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Archival Content: 1999-2005

HIV Prevention Among Drug Users:
A Resource Book for Community Planners & Program Managers

Appendix B: Summaries of Resources That Address Behavioral Theories and Research on HIV Prevention Interventions with Drug Users

Each resource listed in Appendix B reviews and comments on aspects of HIV prevention interventions which will help prevention planners and program managers in considering program activities. The contents of this appendix provides the following information:

  • Brief summaries of selected books, monographs, book chapters, and articles on effectiveness literature
  • Content highlights
  • A bibliography

Appendix B presents summaries of selected books, monographs, chapters of books, and articles. The books, chapters of books, and monographs describe various types of HIV prevention interventions, explore the determinants of behavior, and outline special cultural issues and factors of particular relevance to different groups defined by race/ethnicity, gender, age, and sexual orientation. We selected these materials to expand on and enhance the information that is presented in the Evaluation Summary Forms in Appendix A. For each resource, we provide a summary page that contains an abstract and highlights of the key areas on which the authors focused.

Prevention planners and program managers can review these summaries to determine if a resource has information relevant to their particular planning needs. They can also look for information on target population, type of intervention, and research on effectiveness.

The following summaries are adapted from book jackets, promotional descriptions, and the National Library of Medicine's (NLM) MEDLINE/AIDSLINE article abstracts. In cases where an abstract is unavailable, they are drawn from opening paragraphs in the articles themselves.

The Context of HIV Risk Among Drug Users and Their Sexual Partners

Battjes RJ, Sloboda Z, Grace WC, editors

National Institute on Drug Abuse Research Monograph Series 143. Rockville (MD): National Institutes of Health; 1994. Available from: National Institute on Drug Abuse, NIH Publication No. 94-3750.

This monograph is based on papers that were presented at a technical review meeting on "The Context of HIV Risk Among Drug Users and Their Sexual Partners" held on April 22-23, 1993. The meeting's purpose was to review research on drug use and sexual behaviors of drug users associated with HIV transmission, and develop a research agenda for future directions. The meeting was convened by NIDA and was the result of an earlier NIDA-sponsored meeting that was held in January 1992.


A Contextual Perspective on HIV Risk
Battjes RJ, Sloboda Z, Grace WC

Heterosexual Males
HIV Risk Behaviors of Heterosexual Male Drug Users
Needle RH

Injection and Sexual Risk Behaviors of Male Heterosexual Injecting Drug Users
Stephens RC, Alemagno SA

HIV/AIDS Risks Among Male, Heterosexual Non-injecting Drug Users
Who Exchange Crack for Sex
Inciardi JA

Context of HIV Risk Behavior Among Female Injecting Drug Users and Female
Sexual Partners of Injecting Drug Users
Hartel D

Female Drug Abusers and the Context of Their HIV Transmission Behaviors
Allen K

Factors Associated with Sexual Risk of AIDS in Women
O'Leary A

Men Who Have Sex With Men
Drug Use and HIV Risk Among Gay and Bisexual Men: An Overview
Battjes RJ

Substance Use and HIV-Transmitting Behaviors Among Gay and Bisexual Men
Ostrow DG

Drug Use and HIV Risk Among Male Sex Workers:
Results of Two Samples in San Francisco
Waldorf D

HIV Risk in Drug-Using Adolescents
Smeriglio VL

HIV Risk in Adolescents: The Role of Sexual Activity and Substance Use Behaviors
Boyer CB, Ellen, JM

Going Nowhere Fast: Methamphetamine Use and HIV Infection
Rotherum-Borus MJ, Luna GC, Marotta T, Kelly H

Measurement Issues
The Context of Risk: Methodological Issues
Sloboda Z

Bringing the Context in From the Cold: Substantive, Technical, and Statistical Issues for AIDS Research in the Second Decade
Brunswick AF

The Context of Risk: Ethnographic Contributions to the Study of Drug Use and HIV
Koester SK

Assessing the Reliability and Validity of Self-Reported Risk Behavior
Gibson DR, Young M

Future Directions for Studies on the Context of HIV Risk
Grace WC, Battjes RJ, Sloboda Z

Social Networks, Drug Abuse, and HIV Transmission

Needle RH, Coyle SL, Genser SG, Trotter RT, editors

National Institute on Drug Abuse Research Monograph Series 151. Rockville (MD). National Institutes of Health; 1995. Available from: National Institute on Drug Abuse, NIH Publication No. 95-3889.

This monograph is based on papers that were presented at a technical review meeting on "Social Networks, Drug Abuse and HIV Transmission" held on August 19-20, 1993. The NIDA-sponsored meeting examined the "social network research paradigm and its application to the study of drug use and HIV transmission." The studies reviewed focused on drug abuse and its relationship to HIV transmission within the context of a variety of networks (e.g., drug injectors, sex workers, siblings and other relatives, and sexual partners). Four main conclusions were drawn from the data: 1) network characteristics affect behavioral practices as well as the chance of HIV infection; 2) migration and transient groups affect the incidence of viral transmission of other network groups; 3) the adoption of individual risk behaviors is affected by network membership characteristics and network norms; and 4) "network-oriented interventions aimed at diffusing information about HIV and at changing transactional patterns have been successful at introducing behavioral change among network members, reducing high-risk behaviors, accelerating readiness for treatment, and limiting the spread of HIV."


Introduction: the Social Network Research Paradigm
Needle RH, Coyle SL, Genser SG, Trotter RT

Social Networks in Disease Transmission: the Colorado Springs Study
Rothenberg RB, Woodhouse DE, Potterat JJ, Muth SQ, Darrow WW, Klovdahl AS

Using Dyadic Data for a Network Analysis of HIV Infection and Risk Behaviors
Among Injecting Drug Users
Neaigus A, Friedman SR, Goldstein M, Ildenfonso G, Curtis R, Jose B

Injecting Drug Use, Characteristics of Significant Others, and HIV Risk Behaviors
Price RK, Cottler LB, Mager D, Murray KS

Sibling Homophily in HIV Infection: Biopsychosocial Linkages in an
Urban African American Sample
Brunswick AF, Messeri PA, Dobkin J, Flood MT, Yang A

Focal Networks and HIV Risk Among African American
Male Intravenous Drug Users
Frey FW, Abrutyn E, Metzger DS, Woody GE, O'Brien CP, Trusiani P

A Comparison of Drug Use Networks Across Three Cities
Williams ML, Zhuo Z, Siegal HA, Robles RR, Trotter RT, Jones A

Ethical and Legal Issues in Social Network Research: the Real and the Ideal
Woodhouse DE, Potterat JJ, Rothenberg RB, Darrow WW, Klovdahl AS, Muth SQ

Network Models for HIV Outreach and Prevention Programs for Drug Users
Trotter RT, Bowen AM, Potter JM

A Personal Network Approach to AIDS Prevention: an Experimental Peer
Group Intervention for Street-Injecting Drug Users: the SAFE Study
Latkin CA

Promising Social Network Research Results and Suggestions for a Research Agenda
Friedman SR

Preventing AIDS in Drug Users and Their Sexual Partners

Sorensen JL, Wermuth LA, Gibson DR, Choi KH, Guydish JR, Batki SL
New York: Guilford Press; 1991

The book presents the results of several San Francisco experiments aimed at preventing AIDS among drug users and their sex partners. The authors present research findings that support the proposition that targeted AIDS prevention efforts can be effective. Although the bulk of the work presented occurred in San Francisco, the findings are placed in the context of extensive investigations of other research groups, clinicians, and national and international experts about public policy. The book discusses AIDS, drug use, sexual behaviors, and theories of change. This is followed by chapters that suggest how to prevent AIDS by action with drug users and their sexual partners. The final part of the book makes concluding recommendations about disseminating prevention programs and forming effective policies.


AIDS and Drug Use

Introduction: the AIDS-Drug Connection Sorensen JL

Cases: Implications for AIDS Prevention Wermuth LA

Needle Sharing, Needle Cleaning, and Risk Behavior Change Among Injection Drug Users Guydish JR, Golden E, Hembry K

Unsafe Sex and Behavior Change Shoi KH, Wermuth LA

Theoretical Background Gibson DR, Catania JA, Peterson JL

Preventive Interventions with Drug Users and Their Sexual Partners

Drug Abuse Treatment for HIV-infected Patients Batki SL, London J

Group Counseling to Prevent AIDS Sorensen JL, London J, Morales ES

Individual Counseling Gibson DR, Lovell-Drache J

Reaching and Counseling Women Sexual Partners Wermuth LA, Robbins RL, Choi KH, Eversley R

Social Implications

Adopting Effective Interventions Sorensen JL, Guydish JR

Policy Implications Wermuth LA, Sorensen JL, Franks P

Harm Reduction: A Public Health Response to the AIDS Epidemic Among Injecting Drug Users

Des Jarlais DC, Friedman SR, Ward TP Annual Review of Public Health 1993;14:413-450

This article presents an overview of the harm reduction approach to HIV prevention among injecting drug users (IDUs). It begins with a discussion of the epidemiology of HIV infection among IDUs, outlining the importance of preventing infection in drug-using populations. The authors then summarize what is understood under the harm reduction perspective, i.e., that problems associated with psychoactive drug use are not direct results of drug use as such, but rather drug use behavior, and therefore HIV prevention efforts must focus on specific behaviors that put drug users at risk for HIV. In this perspective, there is no single best solution to preventing HIV infection among drug users; drug users are seen as capable of making rational choices regarding their HIV risk behaviors, and importance is placed on overcoming the marginalization of drug users by society. Several types of HIV prevention programs and approaches for IDUs that may be part of a harm reduction strategy are described, including syringe exchanges; over-the-counter availability of sterile injection equipment; drug abuse treatment, outreach, and bleach distribution programs; HIV counseling and testing; and the formation of drug users' organizations aimed at promoting risk reduction strategies from within drug-using populations. Pragmatic concerns related to the harm reduction approach are discussed, such as questions about whether and how behavior change can be maintained over time, and what role sexual risk behaviors play. Finally, philosophic concerns related to this approach are presented, including whether or not the harm reduction perspective appears to condone illicit drug use.


Early Epidemiology of HIV Infection Among IDUs
Heterosexual and Perinatal Transmission from IDUs
Rapid Transmission of HIV Among IDUs
Non-AIDS Illnesses Associated with HIV Among IDUs
Spread of HIV Among IDUs in Developing Countries
Summary of Epidemiology
The Harm Reduction Perspective on Prevention of HIV Infection Among IDUs
HIV Prevention Programs for IDUs
How Much Prevention is Needed for Success?
Harm Reduction and HIV Prevention: Pragmatic Concerns
Harm Reduction and HIV Prevention: Philosophic Concerns

Social Intervention Against AIDS Among Injecting Drug Users

Des Jarlais DC
New York: Beth Israel Medical Center; 1995 June 1993;14:413-450.

This document discusses the results of major intervention studies (mainly, the NADR/ATOM project), theories of social and behavioral change, and the legal/political system related to HIV/AIDS prevention among the injection drug users. The application of social and behavioral theories of change to HIV/AIDS prevention strategies is discussed.


The Evolution of AIDS Prevention for Reducing HIV Transmission Among IDU
Theories of HIV Prevention Programming
Using Psychological Theories of Health-Related Behavior
Social Change Theories of HIV Risk Reduction Among Injecting Drug Users
Providing Means for Behavior Change
Absence of Harmful Effects of Providing Means for Safer Injection
Effectiveness: HIV Incidence in Outreach/Bleach Distribution Projects
The Effectiveness of Bleach as a Disinfectant for Drug Injection Equipment
HIV Incidence and Syringe Exchange
Integrating Multiple Prevention Programs
Current Problematic Issues in Preventing HIV Infection Among Injecting Drug Users in the United States

HIV/AIDS Prevention For Injecting Drug Users

Friedman SR, Neaigus A, Des Jarlais DC , Sotheran JL, Woods J, Sufian M, Stepherson B, Sterk C
British Journal of Addiction 1992; 87(3):393-404.

Many drug injectors continue to engage in behaviors that lead them to become infected with HIV in spite of a wide variety of public health programs. In addition, many persons have begun to inject drugs in spite of knowing the risks of AIDS. The authors argue that the inadequacy of current efforts to prevent these behaviors suggests that social interventions be tried to complement current programs (almost all of which have an individual focus). Evidence that social factors such as peer pressure and the social relations of race affect risk behavior is presented. Social interventions discussed include organizing drug injectors against AIDS in ways analogous to those in which gays organized against the epidemic, and finding ways to change large-scale social relationships that predispose people to inject drugs.


The State of the Art-and the Need for Improvement

Peer effects on risk and risk reduction
Heterogeneity of drug injection scenes
Race/ethnicity, risk and risk reduction

Collective Action Against AIDS

Changing the Social Structure

Assessing the Social and Behavioral Science Base for HIV/AIDS Prevention and Intervention: Workshop Summary and Background Papers

Institute of Medicine, National Academy of Sciences
Washington (DC): National Academy Press; 1995.

In June 1995, the Institute of Medicine (IOM), with support from the Office of AIDS Research at the National Institutes of Health, convened a workshop committee to consider the contributions of the social and behavioral sciences to AIDS prevention, assess the current understanding of the epidemic, draw new insights to help guide further research on the complex issues associated with the epidemic, and identify important research questions and relevant methodologies needed for the future. This report summarizes the presentations and discussions of the workshop with reference to key insights from the commissioned background and response papers. The workshop extended the review of preventive interventions targeted at individual behavior change found in the 1994 IOM report, AIDS and Behavior: An Integrated Approach. Focused on more social-level analyses, this summary and the accompanying background papers are useful companion documents to the earlier IOM report.


Workshop Topics

Understanding the epidemic
Learning from lives: individuals within a social context
Understanding high-risk communities
Making a difference: controlling the epidemic through social intervention
Evaluating results

Background Papers

HIV/AIDS Prevention: Models of Individual Behavior in Social and Cultural Contexts Ewart CK

Response: What do People Need to Know About AIDS? Fischhoff, B
Response: Cognitive Psychology, Social Networks, and AIDS Heckathron DD

Social Science Intervention Models for Reducing HIV Transmission Friedman SR,
Yypijewska C

Response to Social Science Intervention Models for Reducing HIV Transmission Connors MM

On the Concept of Community Laumann EO

Community Disintegration and Public Health: A Case Study of New York City Fullilove RE

Response: Societal Instability Perspective: Relevance to HIV/AIDS Prevention
Turshen M

Communication Campaigns for HIV Prevention: Using Mass Media in the Next Decade Flora JA, Maiback EW, Holtgrave D

Mexican American Intravenous Drug Users' Needle-Sharing Practices: Implications for AIDS Prevention

Mata AG, Jorquez JS
In: May VM, Albee GW, Schneider SF, editors. Primary prevention of AIDS: psychological approaches. Newbury Park CA: Sage Publications; 1989.

This chapter discusses intravenous drug use and needle-sharing practices among Mexican Americans, potential influences promoting and/or deterring these behaviors, and how these behaviors have been affected by the HIV epidemic. It begins with a historical review of substance abuse among Mexican Americans and describes socioeconomic and cultural factors that affect prevention efforts among ethnic minorities. It then concludes with recommendations for the development of prevention programs among Mexican American drug users and suggests ways in which to involve their social networks (i.e., sexual partners, families and children) in these prevention efforts.


Background and Historical Context
The Problem in Perspective
IV Drug Use in the Barrio

Prevention efforts
Active IV drug users in treatment
Active IV drug users out of treatment
Sexual partners, families, and children

Preventing HIV Transmission: The Role of Sterile Needles and Bleach

Normand J, Vlahov D, Moses LE, editors
National Research Council, Institute of Medicine. Washington (DC): National Academy Press; 1995.

This book is the result of a legislative directive (July 1992 ADAMHA Reorganization ACT) that requested the National Research Council (NRC) and the Institute of Medicine (IOM) to conduct a study to determine the effectiveness of needle exchange and bleach distribution programs. A panel was created and relevant research was gathered and analyzed. This book describes research relevant to the effects of such programs on drug use rates, IDU behaviors, and the spread of AIDS and hepatitis among IDUs and their sexual partners. Also discussed are characteristics associated with effective programs, and recommendations for future research and evaluation methods applicable to the evaluation of such programs.


Dimensions of the Problem
The epidemiology of HIV/AIDS
The epidemiology of injection drug use
Needle exchange and bleach distribution programs in the United States
Community views
The legal environment
The Impact of Needle Exchange and Bleach Distribution Programs
The effectiveness of bleach as a disinfectant of injection drug equipment
The effects of needle exchange programs
Directions for future research
Description and Review of Research Projects in Three Cities (Appendix)
San Francisco

Interventions for Sexual Partners of HIV-Infected or High-Risk Individuals

Padian NS, Wijgert J, O'Brien TR
In: DiClemente RJ, Petterson JL, editors. Preventing AIDS: theories and methods of behavioral interventions. New York: Plenum Press; 1994.

In this chapter the authors assess partner notification and HIV antibody testing and counseling programs. They describe in detail the design and results of a couple-counseling protocol from the California Partner Study and discuss the complexities of identifying partners of HIV infected and high risk individuals, and the effects of HIV antibody testing, counseling, and AIDS education on behavior change. The chapter concludes with a discussion of the limitations and strengths (i.e., external and internal validity, and subject recruitment and attrition) of all of these approaches.


Review of Relevant Interventions
Partner notification
Success in identifying partners
The Effect of HIV Antibody Testing, Counseling, and AIDS Education on Behavior Change
Couple Counseling in the California Partner Study
Nature of the intervention
Effects of the intervention
Limitations of Interventions
External validity
Subject recruitment and attrition
Internal validity

HIV/AIDS Prevention for Drug Users in Natural Settings

Watters JK, Guydish J
In: DiClemente RJ, Peterson JL, editors. Preventing AIDS: theories and methods of behavioral interventions. New York: Plenum Press; 1994.

In this chapter, the authors discuss HIV prevention interventions that have targeted IDUs in natural settings (mostly outreach programs). First they present the historical background of strategies used in traditional drug treatment programs and their limitations for HIV prevention. The authors address benefits and challenges of developing and evaluating HIV prevention programs among drug users in natural settings by describing various research and evaluation methodologies.


Major Approaches to Drug Abuse Treatment and Prevention

Limitations of Drug Treatment as an HIV Prevention Strategy

Prevention Efforts in Natural Settings

Community health outreach
Syringe and needle exchange

Challenges in Evaluating Programs in Natural Settings

Drug-Using Women and HIV: Risk-Reduction and Prevention Issues

Weissman G, Brown V
In: O'Leary A, Jemmott LS, editors. Women at risk: issues in the primary prevention of AIDS. New York: Plenum Publishing Corporation; 1995.

This chapter discusses the educational, cultural, socioeconomic, psychological, and physical barriers drug-using women encounter, describes some of the approaches to overcome them, and provides strategies to develop successful prevention and risk-reduction programs for drug-using women. The results of three major studies (the National AIDS Demonstration Research (NADR) program, the Nontraditional Supports for Drug Using Women project, and the Women Helping to Empower and Enhance Lives (WHEEL) project) are discussed in depth, along with tools used to assess psychological status and risk-behaviors.


Major Approaches to Drug Abuse Treatment and Prevention

New studies
The sex-drug connection: multiplication of risk
Special features of crack use
History of sexual/physical abuse
Dual diagnosis/depression
Lack of social supports
Counseling, testing, and partner-notification issues

Challenges in Evaluating Programs in Natural Settings

Successful models of preventive intervention
Role of drug treatment programs in HIV prevention
Role of needle exchange programs

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