Compliance to Bleach Disinfection Protocols among Injecting Drug Users in Miami

Bleach cleansing of injection equipment has been recommended to reduce the risk of human immunodeficiency virus (HIV) transmission associated with the reuse of injection equipment by injecting drug users (IDUs). We evaluated the recall and performance of the most commonly recommended bleach cleansing procedure of two complete fillings of the syringe with bleach, followed by two complete fillings with rinse water, and not putting used bleach and water back into source containers. IDUs were taught this procedure on enrollment in an HIV prevention demonstration project in Dade County, Florida. During follow-up session 6-12 months after initial training, the knowledge and ability of IDUs to perform bleach cleansing were assessed by trained observers using a standardized method. In 1988-90, we assessed the knowledge and ability of 450 IDUs to perform the bleach cleansing procedure taught at enrollment. More than 90% of IDUs assessed performed the basic steps. However, only 43.1% completely filled the syringe with bleach and only 35.8% completely filled the syringe with bleach at least twice. Substantial proportions of IDUs did not perform all the steps of the previously taught bleach cleansing procedure. Compliance decreased as the number of steps required was increased. This limited compliance may make bleach cleansing less effective and suggests that some IDUs may fail to adequately disinfect injection equipment and therefore sterile needles and syringes are safer than bleach-cleansed ones. Compliance testing can help assess the effectiveness of HIV prevention programs. © 1994 Raven Press, Ltd., New York

Crime victimization among injection drug users

This study uses routine activity theory to examine violent and property crime victimization among a sample of 308 injection drug users (IDUs). We estimate prevalence rates and identify factors that contribute to the victimization of IDUs. The findings suggest that victimization rates of IDUs were much higher than rates found for the general urban population. Generally, crime involvement did not contribute significantly to victimization risk. Use of crack-cocaine increased the likelihood of property crime victimization whereas heroin use decreased the probability of both violent and property crime victimization. Other drug lifestyle activities (i.e., waiting in uncomfortable situations to buy drugs) also affected victimization risk Finally, the results suggest that victimization differed by age and by gender, despite controls for drug use and drug lifestyle activities. Explanations for these results are offered. </jats:p

Effects of drug treatment for heroin sniffers: a protective factor against moving to injection?

We explore the relationship between contact with treatment and transition to injection for heroin sniffers. Our primary research question is, does contact with treatment delay onset of injection for heroin sniffers? A stratified network-based sample was recruited from multiple communities in South Florida which were known for high drug use. Three categories of respondents were recruited based on injection outcome: long-term injectors, short-term injectors, and sniffers (n=900). We answer our research question in two steps. First, we investigate the prevalence of drug treatment for heroin sniffers and injectors using case-control methods. The preliminary findings indicate a positive relationship between contact with treatment and injection status outcome. Second, we further examine the relationship by attempting to identify the causal factors that delay initial injection for a subgroup of current injectors using survival regression procedures. Delaying or preventing transition to injection could significantly decrease risk of HIV transmission by reducing or eliminating risky injecting behaviors. We conclude with a discussion of policy implications and suggestions for future research.Drug treatment HIV/AIDS Transition to injection Heroin Heroin sniffers USA

The consistency of self-reported HIV risk behavior among injection drug users

OBJECTIVES. Most studies of risk factors for human immunodeficiency virus (HIV) rely heavily on retrospective self-reports. The degree to which these reports provide reliable information has received little research attention. The purpose of this study was to assess the extent to which the reliability of retrospective self-report data is affected over time. METHODS. Data were examined from a longitudinal study of risk behaviors among injection drug users. Structured interviews were administered to 366 injection drug users who were asked to recall behaviors that they had reported 6, 12, or 18 months earlier. RESULTS. Kappa coefficients showed moderate initial memory loss for injection and sexual risk behaviors. After 6 months, time had little effect on the ability of injection drug users to recall injection and sexual risk behaviors. For ordinal measures of risk, subjects who gave different reports over time were most likely to disagree by one response category. CONCLUSIONS. These findings support the use of retrospective self-reports in assessing HIV risk behaviors among injection drug users. Retrospective inquiry is likely to remain an important method for collecting data over time

PRIMARY PREVENTIVE HEALTH CARE AMONG INJECTION DRUG USERS, OTHER SUSTAINED DRUG USERS, AND NON-USERS

The primary objective of this paper is to investigate the relationship between sustained illicit drug use and the utilization of primary preventive health care. Data from 1254 African-American, Hispanic Latino, and non-Hispanic Latino white men and women collected in 1996-1997 were analyzed to determine independent risk factors for the utilization of primary preventive health care that was not received as a result of seeking treatment for a specific health condition. When several demographic, health, and drug use variables were assessed in a logistic regression model, gender, ethnicity, health insurance status, drug use, and alcohol use were independently associated with primary preventive care. Women, Hispanic Latinos, and persons who had health insurance were more likely to have received primary preventive health care while injection drug users, other sustained drug users, and "heavy" alcohol users were less likely to have used primary preventive health care services in the past year. [Translations are provided in the International Abstracts Section of this issue.

Revolving Roles in Drug-Related Crime: The Cost of Chronic Drug Users as Victims and Perpetrators

Numerous studies have established a strong connection between the use of illicit drugs and the commission of other illegal activities, including both predatory and property crimes. No study, however, has examined the cost of crimes associated with drug users both as victims and as perpetrators. In the present study, recent data were analyzed from a targeted sample of chronic drug users (CDUs) and a matched sample of non-drug users (NDUs) in Miami-Dade County, Florida, to estimate the incremental cost of crime associated with CDU. Two separate models were employed to estimate (1) the probability of being a victim or a perpetrator of crime and (2) the cost of crime for both situations. The cost measures were transformed to reduce the influence of extreme outliers, and a smearing technique was used to compare the cost of crime for CDUs relative to NDUs. The findings illustrate that criminal activity among CDUs is circular, extensive, and costly. Implications for law enforcement, criminal justice policy, and substance abuse treatment are discussed