Drug Abuse and HIV/AIDS

Research Findings from September, 2000 Director's Report

This section lists selected summaries from NIDA funded research projects that investigate youth drug abuse and HIV/AIDS. The summaries provided were selected from recent issues of the Director's Report to the National Advisory Council on Drug Abuse. For a more comprehensive listing of NIDA funded projects see the Director's Report.

HIV Testing, Drug Use and STD Prevalence Among Juveniles Entering a Rhode Island Correctional Facility

Dr. David Pugatch and colleagues at Brown University surveyed the medical records of 312 incarcerated juveniles (91% boys) to determine the incidence of voluntary HIV testing during their detention stay. Results indicate 69% were tested, 5% reported a history of an STD, 49% used marijuana and 8% used a "hard drug"(e.g., cocaine, heroin and LSD). Results indicate that although adolescents in juvenile detention centers frequently engage in HIV-associated risk-taking behaviors, many youth at high risk for HIV are not being tested. Pugatch, D., Ramratnan, M., Feller, A., Price, D., and Riggs, S. Journal of Correctional Health Care, 6(2), pp. 197-205, 2000.

Substance Use and its Relationship to Depression, Anxiety, and Isolation Among Youth Living with HIV

Reductions from lifetime to recent levels of substance use, the time since HIV diagnosis, physical health symptoms, CD4 counts, emotional distress, and social supports were examined among 227 13 to 24 year old (20% female, 80% male) youth living with HIV (YLH). Substance use pervaded the lives of these youth. Male YLH had used more drugs, more often, and for longer periods than female YLH. However, there had been major reductions in use from lifetime to current reports. Being male, having high emotional distress, and having fewer negative social supports were significantly associated with greater reductions in substance use. There was a trend for the length of time that an individual was seropositive being associated with reductions in substance use. The counterintuitive findings suggest that there must be a re-examination of the role of the social support networks of youth living with HIV, as well as the ways in which emotional distress interact with risk behaviors. Rotheram-Borus, M.J., Murphy, D.A., Swendeman, D., Chao, B., Chabon, B., Zhou, S., Birnbaum, J., and O'Hara, P. Substance Use and its Relationship to Depression, Anxiety, and Isolation Among Youth Living with HIV. International Journal of Behavioral Medicine, 6 (4), pp. 293-311, 1999.

Disclosure of Serostatus Among Youth Living with HIV

Disclosure of serostatus and predictors of disclosure were examined among youth living with HIV (YLH). Disclosure patterns, sociodemographic characteristics, sexual and substance-use risk history, and current health status were examined among 350 youth living with HIV aged 13-23 years (27% African-American, 38% Latino; 72% male). In this group 35 had AIDS, 108 were symptomatic, and 201 were asymptomatic. Most youth disclosed their serostatus to family (87%); unexpectedly, young men (93%) were more likely to disclose to friends than were young women (79%). Being younger at diagnosis was significantly more associated with disclosure to family; young men disclosed more often to friends. Most youth disclosed to all their sexual partners (69%); higher rates of disclosure to sexual partners were associated with having fewer partners and being African-American. Condom use was significantly associated with disclosure for young women, and tended to be related to disclosure for young men. Although many YLH disclosed their serostatus to their partners, condom use was not increased. Interventions are needed to increase condom use among YLH, as well as to encourage disclosure to partners by the 30% of YLH who do not disclose. Lee, M., Rotheram-Borus, M.J., and O'Hara, P. Disclosure of Serostatus Among Youth Living with HIV. AIDS and Behavior, 3 (1), pp. 33-40, 1999.

Ethnography May Inform Correlation Between NEP Use and HIV Seroconversion in Montreal

In this article, researchers describe a rapid ethnographic assessment of needle exchange patrons and street youth substance abusers in Montreal in March of 1997 and October of 1998. The ethnographic assessment was designed to collect preliminary participant observation information that could help to explain the disturbing statistical correlation between needle exchange patronage and HIV infection, which was found to occur among IDUs who used the NEP in Montreal from 1989 to 1995. Scenes visited in Montreal were those where cocaine users hustled cocaine and injected the drug. Authors found a disproportionate representation of cocaine injectors among Montreal NEP users, and observed cocaine bingers who injected cocaine repeatedly and rapidly, without regard to whether the syringe was previously used. They also learned that cocaine injectors primarily asked for wider-gauged syringes compared to the thinner needles requested by heroin users. Injectors explained that the plungers on wider syringes slide more easily so they can flush the cocaine into the bloodstream faster, and supposedly get a more intense initial rush. However, wider-gauged syringes retain a greater volume of blood/biomass after use, which increases the risk of infection to those who reuse them. In addition, since cocaine addicts in Montreal often share bags of cocaine on the run, dissolving the cocaine inside the baggie right on the street, they believe they can draw up more solution faster than their companions with the fast-drawing, wide-gauged syringes. The researchers emphasize the importance of complementing quantitative data with qualitative methods to explain significant statistical associations such as the one reported for Montreal's NEPs, and they argue that NEPs by themselves cannot be expected to stem HIV infection in cities where intravenous cocaine use - characterized by compulsive behavior, craving, and multiple HIV risks - is the drug of choice. Bourgois, P. and Bruneau, J. Needle Exchange, HIV Infection, and the Politics of Science: Confronting Canada's Cocaine Injection Epidemic with Participant Observation. Medical Anthropology, 18, pp. 325-350, 2000.