At-risk Users Research Articles

Long-Term Effectiveness of Diagnosing and Treating Latent Tuberculosis Infection in a Cohort of HIV-Infected and At-Risk Injection Drug Users

Between 1990 and 1998, tuberculin skin tests (TST) and isoniazid preventive therapy (IPT) were provided to injection drug users participating in the AIDS Linked to the Intravenous Experiences cohort. A registry match was conducted with the AIDS Linked to the Intravenous Experiences cohort database and the Maryland State Department of Health and Mental Hygiene tuberculosis registry. Of 2010 participants, 1753 (74%) had a TST placed and read; 536 (31%) were positive. TST positivity was 16% in HIV positives; 39% in HIV negatives (P<0.01). Overall, 299 (56%) TST reactors started IPT; 165 (55%) completed 6 months. Three tuberculosis (TB) cases were diagnosed among HIV negatives (incidence rate=0.16/1000 person-years); 19 among HIV positives (1.94/1000 person-years; incidence rate ratio=12.3 (3.61-64.70). Within the entire cohort, TB rates were 0.81 per 1000 person-years for those not receiving IPT, 0.48 per 1000 person-years for those receiving any IPT, 0.29 per 1000 person-years for those completing at least 30 days, and 0 per 1000 person-years for completers. Ten cases of TB occurred in HIV-infected individuals with negative TSTs. IPT was associated with protection against TB, but uptake was modest. Although it is likely that TB incidence would have increased, especially in HIV-positive subjects, if the IPT program had not occurred, more significant declines in TB incidence in this population will require improved methods for ensuring uptake and completion of IPT and preventing disease in TST-negative individuals.

Explorative survey on the level of online sexual activities and sexual paraphilias

Objectives The objective of this survey is to analyze the relationship between the level of online sexual activities (OSA) and the presence of sexual paraphilias in a sample of 300 Internet users (230 males, 63 females and 7 transsexuals; age 18-58 years). Materials and methods Participants recruitment and data gathering were managed online through a self-report electronic questionnaire that included: The Internet Sex Screening Test, aimed to assess the level of OSA and to divide the users in recreative users and at-risk users; an ad hoc questionnaire (QTSPoo) elaborated to survey the presence of online and offline sexual paraphilias. Results Our data showed a positive and significant relationship between the level of OSA and the time spent online for sexual purposes and also between the level of OSA and the level of sexual paraphilias, specifically: group sex, exhibitionism, fetishism, sadism, masochism, voyeurism, reversed voyeurism, urophilia, narratophilia and picacism. We assessed differences between at-risk group (n=126) and recreative group (n=153) on the basis of some socio-demographic variables and also in relation to frequency and time online for sexual purposes. Specifically, the at-risk users group reports a level of online and offline sexual paraphilias higher than the recreative group. This difference is statistically significant (t(277) = −10.91, p Conclusions The differences assessed between the groups seems to support the theoretical hypothesis that considers the use of Internet to obtain sexual satisfaction a potential factor involved in the complex expression of paraphiliac sexual behaviour.

Premilitary Tobacco Use by Male Marine Corps Recruits

Recognizing both the medical and operational costs of tobacco use, the Department of Defense has made tobacco cessation a top health promotion priority. Military tobacco rates remain high, however, especially among younger personnel and, particularly, in the Marine Corps. Tobacco is prohibited during basic training, but relapse is common following boot camp graduation. The objective of this study was to determine patterns and prevalence of tobacco use among Marine Corps recruits before entering basic training. Over a period of 14 months, 15,689 graduating male recruits completed a survey of their preservice tobacco use. Approximately 81% reported having tried tobacco at least once and 57% were classified as at-risk users. Compared to their civilian peers, more recruits were daily users and many more used smokeless tobacco. Approximately 67% of users evidenced at least one indicator of dependence. There is a clear need for additional tobacco cessation efforts to target this high-risk population.

A Controlled Trial of Brief Intervention Versus Brief Advice for At-Risk Drinking Trauma Center Patients

Numerous reports document that preinjury alcohol use is associated with all modes of injury requiring treatment in a trauma center, with 25% to 50% or more of patients testing positive for alcohol at the time of admission. There is evidence that in trauma patients unaddressed alcohol use problems result in recurrent injury requiring readmission to a trauma center and/or death. A randomized clinical trial was conducted to assess the effectiveness of two types of brief interventions to reduce drinking and the consequences of drinking. Trauma patients defined as at-risk alcohol users (n=497) were randomized into two treatment options: a brief personalized motivational intervention (PMI), or brief information and advice (BIA). After a brief assessment, PMI subjects received a motivational session, feedback letter, and two postdischarge telephone contacts, whereas the BIA group received a brochure and one postdischarge telephone contact. Both groups were reassessed at 6 and 12 months postinjury. Both the PMI and BIA groups had statistically significant reductions in drinking, binge episodes, and consequences related to drinking that persisted from the 6- to the 12-month follow-up. However, although not statistically significant, for those classified as lower-level drinkers (<or=1 drink per day), there was a consistent pattern of maintaining reductions for the PMI group at 12 months compared with the BIA group. Our results suggest that brief interventions (PMI and BIA) that link alcohol consumption with trauma injury and consequences of drinking can be effective in reducing drinking and consequences related to drinking in a significant portion of at-risk nondependent drinkers.

Viral Hepatitis

Viral Hepatitis

Mortality in an Urban Cohort of HIV-Infected and At-Risk Drug Users in the Era of Highly Active Antiretroviral Therapy

Mortality trends among drug users in the era of highly active antiretroviral therapy (HAART) remain unclear. We examined mortality rates, causes of death, and predictors of mortality in 398 human immunodeficiency virus (HIV)-infected and 656 at-risk drug users for the period of 1996-2001. National death index reports were used to confirm deaths, and causes of death were derived from medical records. Cox proportional hazards models were used to determine factors associated with mortality. During 1996-2001, mortality rates in HIV-infected and HIV-uninfected participants were 7.3 and 1.5 deaths per 100 person-years, respectively (P<.001). The mean age at the time of death was 43.6 years for HIV-infected subjects and 47.7 years in HIV-uninfected subjects (P<.001). For 398 HIV-infected participants who were observed for 1443 person-years, death rates decreased from 11.4 to 5.4 deaths per 100 person-years over the 6-year period (P=.04). Among all participants, causes of death were as follows: HIV/AIDS, 27% of subjects; substance abuse, 31%; bacterial infection, 25%; other medical illness, 14%; and violence, 3%. Persons who initiated HAART at a CD4+ lymphocyte count of 201-350 cells/mm3 experienced improved survival, compared with those who initiated it at a CD4+ lymphocyte count of < or =200 cells/mm3 (P=.01). In a multivariate Cox model of HIV-infected subjects, factors independently associated with mortality included receipt of HAART (adjusted hazard ratio [HR(adj)], 0.44; 95% confidence interval [CI], 0.28-0.68) and CD4+ lymphocyte count of < or =200 cells/mm3 (HR(adj), 4.23; 95% CI, 2.24-7.60). Use of methadone or illicit drugs did not predict mortality. To further reduce mortality among drug users, interventions aimed at improving HAART use are warranted. Preventive health and timely management of treatable conditions, such as bacterial infections, also needs emphasis.

Use of Internet Pornography and Men's Well-Being

The widespread and relatively inexpensive influx of high speed Internet technology has rendered the Cybersex pornographic industry a considerably profitable e-commerce business. This exploratory investigation attempts to delineate the intricacies and effects of such technology on individual well-being using ethnographic field research methodology. Although most individuals utilize the Internet for occupational, educational, recreational, and shopping purposes, a sizable male minority exists, known as Cybersex compulsives and at-risk users, who invest an inordinate amount of their time, money, and energy in the pursuit of Cybersex experiences with negative intrapersonal ramifications in terms of depression, anxiety, and problems with felt intimacy with their real-life partners. Such individuals find themselves in a compulsive Cybersex quest for the “perfect” sexual visualization that will match their “lovemap,” only to get disappointed at its fleeting nature.

Online Sexual Activity:An Examination of Potentially Problematic Behaviors

This article focused on a selected random sample of over 7,000 individuals who responded to a survey regarding online sexual activity. Results helped identify potential problem areas for online sexual compulsives and at-risk users. These results provided descriptions of activities that could lead to problematic behavior in three areas: obsession, compulsion, and consequences. In addition, specific results were highlighted by gender differences, and types of cybersex users. As a descriptive article, the results of this study help us understand who online sexual activity users are and how they might experience problems related to their behaviors.

An oncologist-based model of cancer genetic counselling for hereditary breast and ovarian cancer

BackgroundWe describe a multistep model of cancer genetic counselling designed to promote awareness, and disease surveillance and preventive measures for hereditary and familial breast and ovarian cancer. Patients and methodsStep T0 of the model entails information giving; this is followed by pedigree analysis and risk estimation (T1), risk communication and genetic testing (T2), and genetic test result communication (T3). User consent was required to proceed from one step to the next. Surveillance and preventive measures are proposed to at-risk users. Of the 311 subjects who requested cancer genetic counselling, consent data to each counselling step were available for 295: 93 were disease-free, 187 had breast cancer, 12 had ovarian cancer and three had breast plus ovarian cancer. ResultsConsent was high at T0 (98.39%), T1 (96.40%) and T2 (99.65%). Consent decreased at the crucial points of counselling: T2 (87.71%) and T3 [genetic test result communication (85.08%), and extension of counselling to and testing of relatives (65.36%)]. ConclusionsThe model fosters the user’s knowledge about cancer and favours identification of at-risk subjects. Furthermore, by promoting awareness about genetic testing and surveillance measures, the algorithm enables users to make a fully informed choice of action in case of predisposing or familial cancer risk.

Does harm reduction programming make a difference in the lives of highly marginalized, at-risk drug users?

Harm reduction is a controversial model for treating drug users, with little formal research available on its operation and effectiveness. In order to advance the field, we first conducted participatory research of harm reduction with 120 clients using nominal-group technique to develop culturally relevant outcomes to measure progress. Second, we conducted focus group interviews with a different group of clients to help validate the outcomes. Third, we used the outcomes in an evaluation of the largest harm reduction program in New York City, which involved a representative sample of 261 and entailed baseline, post, and six follow-up assessments. The participatory research resulted in outcomes of 10 life areas important to drug users. Evaluation results showed that program participants made positive improvements across most outcomes, with the most substantial progress made in how clients dealt with drug-use problems. Along with their participation in the program, progress in some outcomes was also associated with clients' type of drug use (i.e., stable vs. chaotic), where more stable drug use was associated with better ways of making an income and types of housing. Surprisingly, progress was not associated with the kinds or numbers of services received or the length of time in the program. This was attributed to the service delivery model of harm reduction, in which clients are less inclined to associate their success with a single staff person or with a single service or intervention received than with the program as a whole.

The Challenges of Street Research on Drug Use, Violence, and Aids Risk

Violence is a regular and consequential event in the lives of street drug users, commonly beginning at an early age and continuing throughout their drug careers. Growing evidence indicates that involvement in violence, of various kinds, including as victim, perpetrator, and witness, is a factor in the initiation and continuation of drug use, as well as in AIDS risk behaviours associated with illicit drug consumption. As a result, improving our understanding of the role that violence plays in drug use is critical to drug research, prevention and treatment initiatives, and the development of effective public health efforts designed to reduce the spread of HIV/AIDS and other drug-related diseases. Paying closer attention to violence in qualitative research, however, raises a number of methodological and other problems for drug researchers. This paper, based on an ongoing ethno-epidemiological study of the relationship of violence to drug use and AIDS risk among not-in-treatment Puerto Rican street drug users in Hartford, Connecticut, examines ethical, methodological, human resource, and related issues encountered in studying the intersection of these intimately linked epidemics. Specifically, the paper examines the challenges presented to ethnographic researchers by the everyday violence in the lives of study participants. In other words, this paper is concerned with the study of violence among at-risk drug users and the ways in which a focus on violence challenges our personal, intellectual, emotional, and ethical capacities to undertake this research.

Online sexual compulsivity: Getting tangled in the net

The use of adult Web sites for the purpose of sexual expression is becoming increasingly popular and at times problematic. Online sexual behavior is different for each person, ranging from recreational to pathological use. The types of online users proposed in this article include Recreational Users, Sexual Compulsives, and At-Risk Users (consisting of two subtypes: the Depressive Type and the Stress Reactive Type). Assessment techniques and treatment strategies for each type of user are provided and suggestions for future research are proposed.

Are We Reaching and Enrolling at-Risk Drug Users for Prevention Studies?

The St. Louis EachOneTeachOne (EOTO) project is a National Institute on Drug Abuse (NIDA)-funded cooperative agreement aimed at examining rates of HIV risk behaviors and studying HIV risk reduction interventions among out-of-treatment injection and crack cocaine drug users. This paper uses data collected during the first year of recruitment and enrollment to document the effect of street outreach on HIV risk behavior involvement. The major findings are that: (1) men reported more HIV risk behaviors than did women, but the results failed to show striking racial or ethnic differences; (2) we successfully enrolled women in spite of the fact that our women street contacts were largely ineligible to enroll in EOTO; and (3) actual EOTO enrollees, compared with all street contacts and eligible street contacts, engaged in fewer HIV risk behaviors. These results imply that strategies in addition to street outreach may be needed to enlist more individuals, particularly whites and women who are engaging in the highest risk drug and sexual behaviors.