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Biomedical subjects

S R Friedman

Publications and source records attributed to S R Friedman.

At least 109 records · Page 6Linked to original sources
PubMed1990

Knowledge about and behaviors affecting the spread of AIDS: a street survey of intravenous drug users and their associates in New York City.

An informal survey of knowledge about and behaviors relevant to the spread of AIDS was conducted on the street in New York City during October 1986. The sample (n = 204) includes IV drug users (60%) and others (40%). The informal nature of the interview suggests that respondents gave "salient" answers rather than the complete answers that would be expected in a formal interview situation. A smaller proportion of respondents reported salient knowledge about drug-related transmission of AIDS than had been found in other populations, using formal interview methods. A close association was found between any accurate knowledge about spread of AIDS and likelihood of practicing one or more risk reduction behaviors. New users (persons who had been using drugs for only 1 or 2 years) were significantly less likely than others to have salient knowledge about AIDS transmission and also less likely to practice risk reduction measures.

Acquired Immunodeficiency Syndrome↗
PubMed1990

Psychological and behavioral impact among intravenous drug users of learning HIV test results.

In 1984 as part of a New York City study to examine the prevalence of HIV infection in a substance-abusing population and to test the validity of HIV screening kits, 94 patients at the New York VAMC were tested. Results were made available to 50 (35 seronegative, 15 seropositive) patients in January 1986. Psychological and behavioral impact of learning test results was assessed using standardized psychiatric rating scales. A comparison group of 31 nontested subjects were also evaluated. Ratings were done preresults, approximately 1-2 weeks after results, and 8-10 weeks after informing patients of their HIV status. No major stress reactions were observed. Seropositives experienced a higher level of anxiety 1-2 weeks after learning results but anxiety generally diminished; they made significant behavior changes which were maintained. Seronegatives experienced relief and maintained IV drug risk reduction behavior. Anxiety about contracting AIDS increased in nontested subjects as the study progressed.

AIDS Serodiagnosis↗
PubMed1990

Effects of outreach intervention on risk reduction among intravenous drug users.

Considerable voluntary risk reduction has occurred among IVDUs in New York City. The purpose of the AIDS Outreach Project was to improve upon the existing level of risk reduction by providing information and anonymous HIV testing to street-recruited IVDUs. Intake and follow-up interviews were conducted with 121 subjects (44% of 276 at intake), with a mean of 4.5 months between interviews. Significant risk reduction occurred in many drug and sexual risk behaviors, although not in bleach use, and more than half of the subjects continued to engage in high-risk sexual behavior. An analysis of differences in risk reduction between early and later intake groups indicated that external trends were not sufficient to account for observed risk reduction. Among subjects engaged in high-risk behavior at intake, those who injected less or were enrolled in drug abuse treatment were more likely to stop high-risk drug injecting. Subjects who (at intake) engaged in less frequent unprotected sex, or who had had sex with someone with AIDS, were more likely to stop high-risk sexual behavior. The majority of subjects at low risk at intake maintained low-risk behavior. Informational interventions appear to be most successful among those IVDUs already engaging in lower levels of risk behavior. More effective methods are needed for those whose level of risk behavior is greater. These might include peer pressure and distributing bleach (as opposed to only providing information about bleach).

Acquired Immunodeficiency Syndrome↗
PubMed1990

AIDS and the social relations of intravenous drug users.

Gauging the impact of AIDS on intravenous drug users requires analysis of the cultural, political, and racial contexts of American society in which drug use is embedded. Considerable variation in behavior among drug injectors and noninjectors in different cities over time further complicates an understanding of the dynamics of drug use. AIDS has prompted many IV drug users to change their behavior, though not all users have reduced the risks of transmitting HIV infection. While expanded harm-reduction strategies and drug abuse treatment systems may help limit the epidemic's spread, weak federal support, constrained hospital resources, and racial stigma inhibit more direct action needed to stem the negative social and personal consequences of drug use.

Acquired Immunodeficiency Syndrome↗
PubMed1989

AIDS and i.v. drug use.

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Acquired Immunodeficiency Syndrome↗
PubMed1989

HIV-1 infection among intravenous drug users in Manhattan, New York City, from 1977 through 1987.

Intravenous drug users are the second largest group to develop the acquired immunodeficiency syndrome, and they are the primary source for heterosexual and perinatal transmission in the United States and Europe. Understanding long-term trends in the spread of human immunodeficiency virus among intravenous drug users is critical to controlling the acquired immunodeficiency syndrome epidemic. Acquired immunodeficiency syndrome surveillance data and seroprevalence studies of drug treatment program entrants are used to trace seroprevalence trends among intravenous drug users in the borough of Manhattan. The virus entered this drug-using group during the mid-1970s and spread rapidly in 1979 through 1983. From 1984 through 1987, the seroprevalence rate stabilized between 55% and 60%--well below hepatitis B seroprevalence rates. This relatively constant rate is attributed to new infections, new seronegative persons beginning drug injection, seropositive persons leaving drug injection, and increasing conscious risk reduction.

Acquired Immunodeficiency Syndrome↗
PubMed1989

Cocaine injection and ethnicity in parenteral drug users during the early years of the human immunodeficiency virus (HIV) epidemic in New York City.

Parenteral drug users have a high prevalence of infection with human immunodeficiency virus (HIV), the etiologic agent of acquired immune deficiency syndrome (AIDS). New York City has had a prolonged and extensive epidemic of HIV infection and AIDS. In this study, we analyze, in relation to antibody to HIV (anti-HIV), available data from sera from parenteral drug users collected in New York City during 1978 through 1983 in the course of studies of liver disease. Among parenteral users of both heroin and cocaine, 30 (52%) of 58 had anti-HIV, compared with six (13%) of 48 injectors of heroin only (P less than 0.0001). Only two (11%) of 18 white patients were HIV-infected, compared with 34 (39%) of 88 black or Hispanic patients (P = 0.03). No other factors studied were linked to anti-HIV. In a multiple logistic regression, anti-HIV was significantly more common in parenteral users of both cocaine and heroin (P less than 0.0001), black patients (P = 0.02), and Hispanic patients (P = 0.049). We conclude that parenteral users of both cocaine and heroin as well as black and Hispanic patients were disproportionately HIV-infected during the early years of the HIV epidemic. Use of cocaine and heroin as well as ethnicity were independently linked to anti-HIV. Measures to prevent or treat drug use, HIV infection, and other medical problems while addressing the specific needs of cocaine users and black and Hispanic patients are urgently needed.

Acquired Immunodeficiency Syndrome↗
PubMed1988

A larger spectrum of severe HIV-1--related disease in intravenous drug users in New York City.

Increasing mortality in intravenous (IV) drug users not reported to surveillance as acquired immunodeficiency syndrome (AIDS) has occurred in New York City coincident with the AIDS epidemic. From 1981 to 1986, narcotics-related deaths increased on average 32% per year from 492 in 1981 to 1996 in 1986. This increase included deaths from AIDS increasing from 0 to 905 and deaths from other causes, many of which were infectious diseases, increasing from 492 to 1091. Investigations of these deaths suggest a causal association with human immunodeficiency virus (HIV) infection. These deaths may represent a spectrum of HIV-related disease that has not been identified through AIDS surveillance and has resulted in a large underestimation of the impact of AIDS on IV drug users and blacks and Hispanics.

Acquired Immunodeficiency Syndrome↗
PubMed1988

HIV and intravenous drug use.

There is now evidence from a wide variety of geographic areas that many intravenous drug users will change their behavior in order to reduce their risk of developing AIDS. There is even evidence from some areas that the behavior change has led to relative stabilization of seroprevalence rates, although longer-term studies will be needed to establish this definitively. AIDS behavior change in the area of sexual risk reduction appears to be much more difficult than change of drug injection behavior. Conceptual models of AIDS-related behavior change are needed, particularly models that can incorporate the injection of different drugs and variation in social and psychological characteristics among drug injectors. There is increasing evidence for a wider spectrum of HIV-related morbidity and mortality among intravenous drug users than is captured by the current surveillance definition for AIDS, again emphasizing the need for effective prevention programs.

Acquired Immunodeficiency Syndrome↗
PubMed1988

Specificity of antibody tests for human immunodeficiency virus in alcohol and parenteral drug abusers with chronic liver disease.

Parenteral drug abusers are at risk for acquired immunodeficiency syndrome (AIDS), which is caused by human immunodeficiency virus (HIV). We tested stored sera for antibody to HIV (anti-HIV) using two enzyme-linked immunosorbent assay (ELISA) methods and Western blot. The patients were parenteral drug abusers who had undergone percutaneous liver biopsy for chronic liver disease. Current or former alcohol abuse was noted in 88 (80%) of the 110 patients. The sensitivities of the two ELISA tests in comparison with Western blot, the more specific test for HIV, were 100 and 94%, respectively; the specificities were 94 and 99%. Western blot was positive in 36 (33%) of 110 patients. False-positive ELISA reactions for anti-HIV were seen in five (7%) of 70 patients with negative Western blot analyses. Compared to true-negatives, false-positives had significantly more years of alcohol abuse, younger ages of onset of alcohol abuse, greater frequencies of jaundice and edema, higher levels of alkaline phosphatase, total billirubin, total protein, and globulins, and lower levels of serum albumin. In a stepwise logistic regression, only hyperglobulinemia was significantly associated with a false-positive anti-HIV. We conclude that: (a) ELISA tests for anti-HIV are useful for screening abusers of alcohol and parenteral drugs with chronic liver disease for HIV infection, but positive results must be confirmed with more specific tests such as Western blot; (b) false-positive ELISA reactions in this population are associated with hyperglobulinemia; and (c) studies of HIV testing are needed in other populations of patients with alcoholism or liver disease.

Acquired Immunodeficiency Syndrome↗
PubMed1988

HIV infection among persons who inject illicit drugs: problems and prospects.

Intravenous drug use continues as the second most common risk behavior associated with acquired immune deficiency syndrome (AIDS) in the United States and Europe. Recently there has been increased public and research attention to this problem. Five areas of public health concern for AIDS among i.v. drug users are identified and discussed: (a) the potential spread of human immunodeficiency virus (HIV) to drug users in developing countries; (b) the emergence of cocaine use associated with HIV infection; (c) ethnic differences in seroprevalence rates among i.v. drug users, with ethnic minorities tending to have higher rates; (d) difficulties in changing the sexual behavior of i.v. drug users; and (e) an increased frequency of fatal infections among HIV seropositive drug users that are not counted with the current surveillance definition of AIDS. There have been numerous studies of AIDS risk reduction among i.v. drug users, but the ultimate effect of the behavior change on spread of the virus is not yet clear. Preliminary studies from New York City, San Francisco, and Stockholm indicate a relative stabilization of seroprevalence in those cities, suggesting that the behavior changes reported in those cities may be significantly slowing the rate of viral spread.

Acquired Immunodeficiency Syndrome↗