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Biomedical subjects

S R Friedman

Publications and source records attributed to S R Friedman.

At least 91 records · Page 5Linked to original sources
PubMed1992

Crack cocaine use in a cohort of methadone maintenance patients.

We examined crack use in a cohort of methadone patients originally enrolled in 1984-86. Crack use questions were added to the study in 1987. Of the 494 methadone patients originally enrolled, 228 subjects remained in methadone and were re-interviewed in 1987-88, and 234 remained in methadone and were re-interviewed in 1988-89. Approximately one-quarter of the subjects were using crack at each of the 1987-88 and 1988-89 data collection points, and only 3% of the subjects were using crack at daily or greater frequencies at each of the 1987-88 and 1988-89 interviews. Concurrent crack use was associated with (a) the number of noninjected drugs being used; (b) the number of IV drug-using sexual partners; (c) drug injection; and (d) the use of nonheroin opiates. Persistent crack use, defined as use in both 1987-88 and 1988-89, was associated with previous noninjected drug use and previous suicide attempts. While the potential problem of crack use among methadone patients should not be minimized, it appears that, compared to illicit drug injectors not in treatment, being in methadone maintenance may offer a protective effect against crack use.

Adult↗
PubMed1992

Social intervention against AIDS among injecting drug users.

Many drug injectors continue to engage in behaviors that lead them to become infected with HIV in spite of a wide variety of public health programs. In addition, many persons have begun to inject drugs in spite of knowing the risks of AIDS. The inadequacy of current efforts to prevent these behaviors suggests that additional forms of intervention should be attempted. We suggest that social interventions be tried to complement current programs (almost all of which have an individual focus). Evidence that social factors such as peer pressure and the social relations of race affect risk behavior is presented. Social interventions that are discussed include organizing drug injectors against AIDS in ways analogous to those in which gays organized against the epidemic, and finding ways to change large-scale social relationships that predispose people to inject drugs.

Acquired Immunodeficiency Syndrome↗
PubMed1992

AIDS and the transition to illicit drug injection--results of a randomized trial prevention program.

Illicit drug injection is a major component of the AIDS epidemic in the United States, Europe and some developing countries. Prevention of illicit drug injection would not only reduce HIV transmission but would also reduce the other health, psychological and social problems associated with illicit drug injection. One hundred and four subjects who were using heroin intranasally ('sniffing') were recruited for a study of the transition to drug injection. Eligibility criteria included sniffing as the most frequent route of administration and no more than 60 injections in the past 2 years. All subjects received thorough basic information about AIDS, including HIV antibody test counseling. Subjects were then randomly assigned to a four-session social learning based AIDS/drug injection prevention program or a control condition. Eighty-three subjects were successfully followed at a mean time of 8.9 months. Twenty (24%) of the followed subjects reported injecting illicit drugs during the follow-up period. Drug injection during follow-up was associated with being in the control group, intensity of non-injected drug use, prior injection, and having close personal relationships with current intravenous (IV) drug users.

Acquired Immunodeficiency Syndrome↗
PubMed1992

Implications of the revised surveillance definition: AIDS among New York City drug users.

The Centers for Disease Control (CDC) has proposed revising the AIDS surveillance definition to include any HIV-seropositive person with a CD4 cell count of less than 200 cells per microliter. Based on a study of persons receiving treatment for HIV infection, this new definition would lead to an estimated 50% increase in the number of persons recognized as living with AIDS. Among 440 HIV-seropositive research subjects recruited from drug treatment programs and through street outreach in New York City, 59 met this definition, yet only 25% of those had been reported to the New York City AIDS registry. The new definition, if combined with HIV and T-cell testing at drug treatment and street outreach programs, could thus yield very large increases in the number of injecting drug users meeting the new surveillance definition of AIDS.

Acquired Immunodeficiency Syndrome↗
PubMed1992

HIV testing and sexual behavior among intravenous drug users in Bangkok, Thailand.

The relationships between previous HIV counseling and testing and sexual behavior were examined among injecting drug users in Bangkok. Six hundred one i.v. drug users (IVDUs) were recruited from drug treatment programs in November of 1989. A standardized interview on AIDS risk behavior was administered and a blood sample was collected for HIV testing of the 601 people. Fifty-six percent reported that they had not been previously tested (NPT), 15% had previously tested positive (PT+), and 29% had previously tested negative (PT-). Previous testing was associated with higher levels of safer sex and contraception with primary partners: 56% of the PT+ people with regular partners reported using condoms at least some of the time with that partner, compared with 28% of the PT- and only 20% of the NPT people. Similarly, 89% of the PT+ and 72% of the PT- people, compared with 59% of the NPT people, reported practicing some form of contraception with regular partners. The results strongly support the utility of HIV counseling and testing as a method of reducing heterosexual and perinatal HIV transmission among IVDUs in Bangkok.

AIDS Serodiagnosis↗
PubMed1991

Risk factors and HIV seropositivity among injecting drug users in Bangkok.

Bangkok experienced an extremely rapid spread of HIV infection among drug injectors in 1987 and 1988. This study examines risk factors for HIV infection and deliberate risk-reduction efforts by drug injectors. Two subsamples of injecting drug users were recruited in November 1989, a group in drug-use treatment (n = 342) and a group new to the treatment system (n = 259). Subjects were interviewed about AIDS risk behavior, and a blood sample was collected for HIV testing. Seroprevalence was 39 and 27% in the in-treatment sample and the new-to-treatment sample, respectively. The in-treatment sample seroprevalence rate is similar to rates observed 6 and 12 months earlier. Three factors were independently associated with HIV infection: subsample, having been in prison, and sharing injection equipment with two or more individuals in the previous 6 months. Deliberate risk reduction was reported by 92% of individuals, with 59% reporting that they had stopped sharing injection equipment. It appears that large-scale risk reduction has greatly slowed HIV transmission among drug injectors in Bangkok.

Adult↗
PubMed1991

Cocaine, AIDS and i.v. drug use.

The papers in this volume cover a wide range of important topics. Yet many other equally important topics are not addressed. These include: (1) emerging trends in the epidemiology of HIV and drug use, such as the evidence that crack use may lead many of its practitioners to engage in high risk sex; (2) ways to deliver HIV prophylaxis to infected drug injectors, sexual partners, or perinatally infected children; and (3) the effectiveness of standard outreach in encouraging risk reduction. They do, however, provide important information about how to deal with both cocaine use and AIDS. They also raise many fruitful issues for additional research.

Acquired Immunodeficiency Syndrome↗
PubMed1991

The Tacoma Syringe Exchange.

For over a year, the Tacoma Syringe Exchange has been operating in spite of existing drug paraphernalia laws. One hundred fifty-four subjects have been interviewed regarding drug injection practices for the month prior to first use of the exchange and for the most recent month since using the exchange. Statistically significant reductions in mean frequency of obtaining used syringes, and in mean rate of passing on used syringes, have been reported. Mean number of times bleach was used to disinfect contaminated syringes has risen. The exchange continues to attract mainly men, median age 35, with a long history of injection. No differences have been observed in mean number of injections per month. In order to increase utilization, new sites are planned, but expansion has been hampered by a series of legal problems. Since the exchange draws many difficult to reach individuals, it is an important location for STD screening and drug treatment recruitment. Documentation of participation patterns and barriers to exchange use, and effects upon HIV serological status are recommended.

Acquired Immunodeficiency Syndrome↗
PubMed1991

Organizing as a new approach to AIDS risk reduction for intravenous drug users.

This paper looks at an innovative approach to AIDS risk reduction among intravenous drug users who are not in treatment. The new method utilizes an organizing model that involves the mobilization of drug users to promote risk reduction. This strategy targets the group as well as the individual for change. Standard outreach techniques have had some success in achieving HIV risk reduction, particularly for behavior that reduces risk through altering drug use behavior, but still leaves many users at risk. Intravenous drug users in the Netherlands and gays in the United States have organized around HIV-related issues with some success. Preliminary evidence from New York City suggests that organizing drug users may be an effective approach for achieving significant HIV risk reduction for individual users as well as those they associate with.

Acquired Immunodeficiency Syndrome↗
PubMed1990

What is child sexual abuse?

This paper examines the assumptions that underlie the concept of child sexual abuse. It suggests that the meaning is confusing and that there are significant differences among those assumptions as they differentially impact on statutory requirements for clarity and precision and clinical requirements oriented toward the patient's treatment needs. Suggestions are made as to how this area of abuse might better be handled statutorily, with special emphasis on the need to consider varying community attitudes and expectations.

Adolescent↗
PubMed1990

Working with heroin sniffers: clinical issues in preventing drug injection.

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.

Acquired Immunodeficiency Syndrome↗
PubMed1990

Street-recruited intravenous drug users and sexual risk reduction in New York City.

Previous studies have reported that intravenous drug users (IVDUs) have made considerable drug-use risk reduction, but less sexual risk reduction. This paper presents findings about sexual risk reduction by street-recruited IVDUs in New York City, and examines the predictors of sexual risk reduction. Sixty-one per cent of these street-recruited IVDUs have initiated deliberate sexual risk reduction in order to avoid AIDS. For the total sample (n = 568), as well as for the male IVDUs, specific health belief and social influence factors were significant predictors of sexual risk reduction. For female IVDUs, drug-risk reduction, having a friend or acquaintance who practices sexual risk reduction, and wanting to have a(nother) child were significant predictors of sexual risk reduction. These findings suggest the importance of social support and community organization to promote risk reduction.

Adult↗