Cocaine Use and HIV Infection in Intravenous Drug Users in San Francisco

Chaisson, Richard E.; Bacchetti, Peter; Osmond, Dennis; Brodie, B.O.; Sande, Merle A.; Moss, Andrew R.

doi:10.1001/jama.1989.03420040099027

Cited by 435 publications

(88 citation statements)

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“…94 Cocaine injection is clearly a risk factor for HIV 95 : injection cocaine users are more likely than injection opiate users to share drug injection equipment and to engage in other high-risk behaviors. 44,96,97 The risks associated with injection cocaine use extend to individuals in methadone maintenance. 98,99 Evidence regarding the effect of methadone maintenance on cocaine use is mixed: some individuals increase cocaine use after entering methadone treatment, 44 but the overall effect may be a reduction in injection cocaine use.…”

Section: Discussionmentioning

confidence: 99%

“…98,99 Evidence regarding the effect of methadone maintenance on cocaine use is mixed: some individuals increase cocaine use after entering methadone treatment, 44 but the overall effect may be a reduction in injection cocaine use. 44,96 Methadone maintenance clients who also inject cocaine may not reduce risky behavior by as much as clients who do not inject cocaine, so the exclusion of cocaine injection practices from our model may have overstated the benefit of methadone maintenance.…”

Section: Discussionmentioning

confidence: 99%

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HIV transmission and the cost-effectiveness of methadone maintenance

Zaric¹,

Barnett²,

Brandeau³

2000

Am J Public Health

197

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OBJECTIVES: This study determined the cost-effectiveness of expanding methadone maintenance treatment for heroin addiction, particularly its effect on the HIV epidemic. METHODS: We developed a dynamic epidemic model to study the effects of increased methadone maintenance capacity on health care costs and survival, measured as quality-adjusted life-years (QALYs). We considered communities with HIV prevalence among injection drug users of 5% and 40%. RESULTS: Additional methadone maintenance capacity costs $8200 per QALY gained in the high-prevalence community and $10,900 per QALY gained in the low-prevalence community. More than half of the benefits are gained by individuals who do not inject drugs. Even if the benefits realized by treated and untreated injection drug users are ignored, methadone maintenance expansion costs between $14,100 and $15,200 per QALY gained. Additional capacity remains cost-effective even if it is twice as expensive and half as effective as current methadone maintenance slots. CONCLUSIONS: Expansion of methadone maintenance is cost-effective on the basis of commonly accepted criteria for medical interventions. Barriers to methadone maintenance deny injection drug users access to a cost-effective intervention that generates significant health benefits for the general population.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

HIV transmission and the cost-effectiveness of methadone maintenance

Zaric¹,

Barnett²,

Brandeau³

2000

Am J Public Health

197

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“…Low-income women may be more likely to practice high-risk behaviors associated with AIDS as a result of high rates of depression, high levels of stress, and scarce personal and social resources (Cochran & Mays, 1989;Krueger, Wood, Diehr & Maxwell, 1990;Longshore, 1989;McLeod & Kessler, 1990; Nyamathi & Lewis, 1991). Low-income women are especially at risk due to higher rates of drug abuse, that involves both intravenous drug use with contaminated needles, and the association of crack cocaine use with prostitution and sexually transmitted diseases (Chaisson, Bacchetti, Osmond, Brodie, Sande, & Moss, 1989;Fullilove, Fullilove, Bowser, & Gross, 1990). In addition, poor women who are homeless are at high risk for HIV infection due to the inavailability of socioculturally appropriate AIDS education, low rates of condom use, high rates of prostitution, and many other factors (Christian0 & Susser, 1989;Cochran & Mays, 1989;Krueger et al, 1990;Mays & Cochran, 1988).…”

Section: I34mentioning

confidence: 99%

Psychosocial correlates of emotional distress and risk behavior in african-american women at risk for hiv infection

Nyamathi¹,

Wayment²,

Dunkel-Schetter³

1993

Anxiety, Stress & Coping

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We examined a model of stress and coping in 749 African-American women at risk for HIV infection. Women in the sample were either homeless, intravenous drug users (IVDUs) sexual partners of IVDUs, or prostitutes. A model was hypothesized based on stress and coping theory and research. Antecedents studied were personal resources, specifically self-esteem and available support. Mediators were threat appraisal and coping efforts. Outcomes studied were emotional distress and HIV risk behaviors. Structural equation modeling techniques were used to test hypothesized pathways between these variables. Forty-five percent of the variance in emotional distress in these women was explained by the model with self-esteem and avoidant coping the strongest predictors. Ten percent of the variance in risk behavior was explained by the model with emotional distress the strongest predictor. Direct and indirect pathways predicting risk behavior and distress are discussed. Implications of results for intervention and theory building are considered.

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“…Substance abuse can lead to high-risk sexual behaviors by affecting decision making, compromising judgment, decreasing the likelihood of condom use, and increasing the likelihood of sex-for-drug exchanges and injection drug use. [58][59][60][61][62][63][64][65][66][67][68][69][70][71][72] Yet, research on non-injection drug use and HIV/STIs has lagged considering its importance in the current HIV/STI epidemic.Taken together, these findings mirror changing patterns of transmission of HIV/STIs in the general population. In the early stages of the HIV/STI epidemic, the most common patterns of transmission were injection drug use (approximately one quarter of AIDS cases) and male-tomale sex (two thirds of AIDS cases).…”

mentioning

confidence: 99%

A Longitudinal Study of the Prevalence, Development, and Persistence of HIV/Sexually Transmitted Infection Risk Behaviors in Delinquent Youth: Implications for Health Care in the Community

Romero

Teplin²,

McClelland³

et al. 2007

Pediatrics

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Objective-. To examine the prevalence, development, and persistence of sex and drug behaviors that place delinquent youth at risk for human immunodeficiency virus and other sexually transmitted infections (HIV/STI).Methods-At the baseline interview, HIV/STI drug and sex risk behaviors were assessed in a stratified random sample of 800 juvenile detainees, aged 10 to 18 years. Participants were reinterviewed approximately 3 years later (mean [SD] follow-up, 3.2 [0.3] years; median follow-up, 3.1 years). The final sample in these analyses (n = 724) includes 316 females and 408 males, 393 African Americans, 198 Hispanics, 131 non-Hispanic whites, and 2 participants who self-identified as "other."Results-Nearly three quarters of youth engaged in one or more unprotected sexual risk behaviors at follow-up. Over 60% had engaged in 10 or more risk behaviors at their baseline interview, and nearly two thirds of them persisted in 10 or more risk behaviors at follow-up. Among youth living in the community, many behaviors were more prevalent at follow-up than at baseline. Among incarcerated youth, the opposite pattern prevailed. Development and persistence of HIV/STI risk behaviors differed by gender, race/ethnicity, and age, even after adjusting for incarceration status. Compared with females, males had higher prevalence rates of many HIV/STI risk behaviors and were more likely to persist in some behaviors and develop new ones. Yet, injection risk behaviors were more prevalent among females than males and were also more likely to develop and persist. Compared with persons younger than 18, persons 18 and older had higher prevalence rates of many HIV/STI risk behaviors at follow-up. Overall, there were few racial and ethnic differences in patterns of HIV/STI risk behaviors; most involved the initiation and persistence of substance use among nonHispanic whites and Hispanics.Conclusions-Because detained youth have a median stay of only 2 weeks, HIV/STI risk behaviors in delinquent youth are a community public health problem, not just a problem for the juvenile justice system. Improving the coordination among systems that provide HIV/STI interventions to youth -primary care, education, mental health, and juvenile justice -can reduce the prevalence of risk behaviors and substantially reduce the spread of HIV/STI in young people.Corresponding Author: Linda A. Teplin, PhD, Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, 710 N. Lakeshore Drive, Suite 900, Chicago, IL 60611. . psycholegal@northwestern.edu. NIH Public Access Author ManuscriptPediatrics. Author manuscript; available in PMC 2010 January 29. Published in final edited form as:Pediatrics. 10-14Minorities are also overrepresented in the juvenile justice system, where HIV/STI risk behaviors are prevalent. 15-20 Detained youth report more risk behaviors and initiate them at younger ages than do youth in the community.21 Detained youth are likely to be at continued risk for HIV infection as they age. Adults in p...

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Cocaine Use and HIV Infection in Intravenous Drug Users in San Francisco

Cited by 435 publications

References 10 publications

HIV transmission and the cost-effectiveness of methadone maintenance

HIV transmission and the cost-effectiveness of methadone maintenance

Psychosocial correlates of emotional distress and risk behavior in african-american women at risk for hiv infection

A Longitudinal Study of the Prevalence, Development, and Persistence of HIV/Sexually Transmitted Infection Risk Behaviors in Delinquent Youth: Implications for Health Care in the Community

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