ISSN:0952-0481    

DOI:10.1111/j.1360-0443.1992.tb01934.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

AbstractThis paper examines findings and trends from the first decade of research on AIDS among injecting drug users as a basis for projecting into the next decade. One of the most disturbing aspects of AIDS and HIV infection among injecting drug users which emerged in the first decade is the globalization of the problem. Further geographic spread can be expected, particularly in developing countries. Rapid spread of HIV among drug injectors has occurred in many different cities, with a lack of AIDS awareness and mechanisms for efficient mixing of the at‐risk population appearing to be important contributing factors. Drug injectors have modified their behavior in response to a wide variety of AIDS prevention programs. No single type of prevention program should be viewed as a panacea, and a comprehensive system of programs will undoubtedly be needed. Changing sexual risk behavior has proven to be considerably more difficult than changing drug injection risk behavior, and is an area in need of much more researc

ISSN:0952-0481    

DOI:10.1111/j.1360-0443.1992.tb01935.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

AbstractThe National Institute on Drug Abuse (NIDA), the lead Federal agency charged with research on reducing the demand for illicit drugs in the US, has actively pursued the associated challenge of reducing drugs‐related HIV transmission. Drug abuse‐related spread of the virus occurs not only through sharing contaminated needles but also sexually to partners and perinatally from infected mothers to their offspring. Through a national research and demonstration program, NIDA supports primary AIDS risk reduction activities focused on identifying effective drug abuse prevention and treatment strategies. AIDS is increasingly a disease found in women, children, minorities, and people who live in rural areas. NIDA's efforts are clearly responsive to the changing nature of this epidemic. Among the many promising initiatives currently underway are a medications development program to find new pharmacotherapies for treating drug addiction; an array of National AIDS Outreach Demonstration Projects implementing alternative control strategies for drug abusers not attracted to or successful in drug abuse treatment; establishment of several treatment research units for designing and conducting studies on treatment effectiveness; and a variety of programs aimed at identifying and potentially reducing the risks of prenatal drug use to both mother and child. Effective dissemination of our findings is particularly critical to the overall impact of our research efforts. Collaborative activities teaming NIDA with a multitude of organizations also addressing AIDS related issues are designed to provide a synergistic impact on this complex and multifaceted public health cri

ISSN:0952-0481    

DOI:10.1111/j.1360-0443.1992.tb01936.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

AbstractThis paper analyses the relationship of history to two current and inter‐related policy issues, AIDS and drugs. AIDS, in particular in its early years, was a disease surrounded by history; and historians and others actively brought the ‘lesson of history’ into the public debates. Cholera and the Black Death provided historical examples of reactions to past epidemic disease; and the record of voluntarism in Britain in the area of sexually transmitted diseases was used to justify a non‐punitive response to AIDS. As the perception of AIDS has changed from epidemic to chronic disease, as reactions to the disease have become ‘normalized’, so the type of historical input has also altered. The lesson of history' approach has appeared less relevant, or has changed focus to encompass chronic—TB, multiple sclerosis—rather than epidemic disease. The concept of AIDS itself as an historic event, of the ‘contemporary history’ of AIDS has also come to the fore. The paper contrasts the relationship of AIDS and history with the ahistorical reaction to the particular impact of AIDS on drug policy. The policy reaction to illicit drugs has been historically conscious, in particular in the 1960's. But little of this historical perspective filtered into the reaction to AIDS on drug policy. Drugs, unlike AIDS, was not an open policy arena. The paper argues that overall drug policy objectives were already clear and it suited no policy interest to call on the historical record. The achievement of established policy objectives was better achieved by an emphasis on the newness of development, a response to potentially epidemic and un

ISSN:0952-0481    

DOI:10.1111/j.1360-0443.1992.tb01937.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

AbstractThe utility of mathematical models in understanding the dynamics of HIV transmission among injecting drug users (IDUs) and their non‐IDU sex partners is discussed. We emphasize the need for collaborative relationships between modellers and drug‐use researchers, and we stress that models should be based on data in both their formulation and development stages. We outline some of the possible data requirements of transmission models and we highlight the need for the collection of appropriate quantitative data, so that modellers can estimate specific parameters for their models. We believe that discussion of the needs and utility of mathematical modelling will lead to mutually beneficial collaborations between theoreticians and drug‐use researchers. These collaborations may aid in the Design and the evaluation of effective behavioural or medical intervention strat

ISSN:0952-0481    

DOI:10.1111/j.1360-0443.1992.tb01938.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

AbstractEpidemiological data on HIV seroprevalence has been essential in assessing the (future) extent of the AIDS epidemic. By coupling these data with quantifiable variables related to injection drug use (frequency of injecting, number of needle sharing partners) specific ‘risk behaviors’ could be determined, accounting for the rapid spread of the virus in the injecting drug user (IDU) population. Yet, such data give little information on the social mechanisms and setting generating such risk behaviors. In order to understand the transmission of HIV among the IDU population one needs to study the micro settings and social context of drug use. This paper describes and explores certain patterns of drug use, sharing, and natural support systems found amongst IDUs in two very different cities, Rotterdam (The Netherlands) and the Bronx, New York City (USA). By specifying details of the micro‐settings of everyday drug use in both locales, it is possible to identify certain common elements and consequences of personal and social behavior driven by drug use per se (e.g. drug preference), and to differentiate these from behaviors and consequences determined by drug policy and the social context in which drug use actually occurs. These policies and the social context they create can in turn be shown to relate to risks for HIV transmission, e.g. the increased likelihood of sharing injection equipment. A more careful ethnographic approach, taking advantage of natural experimental opportunities, comparisons and controls, may be utilized to examine drug‐related behaviors in their social context and to better assess their relevance to public health–especial

ISSN:0952-0481    

DOI:10.1111/j.1360-0443.1992.tb01939.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

AbstractMany 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 inadequacy of current efforts to prevent these behaviors suggests that additional forms of intervention should be attempted. We suggest 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 that are 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 drug

ISSN:0952-0481    

DOI:10.1111/j.1360-0443.1992.tb01940.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

AbstractThere is considerable evidence that drug injectors are reducing their HIV risk, but changes in syringe sharing behaviour have been greater than those in sexual risk behaviour. This paper reviews the literature on sexual risk behaviour in injecting drug users. It focuses on the major areas of concern: HIV prevalence among drug injectors; sexual risk behaviour; the potential for heterosexual transmission; condom use; sexual risk and women; pregnancy; male homosexual activity and drug use; the effect of drugs on sexual behaviour and prostitution. The paper also considers some of the difficulties in changing sexual risk behaviour and suggests some ways forward for intervention and prevention.

ISSN:0952-0481    

DOI:10.1111/j.1360-0443.1992.tb01941.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

AbstractThis paper reviews issues related to the measurement of drug use and other behaviors in studies of human immunodeficiency virus (HIV) infection in intravenous drug users. These issues include: (1) choice of variables, (2) study design, (3) time frame of measurement, (4) categories of measurement, (5) interviewer effects, and (6) validity of measurement. Difficulties and approaches for measuring drug use and other intimate behaviors in intravenous drug users are discussed. Attempts to come to terms with these measurement issues in the context of HIV infection in intravenous drug users should lead to the Junker development of methods for use in the general context of drug abuse research.

ISSN:0952-0481    

DOI:10.1111/j.1360-0443.1992.tb01942.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY

摘要:

AbstractRecognition of changes in the nature and extent of problem drug taking in the early 1980s led to changes in service provision and to an increased interest in help‐seeking. The advent of AIDS accelerated these changes. This paper introduces concepts from the wider field of help‐seeking and compliance with preventive health measures. It reviews the major conclusions of studies of help‐seeking by problem drug takers, and identifies areas for further research. These include the need to ‘unpack’ the concept of ‘drug problems’ and to differentiate dimensions of needs in different individuals and populations; to evaluate attempts to make services attractive and accessible and to contact out‐of‐treatment groups; to assess the role of ‘significant others’; to understand the demands that changing service roles place on agency staff; and to give greater prominence to studies of the process of help‐seeking in terms of drug users' perceptions of their drug use, of problems, of risks and of services within the wider cont

ISSN:0952-0481    

DOI:10.1111/j.1360-0443.1992.tb01943.x

出版商:Blackwell Publishing Ltd    

年代:1992

数据来源: WILEY