A dual site project was conducted to assess determinants of injection and sex-related risk behaviors among Puerto Rican drug users. The project focused on injection drug users and crack smokers, and was conducted in East Harlem, NY and Bayamón, PR in 1996-2000. Qualitative methods included ethnographic mapping, focus groups, in-depth interviews, and observations. A survey component (East Harlem, n = 800; Bayamón, n = 400) was also conducted. Procedures to ensure integration of methodologies and comparability of data were developed. This paper describes the qualitative and survey methods used, and presents the comparative HIV risk behaviors. The integration of the two methodologies served multiple functions: each component identified issues to be addressed in the other, enhanced cross-site comparability of data, and assisted in interpretation of findings. The survey data showed high levels of risk behaviors in both communities, with significantly higher levels of risk reported in Bayamón. Conducting studies of similar ethnic groups in different communities provides opportunities to examine diverse sources of influence on risk behaviors. The integration of qualitative and quantitative methods can enhance comparability and understanding of findings, particularly when there are differences in behaviors between communities.

Retention in outpatient psychotherapy of 148 crack and cocaine abusers was examined. The clients were predominantly Black (63%) and Hispanic (21%), predominantly male (87%), and the majority (66%) had completed no more than 12 years of high school. Clients entered treatment in a low-cost treatment center in New York City between June 1987 and November 1988. Forty-two percent (62) of the subjects were seen for one or two research interviews only, and did not return to begin therapy. Of the 86 persons who came to at least one therapy session, 30% (26) dropped out before the third session, 28% (24) dropped out between the third and fifth sessions, and 42% (36) were retained for six or more sessions. Short-term and longer-term retentions were analyzed separately, using a battery including sociodemographic variables, treatment history, psychiatric symptomatology, number of arrests, and drug use variables. None of the variables considered was significantly related to short-term retention. There were large although not significant differences in longer term retention by therapist. Longer-term retention was associated significantly with being White (contrasted with being Black) and being young. Nonsignificant but large associations were found between longer-term retention and having few arrests, being Hispanic (contrasted with being Black), and having low SCL-90 scores. Results are compared with previous findings about retention in drug and alcohol treatment. It is suggested that future research on retention in treatment focus less on client variables and more on therapist and program variables.

Female offender populations and females in jail include large proportions of injecting drug users (IDUs), who are at high risk of contracting or transmitting HIV. Women IDUs (n = 165) were recruited and interviewed at New York City's central jail facility for women. The study examined these women's patterns of HIV risk behaviors related to drugs and sex and identified behavioral and attitudinal correlates of HIV serostatus. The women typically used both injectable and non-injectable drugs prior to arrest, primarily heroin, cocaine powder, crack, and illicit methadone. Self-reported HIV seropositivity was 43%. Variables correlated with HIV serostatus in the bivariate analysis were: cocaine injection frequency; lifetime injection risk behavior; providing oral sex during male crack use; Hispanic ethnicity; sharing of needles/syringes; sharing of cookers; sharing injection equipment with friends; heroin smoking (negative); injection risk acceptance; peer norms and behavior; lifetime sexual risk behavior; frequency of sex with men; provision of sex for money or drugs; and knowing people with AIDS. The first four variables listed retained statistical significance in a multiple logistic regression analysis. The paper considers the need to tailor AIDS prevention interventions for woman IDUs in jail, including taking into account risk behaviors that occur within frequently reported same-sex partnerships.

Condom use was studied for 421 sexually active, minority male adolescents who were currently in jail in New York City. Over three-quarters of the youths were users of alcohol and marijuana and about one-quarter were users of cocaine or crack, but drug injectors were rare. In the six months before arrest they had multiple sexual partners and about one-third had engaged in anal intercourse. Inconsistent condom use was the norm, with 17% reporting that they never used condoms and only 15% reporting that they used condoms every time for insertive sex. In multivariate analysis, more frequent condom use was independently predicted by gay/bisexual preference, greater acceptability and accessibility of condoms, partners' receptivity to use, self-initiation of use, and self-efficacy of avoiding AIDS. Condoms were used less frequently with steady than with causual partners, and rarely for anal or oral sex. AIDS prevention curricula addressing these factors should be delivered to high risk adolescents while they are temporarily accessible in jail.

Objective Injection drug use (IDU) remains a major risk factor for HIV-1 acquisition. The complex interplay between drug use, non-sterile injection, and Hepatitis C remains poorly understood. We conducted a pilot study to determine the effect of IDU on immune parameters among HIV-uninfected and -infected individuals. We hypothesized that IDU could further augment immunological changes associated with HIV-1 infection, which could in turn affect HIV pathogenesis Methods HIV-uninfected and -infected subjects with IDU, and non-IDU controls were recruited to obtain socio-demographic and drug-related behaviours. Blood (PBMC) and mucosal (MMC) mononuclear cells were analysed for cellular markers of immune activation (CD38 and Ki67). Serum ELISA was performed to determine levels of soluble CD14, a marker of immune activation. Results No significant quantitative differences in CD4+ and CD8+ T cell levels were observed between IDU and non-IDU subjects when accounting for the presence of HIV-1 infection. However, increased levels of cellular and soluble markers of immune activation were documented in cells and plasma of HIV-uninfected IDU subjects compared to non-injectors. Additionally, sharing of injection paraphernalia was related to immune activation among HIV-uninfected IDU subjects. Conclusion IDU, with or without HIV-1 infection, results in a significant increase in immune activation in both the peripheral blood and the GI tract. This may have significant impact on HIV transmission, pathogenesis, and immunologic responses to combination antiviral therapy. This study provides compelling preliminary results which in turn support larger studies to better define the relationship between IDU, infection with HIV-1, co-infection with Hepatitis C and immunity.

This article investigates the association between residential status and human immunodeficiency virus (HIV) risk behaviors among island and New York Puerto Rican injection drug users (IDUs). We assigned 561 subjects from New York City and 312 from Puerto Rico to five residential status categories: living in parent's home, living in own home, living in other's home, living in temporary housing (hotel, single-room occupancy [SRO] hotels), and homeless (living in streets/shelters). Dependent variables included injection- and sex-related risk behaviors (sharing syringes, sharing other injection paraphernalia, shooting gallery use, and having paid sex). Chi square, t tests, and multivariate logistic analysis tests were performed separately by site. About one-quarter of the sample in each site was homeless. Island Puerto Ricans were more likely to live with their parents (44% vs. 12%, p < .001), and more New York IDUs lived in their own home (30% vs. 14%, p < .001). In New York, gallery use and paid sex were associated with living in other's home, living in parent's home, and being homeless. Sharing paraphernalia was related to living in other's home, living in temporary housing, and being homeless. In Puerto Rico, having paid sex was associated with homelessness. High-risk behaviors were more likely among homeless IDUs in both sites. Programs to provide housing and target outreach and other prevention programs for homeless IDUs would be helpful in reducing HIV risk.

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This study examines the influence of peer norms on sharing of injection paraphernalia (e.g., indirect sharing behaviors, including sharing of cookers, cotton, rinse water and back/front loading) among Puerto Rican injection drug users (IDUs) in Bayamón, Puerto Rico, and East Harlem, New York City. Data were collected from 873 Puerto Rican IDUs recruited in the two locations by outreach workers. Multiple logistic regression was conducted using sociodemographic and other control variables (e.g., education, frequency of injection, pooling money to buy drugs, use of needle exchange program, injection in galleries and syringe sharing behaviors) and two types of norms related to sharing of injection paraphernalia-encouraging risk norms (what others approve) and objecting to risk norms (what others disapprove). One type of norms, encouraging or approval norms, was associated with indirect sharing in New York but not in Puerto Rico. Pooling money to buy drugs, use of shooting galleries and syringe sharing was associated with indirect sharing in both locations. Prevention programs to reduce indirect sharing behaviors should take into consideration different types of risk norms in order to reduce indirect sharing risk behaviors.