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1.  Transitions in Latent Classes of Sexual Risk Behavior Among Young Injection Drug Users Following HIV Prevention Intervention 
AIDS and behavior  2014;18(3):464-472.
We analyzed data from a large randomized HIV/HCV prevention intervention trial with young injection drug users (IDUs). Using categorical latent variable analysis, we identified distinct classes of sexual behavior for men and women. We conducted a latent transition analysis to test the effect of the intervention on transitions from higher to lower risk classes. Men who were in a high-risk class at baseline who received the intervention were 86% more likely to be in a low-risk class at follow-up compared to those in the control group (p = .025). High-risk intervention participants were significantly more likely to transition to the class characterized by unprotected sex with a main partner only, while low-risk intervention participants were significantly less likely to transition to that class. No intervention effect was detected on the sexual risk behavior of women, or of men who at baseline were having unprotected sex with a main partner only.
doi:10.1007/s10461-013-0601-2
PMCID: PMC3932146  PMID: 23975477
HIV; prevention; injection drug use; sexual risk behavior; latent class analysis
2.  Transitions in Latent Classes of Sexual Risk Behavior Among Young Injection Drug Users Following HIV Prevention Intervention 
AIDS and Behavior  2013;18:464-472.
We analyzed data from a large randomized HIV/HCV prevention intervention trial with young injection drug users (IDUs). Using categorical latent variable analysis, we identified distinct classes of sexual behavior for men and women. We conducted a latent transition analysis to test the effect of the intervention on transitions from higher to lower risk classes. Men who were in a high-risk class at baseline who received the intervention were 86 % more likely to be in a low-risk class at follow-up compared to those in the control group (p = 0.025). High-risk intervention participants were significantly more likely to transition to the class characterized by unprotected sex with a main partner only, while low-risk intervention participants were significantly less likely to transition to that class. No intervention effect was detected on the sexual risk behavior of women, or of men who at baseline were having unprotected sex with a main partner only.
Electronic supplementary material
The online version of this article (doi:10.1007/s10461-013-0601-2) contains supplementary material, which is available to authorized users.
doi:10.1007/s10461-013-0601-2
PMCID: PMC3932146  PMID: 23975477
HIV; Prevention; Injection drug use; Sexual risk behavior; Latent class analysis
3.  Prevalence of Psychiatric Disorders Among Young Injection Drug Users* 
Drug and Alcohol Dependence  2012;124(1-2):70-78.
Background
Studies of individuals in treatment for substance use have found high rates of psychiatric disorders, however little is known about the mental health of drug users not in treatment. This study aimed to assess the prevalence of lifetime and recent substance use and psychiatric disorders among young injection drug users (IDU) outside of a treatment setting.
Methods
Participants were recruited through outreach and respondent-driven sampling. Trained interviewers administered the Psychiatric Research Instrument for Substance and Mental Disorders. Interviews were conducted at two field stations operated by Community Outreach Intervention Projects in Chicago. Participants were 570 young adults (18-25 years) who injected drugs in the previous 30 days. Heroin was the primary drug used in this sample. Past 12-month and lifetime substance use disorders and primary and substance-induced mental disorders were based on DSM-IV diagnostic criteria.
Results
Nearly all participants met the criteria for heroin dependence. Multiple substance use disorders were common; cannabis was the most common substance involved after heroin, followed by alcohol and cocaine. Major depression, alcohol dependence, antisocial personality disorder, and borderline personality disorder were highly prevalent. Other psychiatric disorders were observed at levels consistent with other young adult samples.
Conclusions
Young IDU experience major depression, alcohol dependence, anti-social personality disorder, and borderline personality disorder at high rates, and multiple substance use disorders are common. Anxiety disorders in this population appear to be similar in prevalence to young adults in general.
doi:10.1016/j.drugalcdep.2011.12.012
PMCID: PMC3350828  PMID: 22226707
injection drug use; mental health; comorbidity; respondent-driven sampling
4.  Prevalence and Correlates of Former Injection Drug Use Among Young Non-injecting Heroin Users in Chicago 
Substance use & misuse  2010;45(12):2000-2025.
Non-injecting heroin users (NIHU) 16–30 years-old were street recruited in Chicago between 2002–2005 to examine factors associated with having ever injected. Participants completed computerized self-administered interviews and provided specimens for HIV and hepatitis serotesting. Of 689 NIHU, 51.2% were non-Hispanic Black, 64.4% were male, and the median age was 25 years. Former injection was reported by 17.9%; of those, 66.7% injected <10 times. Multivariable analysis identified individual and social factors that place young NIHU at increased risk of injection. Targeted interventions are necessary to prevent transitions to injection and reduce transmission of HIV and viral hepatitis infections.
doi:10.3109/10826081003682875
PMCID: PMC3632501  PMID: 20380556
heroin; non-injecting heroin use; injection drug use; transitions to injection; HIV infection; hepatitis B and C infection
5.  Chronic hepatitis C virus infection and increases in viral load in a prospective cohort of young, HIV-uninfected injection drug users 
Drug and alcohol dependence  2011;119(3):166-171.
Background
Chronic hepatitis C (HCV) infection, defined as persistent RNA (viral load) for at least 6 months, accounts for up to 50% of all cirrhosis, end-stage liver disease and liver cancer cases. Moreover, elevated HCV viral load is consistently associated with high infectivity and poor therapy response. This study aims to identify modifiable behavioral correlates both chronic HCV infection and increases in viral load over time among injection drug users (IDUs).
Methods
Cross-sectional and longitudinal analyses were performed using self-interview and serological data from a prospective cohort study (2002–2006) among young (age 18–35), HIV-negative, HCV therapy-naïve IDUs (n=113) from metropolitan Chicago, Illinois, USA.
Results
After adjustment for age, gender and race/ethnicity, using drugs measured or mixed in someone else’s syringe (odds ratio=2.7, 95% confidence interval: 1.1, 6.7) was associated with chronic (n=75, 66%) versus resolved (n=38, 34%) HCV infection status. Among chronically-infected IDUs, injecting with a new, sterile syringe infrequently (< 1/2 half the time when injecting) compared to frequently (1/2 the time or more when injecting) was associated with increases in viral load over time after adjusting for age, gender, race/ethnicity and time effects.
Conclusions
Reductions in risky injection-related practices among young IDUs may ameliorate both the burden of chronic HCV infection-related liver disease and elevated viral load-related poor treatment response.
doi:10.1016/j.drugalcdep.2011.06.005
PMCID: PMC3206181  PMID: 21724339
Hepatitis C; chronic; injection drug use; longitudinal; viral load
6.  Peer-Education Intervention to Reduce Injection Risk Behaviors Benefits High-Risk Young Injection Drug Users: A Latent Transition Analysis of the CIDUS 3/DUIT Study 
AIDS and Behavior  2012;17(6):2075-2083.
We analyzed data from a large randomized HIV/HCV prevention intervention trial with young injection drug users (IDUs) conducted in five U.S. cities. The trial compared a peer education intervention (PEI) with a time-matched, attention control group. Applying categorical latent variable analysis (mixture modeling) to baseline injection risk behavior data, we identified four distinct classes of injection-related HIV/HCV risk: low risk, non-syringe equipment-sharing, moderate-risk syringe-sharing, and high-risk syringe-sharing. The trial participation rate did not vary across classes. We conducted a latent transition analysis using trial baseline and 6-month follow-up data, to test the effect of the intervention on transitions to the low-risk class at follow-up. Adjusting for gender, age, and race/ethnicity, a significant intervention effect was found only for the high-risk class. Young IDU who exhibited high-risk behavior at baseline were 90 % more likely to be in the low-risk class at follow-up after the PEI intervention, compared to the control group.
doi:10.1007/s10461-012-0373-0
PMCID: PMC3672505  PMID: 23142857
Injection drug use; Intervention; HIV; HCV; Latent class analysis
7.  Relationship characteristics associated with anal sex among female drug users 
Sexually Transmitted Diseases  2010;37(6):346-351.
Background
Anal sex is an important yet little studied HIV risk behavior for women.
Methods
Using information collected on recent sexual encounters, we examined the influence of sex partner and relationship characteristics on the likelihood of engaging in anal sex among women with a high risk of HIV infection.
Results
Anal sex was nearly three times more common among actively bisexual women (OR = 2.96, 95% CI 2.17 – 4.03). Women were more likely to have anal sex with partners who injected drugs (OR = 2.32, 95% CI 1.44 – 3.75), were not heterosexual (OR = 1.85, 95% CI 1.18 – 2.90), and with whom they exchanged money or drugs for sex (OR = 1.79, 95% CI 1.10 – 2.90). The likelihood of anal sex also increased with the number of nights sleeping together (OR = 1.15, 95% CI 1.06 – 1.24). In contrast, emotional closeness and social closeness were not associated with anal sex. Condom use during anal sex was uncommon, and did not vary according to partner or relationship characteristics.
Conclusions
Our findings support the need for HIV prevention interventions that target anal sex among heterosexuals, particularly in drug-using populations residing in neighborhoods with elevated levels of HIV prevalence.
doi:10.1097/OLQ.0b013e3181c71d61
PMCID: PMC3278856  PMID: 20065891
anal sex; heterosexual; women; drug-involved; HIV/AIDS
8.  The Relative Role of Perceived Partner Risks in Promoting Condom Use in a Three-City Sample of High-Risk, Low-Income Women 
AIDS and Behavior  2010;15(7):1347-1358.
We examined the effect of women’s perceptions of sexual partner risks on condom use. Women from three US cities (n = 1,967) were recruited to provide data on HIV risks. In univariate models, increased odds of condom use were associated with perceiving that partners had concurrent partners and being unaware of partners': (a) HIV status, (b) bisexuality, (c) concurrency; and/or (d) injection drug use. In multivariate models, neither being unaware of the four partner risk factors nor perceiving a partner as being high risk was associated with condom use. Contextual factors associated with decreased odds of condom use were having sex with a main partner, homelessness in the past year, alcohol use during sex, and crack use in the past 30 days. Awareness of a partner’s risks may not be sufficient for increasing condom use. Contextual factors, sex with a main partner in particular, decrease condom use despite awareness of partner risk factors.
doi:10.1007/s10461-010-9840-7
PMCID: PMC3180610  PMID: 20976538
Perceptions of partner HIV risk behaviors; Condom use; HIV transmission to women; Crack; Alcohol
9.  Differences in Sexual Identity, Risk Practices, and Sex Partners between Bisexual Men and Other Men among a Low-Income Drug-Using Sample 
Men who have sex with men and women (MSMW) represent an important target population for understanding the spread of HIV because of the inherent bridging aspect of their sexual behavior. Despite their potential to spread HIV between gender groups, relatively little recent data have been reported about this population as a subgroup distinct from men who have sex with men only. This paper analyzes data from the Chicago site of Sexual Acquisition and Transmission of HIV Cooperative Agreement Program to characterize 343 MSMW in terms of their demographics, drug use, sexual risk behavior, sexual identity, and sex partners. Results show the MSMW sample to be extremely disadvantaged; to have high rates of drug use, including injection and crack use; to report more female than male sex partners; to not differ from gay and heterosexual men in rates of condom use; and, for the most part, to report sexual identities that are consistent with their sex behavior. MSMW represent an important subpopulation in the HIV epidemic and should be targeted for risk reduction interventions.
doi:10.1007/s11524-009-9367-2
PMCID: PMC2705486  PMID: 19479381
Men who have sex with men; HIV; Drug use; Risky sex; Anal sex; Sexual identity; Respondent-driven sampling
10.  Identifying Hidden Sexual Bridging Communities in Chicago 
Bridge populations can play a central role in the spread of human immunodeficiency virus (HIV) by providing transmission links between higher and lower prevalence populations. While social network methods are well suited to the study of bridge populations, analyses tend to focus on dyads (i.e., risk between drug and/or sex partners) and ignore bridges between distinct subpopulations. This study takes initial steps toward moving the analysis of sexual network linkages beyond individual and risk group levels to a community level in which Chicago’s 77 community areas are examined as subpopulations for the purpose of identifying potential bridging communities. Of particular interest are “hidden” bridging communities; that is, areas with above-average levels of sexual ties with other areas but whose below-average AIDS prevalence may hide their potential importance for HIV prevention. Data for this analysis came from the first wave of recruiting at the Chicago Sexual Acquisition and Transmission of HIV Cooperative Agreement Program site. Between August 2005 through October 2006, respondent-driven sampling was used to recruit users of heroin, cocaine, or methamphetamine, men who have sex with men regardless of drug use, the sex partners of these two groups, and sex partners of the sex partners. In this cross-sectional study of the sexual transmission of HIV, participants completed a network-focused computer-assisted self-administered interview, which included questions about the geographic locations of sexual contacts with up to six recent partners. Bridging scores for each area were determined using a matrix representing Chicago’s 77 community areas and were assessed using two measures: non-redundant ties and flow betweenness. Bridging measures and acquired immunodeficiency syndrome (AIDS) case prevalence rates were plotted for each community area on charts representing four conditions: below-average bridging and AIDS prevalence, below-average bridging and above-average AIDS prevalence, above-average bridging and AIDS prevalence, and above-average bridging and below-average AIDS prevalence (hidden bridgers). The majority of the 1,068 study participants were male (63%), African American (74%), and very poor, and the median age was 44 years. Most (85%) were sexually active, and 725 provided useable geographic information regarding 1,420 sexual partnerships that involved 57 Chicago community areas. Eight community areas met or came close to meeting the definition of hidden bridgers. Six areas were near the city’s periphery, and all eight areas likely had high inflows or outflows of low-income persons displaced by gentrification. The results suggest that further research on this method is warranted, and we propose a means for public health officials in other cities to duplicate the analysis.
doi:10.1007/s11524-009-9371-6
PMCID: PMC2705490  PMID: 19543836
HIV/STIs; Drug users; Sexual networks; Bridging; Gentrification; Respondent-driven sampling; HIV prevention planning
11.  Simultaneous Recruitment of Drug Users and Men Who Have Sex with Men in the United States and Russia Using Respondent-Driven Sampling: Sampling Methods and Implications 
The Sexual Acquisition and Transmission of HIV Cooperative Agreement Program (SATHCAP) examined the role of drug use in the sexual transmission of the human immunodeficiency virus (HIV) from traditional high-risk groups, such as men who have sex with men (MSM) and drug users (DU), to lower risk groups in three US cities and in St. Petersburg, Russia. SATHCAP employed respondent-driven sampling (RDS) and a dual high-risk group sampling approach that relied on peer recruitment for a combined, overlapping sample of MSM and DU. The goal of the sampling approach was to recruit an RDS sample of MSM, DU, and individuals who were both MSM and DU (MSM/DU), as well as a sample of sex partners of MSM, DU, and MSM/DU and sex partners of sex partners. The approach efficiently yielded a sample of 8,355 participants, including sex partners, across all four sites. At the US sites—Los Angeles, Chicago, and Raleigh–Durham—the sample consisted of older (mean age = 41 years), primarily black MSM and DU (both injecting and non-injecting); in St. Petersburg, the sample consisted of primarily younger (mean age = 28 years) MSM and DU (injecting). The US sites recruited a large proportion of men who have sex with men and with women, an important group with high potential for establishing a generalized HIV epidemic involving women. The advantage of using the dual high-risk group approach and RDS was, for the most part, the large, efficiently recruited samples of MSM, DU, and MSM/DU. The disadvantages were a recruitment bias by race/ethnicity and income status (at the US sites) and under-enrollment of MSM samples because of short recruitment chains (at the Russian site).
doi:10.1007/s11524-009-9365-4
PMCID: PMC2705484  PMID: 19472058
Respondent-driven sampling; HIV; MSM; MSMW; DU; IDU; SATHCAP
12.  Gender Differences in Baseline Health, Needs at Release, and Predictors of Care Engagement Among HIV-Positive Clients Leaving Jail 
AIDS and behavior  2013;17(0 2):195-202.
Women represent a significant and growing segment of jail detainees and persons living with HIV. This paper examines gender differences in health status, care and social service needs, and care engagement among jail releasees with HIV. Data are from 1,270 participants in the HRSA-funded Enhancing Linkages to HIV Primary Care and Social Services multisite demonstration project (EnhanceLink). Compared to men, more women reported homelessness, reduced adherence to prescribed ART, worse health, more severe substance use disorders, and more chronic health conditions. Men and women generally reported different needs post-release. As the number of expressed needs increased, women were more likely to drop out of care. Our findings suggest that effective and gender-specific strategies are required to identify needs, link services between jails and communities, and sustain retention of women with HIV in programs after release from criminal justice settings.
doi:10.1007/s10461-012-0391-y
PMCID: PMC3758427  PMID: 23314801
Women; Jail; Linkage to care; Gender differences; Health status
13.  Racial and Ethnic Changes in Heroin Injection in the United States: Implications for the HIV/AIDS Epidemic 
Drug and alcohol dependence  2008;94(1-3):221-233.
Background
Racial/ethnic differences in drug injection prevalence contribute to disparities in HIV infection rates in the U.S. between Whites, Blacks and Hispanics. We examine trends in the demographic characteristics of heroin injection drug users (IDUs) that may impact future HIV rates.
Methods
Descriptive analyses were conducted of 1) the national Treatment Episode Data Set for 1992−2004 and of the 2002−2004 baseline data from 2) CIDUS-III, a 5-city study that recruited 3,285 young IDUs, and 3) NIHU-HIT, a Chicago study of 647 young noninjecting heroin users.
Results
Between 1992 and 2004, heroin was the injected drug most often reported at admission to drug treatment. During this period, the proportion of admissions reporting injection declined 44% among Blacks but only 14% for Whites. The peak age for heroin IDUs in treatment increased 10 years for Blacks while declining over 10 years for Whites. CIDUS-III enrolled about 8 times more White (64%) than Black (8%) young IDUs despite recruiting two-thirds of the sample in cities where Blacks constituted 27%−64% of the population. Blacks comprised 53% of noninjecting heroin users in the Chicago NIHU-HIT, but only 2% of Chicago's CIDUS-III sample of heroin IDUs. Among noninjecting heroin users, Whites were more likely than Blacks to have ever injected (X2d.f.=1=17.1, p<0.001). Qualitative data supported greater resistance to injection among young Blacks than Whites.
Conclusions
Among heroin users, young Blacks are resisting injection initiation while young Whites exhibit the opposite tendency. New research should investigate reasons for this trend and its impact on the HIV epidemic and future service needs.
doi:10.1016/j.drugalcdep.2007.11.020
PMCID: PMC2268905  PMID: 18242879
injection drug use; heroin; race/ethnicity; age; HIV
14.  Comparison of HIV infection risk behaviors among injection drug users from East and West Coast US cities 
This study assessed whether behavioral differences explained higher human immunodeficiency virus (HIV) seroprevalence among injection drug users (IDUs) in three East Coast versus two West Coast cities in the United States. Sociodemographic, sexual, and injecting information were collected during semiannual face-to-face interviews. Baseline data from New York City; Baltimore, Maryland; and New Haven, Connecticut, were compared with data from Los Angeles, California, and San Jose, California. Among 1,528 East Coast and 1,149 West Coast participants, HIV seroprevalence was 21.5% and 2.3%, respectively (odds ratio [OR] 11.9; 95% confidence interval [CI] 7.9–17.8). HIV risk behaviors were common among IDUs on both coasts, and several were more common among West Coast participants. Adjusting for potential risk factors, East (vs. West) Coast of residence remained highly associated with HIV status (adjusted OR 12.14; 95% CI 7.36–20.00). Differences in HIV seroprevalence between East and West Coast cities did not reflect self-reported injection or sexual risk behavior differences. This suggests that other factors must be considered, such as the probability of having HIV-infected injection or sexual partners. Prevention efforts are needed on the West Coast to decrease HIV-associated risk behaviors among IDUs, and further efforts are also needed to reduce HIV incidence on the East Coast.
doi:10.1093/jurban/jth112
PMCID: PMC3456450  PMID: 15136659
Epidemiology; Human immunodeficiency virus; Incidence; Injection drug use; Prevalence; Risk factors
15.  Peer-Education Intervention to Reduce Injection Risk Behaviors Benefits High-Risk Young Injection Drug Users: A Latent Transition Analysis of the CIDUS 3/DUIT Study 
AIDS and behavior  2013;17(6):2075-2083.
We analyzed data from a large randomized HIV/HCV prevention intervention trial with young injection drug users (IDUs) conducted in five U.S. cities. The trial compared a peer education intervention (PEI) with a timematched, attention control group. Applying categorical latent variable analysis (mixture modeling) to baseline injection risk behavior data, we identified four distinct classes of injection-related HIV/HCV risk: low risk, non-syringe equipment-sharing, moderate-risk syringe-sharing, and high-risk syringe-sharing. The trial participation rate did not vary across classes. We conducted a latent transition analysis using trial baseline and 6-month follow-up data, to test the effect of the intervention on transitions to the low-risk class at follow-up. Adjusting for gender, age, and race/ethnicity, a significant intervention effect was found only for the high-risk class. Young IDU who exhibited high-risk behavior at baseline were 90 % more likely to be in the low-risk class at follow-up after the PEI intervention, compared to the control group.
doi:10.1007/s10461-012-0373-0
PMCID: PMC3672505  PMID: 23142857
Injection drug use; Intervention; HIV; HCV; Latent class analysis

Results 1-15 (15)