviewed about sexual and drug-risk behaviors. RESULTS: Receiving drugs via backloading in the previous 2 years was reported by 24.5% of the subjects. These subjects had significantly higher HIV seroprevalence than those who did not receive drugs by backloading (odds ratio, 2.2; 95% confidence interval, 1.5-3.1). Backloading remained positively and significantly associated with HIV seropositivity in stepwise logistic regression, and in a series of simultaneous logistic models controlling for sociodemographic variables and for sexual and drug risk variables. CONCLUSIONS: Backloading can be a route of HIV transmission among IDU and should be incorporated into risk-factor studies and HIV transmission modeling. Many IDU who avoid other high-risk drug-injection practices may overlook the risk of backloading. HIV prevention programs should warn IDU against syringe-mediated drug-sharing and work together to develop ways to avoid it.

Adult↗
PubMed1993

An interview study of participants in the Tacoma, Washington, syringe exchange.

Although European and Australian studies of syringe exchange programs have reported safer injection among participants and no increase in drug use, the generalizability of these findings to the US is uncertain. We report on the operations and potential effectiveness of the longest-operating syringe exchange in the US and compare our results to studies of exchange programs outside the US. The sample of 204 study subjects reported no change in the frequency of injection, from 155 to 152 injections per month, and a decline in the frequency of unsafe injections, from 56 to 30 times per month, while participating in the program. In all studies, participants report reduction in unsafe injections, and no increase in illicit drug use. However, the comparison also suggests that a high proportion of Tacoma exchangers have higher initial rates of drug injection, unsafe injection and homelessness, all of which were associated with unsafe injection while using the exchange. These indicate a need for additional services but that the Tacoma program is no less effective than European and Australian programs.

Acquired Immunodeficiency Syndrome↗
PubMed1993

CD4 lymphocytopenia among injecting drug users in New York City.

Recent cases of "AIDS-like" CD4 lymphocytopenia in the absence of HIV infection have generated considerable scientific and public interest. We studied CD4 cell counts and percentages from 1984 to 1992 among 1,246 HIV-seronegative injecting drug users in New York City, a population at very high risk for exposure to bloodborne pathogens. Severe CD4 lymphocytopenia was rare, and there was no evidence of an increase over time. Of 229 subjects with longitudinal data, only four met the surveillance definition for "idiopathic CD4 lymphocytopenia" (ICL). CD4 cell counts of < 500 cells/microliters were, however, associated with subsequent HIV seroconversion (12.7/100 person-years at risk, relative risk (RR) = 4.53, 95% exact binomial confidence interval (CI) 1.7-10.7, p = 0.002).

Adult↗
PubMed1993

Racial differences in sexual behaviors related to AIDS in a nineteen-city sample of street-recruited drug injectors. NADR Consortium.

Questionnaire data from almost 12,000 street-recruited drug injectors in 19 cities were analyzed to determine racial differences that may affect transmission of the human immunodeficiency virus (HIV). Self-reported sexual behaviors of drug injectors differ by city-type. White male drug injectors reported less unprotected vaginal sex than black or Latino males in multicultural--black/white/Mexican-origin and biracial cities. Black drug users of both sexes were less likely than white or Latino drug users to report unprotected and sex in multicultural--black/white/Mexican-origin and multicultural--black/white/Puerto Rican cities. The reported percentage of sex acts in which a condom was used was similar for black, white, and Puerto Rican men, and for black and white women, in all city types, but Puerto Rican women reported more condom use than black women. Mexican-origin drug injectors of each gender were least likely to report using condoms in multicultural--black/white/Mexican-origin cities. Black drug injectors are particularly likely to report having sex partners who do not inject drugs, as are Puerto Rican men and as are whites in multicultural--black/white/Mexican-origin cities. High-risk sex without condoms is widely reported among all groups of drug injectors studied: Each racial/gender group in each city-type averaged 15 or more episodes of unprotected vaginal sex per month, and 10% of most subgroups report having anal sex within the past 6 months. At least 45% of subjects in each city-type reported sex with noninjectors of the opposite gender. Without continued and expanded intervention, these data are consistent with HIV spreading to drug injectors, their sexual partners, and their future children, in all racial/ethnic groups.

Acquired Immunodeficiency Syndrome↗
PubMed1993

HIV infection and AIDS among drug injectors at Rio de Janeiro: perspectives and unanswered questions.

Data from various countries show considerable variation in the rate of spread of the human immunodeficiency virus (HIV) among drug injectors. Although further research is needed to predict the rate of increase of seroprevalence at Rio de Janeiro, preliminary data confirm the presence of the virus, with a seroprevalence of about 33 per cent in 1990. Issues arising from research into the probable determinants of viral spread among the thousands of drug injectors in the city are outlined in the present paper. Even before the research is completed, however, it is clear that interventions are needed to reduce further viral transmission both among drug injectors and from them to their sexual partners and offspring. Efforts should be made to prevent the population at risk from initiating the practice of drug injection, and to promote a major expansion in drug abuse treatment facilities. Drug injectors should also be encouraged to reduce the risk of their becoming infected or passing on the virus to others, through educational outreach, through the distribution of supplies that facilitate risk reduction (bleach, syringes, condoms), and through innovative approaches to behaviour change.

Acquired Immunodeficiency Syndrome↗
PubMed1993

Critical issues regarding AIDS among injecting drug users.

The paper identifies and reviews some critical issues in the field of human immunodeficiency virus (HIV) transmission among intravenous drug users. First, it discusses political denial and compartmentalization of the problem, giving an example from the United States that illustrates the lack of a coherent national strategy. It then reviews the role that stereotypes play in policy-making and points out that behaviour change can be considerable, giving details of successful safer injection programmes. The conditions that foster injection as a mode of ingesting drugs are reviewed, as in the role of drug trans-shipment patterns, particularly as a possible conduit of HIV. Finally, the role of prisons as places for the spread of HIV, and therefore for its prevention, is discussed.

Acquired Immunodeficiency Syndrome↗