Elevated HIV Risk Research Articles

HIV risk among long‐haul truckers in the USA

Long‐haul truck driving has been associated with HIV risk in developing countries but little research to date has considered whether truckers in the USA may also be at elevated risk for HIV and other STIs. This multi‐method qualitative study explored HIV‐risk factors among regional and cross‐country truck drivers who were based in the southeastern USA. Data collection methods included focus groups conducted at company hubs and over Citizen's Band (CB) radio, and key informant interviews. Results indicated that sexual opportunities and risks are greater for long‐haul drivers who often travel for long periods without returning home and who may engage in ‘highway sex’ in the absence of a regular home‐life. Structural factors that have reduced drivers' autonomy, sexual risk taking and free time while traveling include recent trucking regulations, electronic surveillance and industry‐wide trends emphasizing speed and efficiency. Other factors, such as age, experience, type of employment and type of route also play a role. Further research is needed to determine if these qualitative findings can be quantified in population‐based studies that also include biomarker and incidence data.

The Cedar project: prevalence and correlates of HIV infection among young Aboriginal people who use drugs in two Canadian cities

INTRODUCTION: During the past decade, the number of Aboriginal people diagnosed with HIV in Canada has grown more than any other ethnicity. Whereas the majority of infections are related to injection drug use, factors that explain elevated risk and transmission of HIV among Aboriginal young people who use illicit drugs are not well understood.Study Design. Observational study.Methods. The Cedar Project is an observational study of Aboriginal youth living in Vancouver and Prince George, BC. Eligibility criteria include age (14–30 years) and self-reported use of non-injection or injection drugs at least once in the month before enrolment. Between October 2003 and April 2005, 512 participants were recruited and completed a questionnaire administered by an Aboriginal interviewer. Multivariable logistic regression analysis was used to model the independent association of demographic and behavioural variables of individuals with HIV infection.Results. Of the participants, 235 resided in Prince George and 277 in Vancouver. Among the 276 participants that used injection drugs, HIV prevalence was significantly higher in Vancouver (17% vs. 7%) but HCV prevalence was higher in Prince George (62% vs. 57%). In Vancouver, 40% of injectors reported daily heroine use compared with 12% in Prince George. In contrast, Prince George participants were more likely to report daily injection of cocaine compared with those in Vancouver (37% vs. 21%). A higher percentage of Prince George participants reported having difficulty accessing clean syringes (22% vs. 8%). History of non-consensual sex, residing in Vancouver and duration of injection drug use were independent factors associated with increased risk of HIV infection.Conclusions. HIV and HCV prevalence are elevated in young Aboriginal drug users residing in Vancouver and Prince George. Heterogeneity exists in these locations with respect to drug of choice and access to clean syringes. Prevention and treatment programs are urgently required in this population.

Do Criminal Laws Effect HIV Risk Behavior? An Empirical Trial

All states have criminal laws that can be used to punish sexual behaviors that pose some risk of HIV transmission; half have HIV-specific laws criminalizing sexual contact by people with HIV unless they abstain from unsafe sex, or disclose their HIV status and obtain consent from their partners. Whether these laws influence behavior is unknown. Illinois and New York exhibit contrasting legal conditions. Illinois has an HIV-specific law explicitly requiring disclosure by HIV+ persons. New York has no HIV-specific law. This study tests the null hypothesis that differences in law and beliefs about the law do not influence condom use in anal or vaginal sex. In this empirical study, 490 people at elevated risk of HIV were interviewed, 248 in Chicago and 242 in New York City. Approximately half in each state were men who have sex with men (MSM) and half were injecting drug users (IDUs). Respondents were classified as MSM if they reported ever having had sex with a man, and as IDUs if they reported having injected drugs at least twice in the last three months. One-hundred sixty two subjects reported known HIV infection (Chicago 58; New York City 104). Three-hundred twenty-eight reported being HIV negative or not knowing their HIV status. Indicators of the law were 1) residence in the state, and 2) belief that it is a crime for a person with HIV to have sex with another person without disclosing his or her serostatus. Using stepwise logistic regression, we examined independent predictors of unprotected sex, adjusting for factors including age, race/ethnicity, disclosure, biological sex at birth, sexual orientation and number of partners. People who lived in a state with a criminal law explicitly regulating sexual behavior of the HIV-infected were little different in their self-reported sexual behavior from people in a state without such a law. People who believed the law required the infected to practice safer sex or disclose their status reported being just as risky in their sexual behavior as those who did not. Our data do not support the proposition that passing a law prohibiting unsafe sex or requiring disclosure of infection influences people's normative beliefs about risky sex. Most people in our study believed that it was wrong to expose others to the virus and right to disclose infection to their sexual partners. These convictions were not influenced by the respondents' beliefs about the law or whether they lived in a state with such a law or not. Because law was not significantly influencing sexual behavior, our results also undermine the claim that such laws drive people with and or at risk of HIV away from health services and interventions. We failed to refute the null hypothesis that criminal law has no influence on sexual risk behavior. Criminal law is not a clearly useful intervention for promoting disclosure by HIV+ people to their sex partners. Given concerns about possible negative effects of criminal law, such as stigmatization or reluctance to cooperate with health authorities, our findings suggest caution in deploying criminal law as a behavior change intervention for seropositives.

Factors Associated with Public Injecting Among Users of Vancouver's Supervised Injection Facility

Background: We evaluated factors associated with public drug injection among a cohort of injection drug users (SEOSI) originally recruited from within Vancouver's supervised injecting facility (SIF). Methods: We used univariate statistics and logistic regression to examine factors associated with public drug injection among SEOSI participants. Findings: Between June 2004 and July 2005, 714 IDU were followed up as part of SEOSI. In multivariate analyses, factors associated with public drug injection included homelessness (adjusted odds ratio (aOR) = 3.10; p < .001), syringe lending (aOR = 5.39; p < .001), requiring help injecting (aOR = 1.60; p = .05), and reporting that wait times affected frequency of SIF use (aOR = 3.26; p < .001). Interpretation: Persistent public injection was independently associated with elevated HIV risk behaviors, as well as programmatic factors that limit SIF use. SIF program expansion may further help to reduce persistent risk behaviors and the community concerns related to public injection drug use.

Increasing use and associated harms of crystal methamphetamine injection in a Canadian setting

Background There is a growing concern surrounding crystal methamphetamine use in Canada despite surprisingly little empirical data to support such claims. We evaluated the trends in crystal methamphetamine injection and factors associated with injection of the drug among a cohort of injection drug users (IDU) in Vancouver. Methods We conducted a prospective analysis of factors associated with crystal methamphetamine injection among participants enrolled in the Vancouver Injection Drug Users Study (VIDUS). Since serial measures for each individual were available, variables potentially associated with crystal methamphetamine injection were evaluated using generalized estimating equations (GEE) with logit link for binary outcomes. Results Overall, 1587 IDU were enrolled into the VIDUS cohort between May 1996 and December 2004. The proportion of IDU who reported injecting crystal methamphetamine during the last 6 months increased during the study period (Cochran–Armitage trend test, p < 0.001). In multivariate GEE analyses, crystal methamphetamine injection was independently associated with younger age (adjusted odds ratio [AOR]: 4.77, 95% confidence interval [CI] = 3.40–6.70), Caucasian ethnicity (AOR = 2.21, 95% CI = 1.57–3.12), syringe borrowing (AOR = 1.62, 95% CI = 1.22–2.13), and syringe lending (AOR = 1.40, 95% CI = 1.02–1.86). Interpretation There was a significant trend towards increasing crystal methamphetamine injection in this setting and elevated HIV risk behavior and younger age were independently associated with crystal methamphetamine injection. Given that banning precursor chemicals has had a limited effect on reducing methamphetamine supply in other jurisdictions, pragmatic and effective interventions are needed to address the growing use of this drug.

Sexual and Drug Behavior Patterns and HIV and STD Racial Disparities: The Need for New Directions

We used nationally representative data to examine whether individuals' sexual and drug behavior patterns account for racial disparities in sexually transmitted disease (STD) and HIV prevalence. Data were derived from wave III of the National Longitudinal Study of Adolescent Health. Participants were aged 18 to 26 years old; analyses were limited to non-Hispanic Blacks and Whites. Theory and cluster analyses yielded 16 unique behavior patterns. Bivariate analyses compared STD and HIV prevalences for each behavior pattern, by race. Logistic regression analyses examined within-pattern race effects before and after control for covariates. Unadjusted odds of STD and HIV infection were significantly higher among Blacks than among Whites for 11 of the risk behavior patterns assessed. Across behavior patterns, covariates had little effect on reducing race odds ratios. White young adults in the United States are at elevated STD and HIV risk when they engage in high-risk behaviors. Black young adults, however, are at high risk even when their behaviors are normative. Factors other than individual risk behaviors and covariates appear to account for racial disparities, indicating the need for population-level interventions.

Psychiatric Comorbidity Is Associated With Drug Use and HIV Risk in Syringe Exchange Participants

The present study evaluated the effects of psychiatric comorbidity on substance use disorder prevalence, HIV risk behavior, and other problem severity in male and female out-of-treatment injection drug users newly registered at a syringe exchange program. Participants (N = 338) were administered the Structured Clinical Interview for the DSM-IV, the Addiction Severity Index, and the Risk Assessment Battery, and classified into one of four diagnostic groups: (1) no antisocial personality disorder (APD) or Axis I psychiatric disorder (N = 162), (2) APD only (N = 74), (3) Axis I psychiatric disorder only (N = 55), or (4) APD plus Axis I psychiatric disorder (N = 47). Psychiatric comorbidity was associated with higher rates of substance use disorder and more HIV risk and other problem severity. In general, participants with both APD and an Axis I disorder exhibited the most problem severity. APD was uniquely associated with higher prevalence for each substance use disorder assessed in this study and with elevated HIV risk. These results support and extend studies conducted with opioid-dependent individuals recruited from treatment and community settings, and reinforce the need to develop interventions to encourage syringe exchange program participants to enroll in treatment.

Dyadic HIV status and psychological distress among women on methadone

Studies examining the association between psychological distress and HIV status among women belonging to populations at elevated risk for HIV have found mixed results. The goal of this study is to shed greater insight into possible explanations for the mixed findings of the earlier studies. Specifically, we examine psychological distress as a function of dyadic HIV status--that is, the combination of a participant and her partner's HIV statuses--among women attending methadone maintenance treatment programs (MMTPs). A random sample of 349 female MMTP patients involved in intimate relationships provided self-reported data via structured, face-to-face interviews. Hypothesis testing involved multiple linear regression with 3 orthogonal contrast codes constructed from dyadic HIV status. Levels of psychological distress did not differ significantly between HIV-negative and HIV-positive women. HIV-negative women with HIV-positive partners reported significantly greater global levels, number of symptoms, and symptom severity of psychological distress compared to those with HIV-negative partners. HIV-positive participants with HIV-positive partners reported significantly lower global levels and symptom severity of psychological distress compared to those with HIV-negative partners. Findings support that psychological distress appears to differ as a function of the combination of a woman and her partner's HIV status rather than the woman's HIV status alone. Thus, dyadic HIV status represents an important factor with respect to the mental health needs of women in drug treatment.

Initiation of opiate addiction in a Canadian prison: a case report

BackgroundIn North America, the harms of illicit drug use have been responded to primarily through law enforcement interventions. This strategy has resulted in record populations of addicted individuals being incarcerated in both Canada and the United States. The incarceration of non-violent drug offenders has become increasingly controversial as studies demonstrate the harms, including elevated HIV risk behavior, of incarcerating injection drug users. Other harms, such as the initiation of illicit drug use by prison inmates who previously did not use drugs, have been less commonly described.Case PresentationWe report on the case of an individual who initiated non-injection opiate use in a Canadian prison and developed an addiction to the drug. Upon release into the community, the individual continued using opiates and sought treatment at a clinic. The patient feared that he might initiate injection use of opiates if his cravings could not be controlled. The patient was placed on methadone maintenance therapy.ConclusionWhile anecdotal reports indicate that initiation in prison of the use of addictive illicit substances is frequent, documentation through clinical experience is rare, and the public health implications of this behavior have not been given sufficient attention in the literature. Strategies of incarcerating non-violent drug offenders and attempting to keep illicit drugs out of prisons have not reduced the harms and costs of illicit drug use. Effective, practical alternatives are urgently needed; expanded community diversion programs for non-violent drug offenders deserve particular attention.

Hepatitis C virus and HIV co-infection in people with severe mental illness and substance use disorders

The 5-7% of adults in the United States with severe mental illness (SMI), especially the 50% who are 'dually diagnosed' with co-occurring substance use disorders (SUD), are at an elevated risk of HIV and hepatitis C virus (HCV). However, little is known about HIV/HCV co-infection in this population. This paper examines the prevalence and correlates of HIV, hepatitis C, and HIV/HCV co-infection in a large, multisite sample of SMI clients. We conducted a re-analysis of data on prevalence and correlates of blood-borne infections in a multisite sample of SMI clients. In 1997-1998, 755 SMI clients were tested for HIV, hepatitis B virus and HCV, and assessed for demographic, illness-related and other behavioral risk factors for blood-borne infections. The prevalence and correlates of co-infection were examined, as well as the knowledge, attitudes and risk behaviors of individuals with HCV mono-infection. Of the 755 participants, 623 (82.5%) were negative for both HIV and HCV, 23 (3.0%) were positive for HIV, 109 (14.4%) were positive for HCV, and 13 (1.7%) were co-infected with HIV and HCV. Overall, 2.5% of dually diagnosed participants were co-infected, whereas only 0.6% of SMI participants without a comorbid SUD diagnosis were co-infected. Co-infection was associated with psychiatric illness severity, ongoing drug abuse, poverty, homelessness, incarceration, urban residence and minority status. HCV-mono-infected clients continued to engage in high levels of risk behavior for HIV. In addition to efforts to identify and treat SMI patients with HIV/HCV co-infection, HCV-mono-infected clients should be targeted for prevention interventions.

HIV Vaccine Acceptability among Women at Risk: Perceived Barriers and Facilitators to Future HIV Vaccine Uptake

The purpose of this study is to explore perceived barriers and facilitators to the uptake of future U.S. Food and Drug Administration-approved HIV vaccines among women at elevated risk for HIV. We conducted four client focus groups (N = 41) and one focus group of women's health care professionals (N =9). Participants were recruited from diverse community agencies and health care clinics in Los Angeles using purposive, venue-based sampling. Data were analyzed using narrative thematic analysis and Ethnograph qualitative software. Barriers to HIV vaccine uptake included fear of vaccine-induced HIV infection, reproductive side effects, injection concerns, gendered roles and power dynamics, HIV stigma, discrimination, affordability, and mistrust. The provision of affordable and accessible HIV vaccines, ideally through routine care, along with culturally tailored, gender-specific HIV vaccine intervention and policy, can ensure the full potential of HIV vaccines to empower women to protect themselves against HIV infection.

Unstable housing, associated risk behaviour, and increased risk for HIV infection among injection drug users

We sought to examine the relationship between housing status and risk of HIV-infection among injection drug users in Vancouver, Canada. Using Kaplan–Meier survival analysis, we found an elevated HIV incidence rate among those who reported residing in unstable housing (log-rank p = 0.006 ). In Cox's regression survival analysis, unstable housing remained marginally associated with elevated risks of HIV infection (relative hazard=1.40 (95% confidence interval: 0.09–2.00); p = 0.084 ) after adjustment for potential confounders including syringe sharing. Adjusted generalized estimating equations analysis that examined factors associated with unstable housing demonstrated that residing in unstable housing was independently associated with several HIV risk behaviours including borrowing used needles (adjusted odds ratio (OR)=1.14) and sex-trade involvement (adjusted OR=1.19). Our findings suggest that unstable housing environments are associated with elevated risk of HIV- infection due to risk behaviours that take place in these environments. Implications for policy including more comprehensive housing interventions (e.g. ‘floating support’) are discussed.

Trends in HIV Seroprevalence and Risk Among Gay and Bisexual Men Who Inject Drugs in San Francisco, 1988 to 2000

Objectives: To determine trends in HIV infection and risk behaviors among streetrecruited self-identified gay and bisexual male injection drug users (IDUs) in San Francisco. Methods: Trends in HIV infection and risk behaviors were calculated for gay/bisexual (n = 1594 interviews) IDUs in 26 semiannual cross sections from 1988 to 2000. Results: HIV seroprevalence among gay/bisexual IDUs decreased from the range of 35% to 45% in 1988/1989 to 25% in 1996 and then began to increase, reaching 42% in 2000. In contrast, HIV prevalence among heterosexual male IDUs remained stable during the study period. For gay/bisexual IDUs, injection and sex-related HIV risk behaviors declined modestly throughout the study period. As of the last cross section (July 2000), however, over a third of respondents reported recent syringe sharing or unprotected anal sex. Conclusions: Gay/bisexual men who inject drugs continue to be at elevated risk for HIV, suggesting that interventions such as amphetamine drug treatment and sexual risk reduction programs targeted at this population are needed.

Trends in HIV seroprevalence and risk among gay and bisexual men who inject drugs in San Francisco, 1988 to 2000.

To determine trends in HIV infection and risk behaviors among street-recruited self-identified gay and bisexual male injection drug users (IDUs) in San Francisco. Trends in HIV infection and risk behaviors were calculated for gay/bisexual ( n = 1594 interviews) IDUs in 26 semiannual cross sections from 1988 to 2000. HIV seroprevalence among gay/bisexual IDUs decreased from the range of 35% to 45% in 1988/1989 to 25% in 1996 and then began to increase, reaching 42% in 2000. In contrast, HIV prevalence among heterosexual male IDUs remained stable during the study period. For gay/bisexual IDUs, injection and sex-related HIV risk behaviors declined modestly throughout the study period. As of the last cross section (July 2000), however, over a third of respondents reported recent syringe sharing or unprotected anal sex. Gay/bisexual men who inject drugs continue to be at elevated risk for HIV, suggesting that interventions such as amphetamine drug treatment and sexual risk reduction programs targeted at this population are needed.

Age and HIV Risk in a National Sample of Injection Drug and Crack Cocaine Users

A national sample of 25,106 out-of-treatment crack cocaine and injection drug users was examined to determine the effect of aging on HIV risk behavior. Injectors and crack cocaine users aged 55 and over were compared to those who were aged 18 to 54 years of age. Results showed that the behavior risk of older persons did not differ substantially from those reported by other age groups, and that injection risk rose steadily along with age for all ages represented in the sample. The authors conclude that older persons who use illegal drugs remain at elevated risk for HIV compared to the general population, and may be in need of more targeted intervention strategies.

Close Relationships and Elevated HIV Risk Behavior: Evidence and Possible Underlying Psychological Processes

A review of research on AIDS preventive behavior indicates that minority and nonminority heterosexual adolescents and adults, gay men, injection drug users, and commercial sex workers are all less likely to practice safer sex with close relationship partners, compared with partners they perceive to be “casual” sexual partners. Because many individuals in close relationships have engaged in HIV risk behavior over extended periods of time and are unaware of their actual HIV status, practicing unprotected sexual intercourse with a committed relationship partner who is not tested for HIV appears to be a major and unrecognized source of HIV risk. This article reviews the evidence for higher levels of HIV risk behavior in close relationships and then presents relevant conceptual and empirical work to explore the psychological processes that may underlie risky sexual behavior in close relationships, using as a framework the information–motivation–behavioral skills model of preventive behavior.

Close relationships and elevated HIV risk behavior: Evidence and possible underlying psychological processes.

A review of research on AIDS preventive behavior indicates that minority and nonminority heterosexual adolescents and adults, gay men, injection drug users, and commercial sex workers are all less likely to practice safer sex with close relationship partners, compared with partners they perceive to be “casual” sexual partners. Because many individuals in close relationships have engaged in HIV risk behavior over extended periods of time and are unaware of their actual HIV status, practicing unprotected sexual intercourse with a committed relationship partner who is not tested for HIV appears to be a major and unrecognized source of HIV risk. This article reviews the evidence for higher levels of HIV risk behavior in close relationships and then presents relevant conceptual and empirical work to explore the psychological processes that may underlie risky sexual behavior in close relationships, using as a framework the information–motivation–behavioral skills model of preventive behavior.