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Query: UMLS:C0019693 (HIV)
 170,526 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Studies that involve subjects who are HIV infected as well as chemically dependent present special challenges to the study team. HIV infection is now so common in many parts of the country and infection can potentially influence so many commonly used endpoints for perinatal chemical dependence studies that HIV must be considered in these studies. Some of the factors that need to be taken into account in the design of studies include the staging of HIV illness, the consequences of HIV-induced CNS disease, the effects of HIV treatment, and the biases in subject selection that arise due to inaccurate information about risk factors and imbalance in sources of subjects and controls. In addition, the study team needs to remember the community and staff fear and bias that are often encountered in the care of HIV-infected patients. Fruitful sources of subjects for perinatal studies include prenatal clinics and delivery rooms, chemical dependence programs, and the network of community social agencies. Retention of this challenging group is strongly aided by the establishment of a seamless system of services that includes all aspects of general medical care, HIV specialty care, access to treatment protocols, and psychosocial care.
NIDA Res Monogr 1992
PMID:Perinatal substance abuse and AIDS: subject selection, recruitment, and retention. 162 Jan 94

The correctional setting provides an opportunity to serve IV drug users who might otherwise be difficult to access. Interventions--including education, counseling, treatment for HIV-1 infection, and treatment for drug abuse--conducted in the correctional setting could have benefits for individual inmates and the surrounding community.
NIDA Res Monogr 1992
PMID:HIV-1 infection in the correctional setting. 162 Feb 26

The prevention of AIDS has justified recent increases in drug abuse treatment expenditures. Three of the epidemiologic considerations involved in assessing the cost-effectiveness of drug treatment for primary prevention of AIDS among IV drug users were discussed. First, the considerable geographic variation in the prevalence of the virus that causes AIDS suggests that areas with relatively low infection levels may be more cost-effective targets when allocating limited drug abuse treatment resources. Expansions and modifications in the current national HIV-1 serologic surveillance system will be needed to make informed resource allocation decisions. Second, when comparing the cost-effectiveness of two alternative treatment modalities or programs, the number of new HIV-1 infections does not appear to be an appropriate outcome measure. Serologic testing should be supplemented with self-reported drug use behaviors, with or without drug testing. Finally, significant opportunity costs may be associated with employing drug abuse treatment as the principal approach to primary prevention of HIV-1 infection among IVDUs, when alternative and complementary approaches are also effective. Specifically, treatment expansion is unlikely to be cost-effective when the demand for publicly funded treatment slots exceeds the number available and in communities where only a small minority of IVDUs are enrolled in treatment.
NIDA Res Monogr 1991
PMID:Cost-effectiveness of drug abuse treatment for primary prevention of acquired immunodeficiency syndrome: epidemiologic considerations. 176 35

This chapter identified three methods by which crack cocaine is distributed at the retail level: the street-corner or walk-up sales system, the runners and beepermen system, and the crack house. The chapter devoted primary attention to the crack house, because it appears as the most popular method for distribution. In examining the crack house, it is noted that there are identifiable styles of crack-house operations. If the quality and quantity of social interaction, as well as the situation in which sellers posture themselves, are taken as indices, then a typology can be created characterizing crack-house operations. One end of the scale is an austere method in which social interaction between buyer and seller is severely restricted; on the other, crack houses operate as tavern-style exchange locations, which include socialization above and beyond that required for the exchange of money for crack. The nature of these exchanges are themselves important, since they involve social behaviors that are of concern. One concern is the degree and nature of violence as it is associated with drug abuse. The data in this chapter describe some ways in which violence appears within the crack subculture. This violence comes from multiple sources, but some prominent ones appear to be the businesslike operations of crack distribution, the personal disorganization that surrounds and characterizes the crack-consuming environment, and the distortions of character that crack users describe as often accompanying significant binges of crack consumption. Distributors use violence to control situations. Violence is most prominently used for security at the point of retail sale, to periodically resolve conflicts with rivals, and to discipline employees when necessary. Insofar as it is described by this group of informants, crack as a social phenomenon is tied to violent and abusive behavior. This chapter reports on behaviors that, although not traditionally violent, are of concern and bear upon public health and safety. Tavern-style crack houses may encourage and make possible hypersexuality among participants and thus increase STD and HIV risks. The use of barter as a supplement to a cash economy in the crack trade represents further complications in creating social policies in reaction to this behavior. A range of other illegal and problematic behaviors was also described, illustrating the complexity of interactions that constitute the life of street-level crack users. The social policies that may be called for in response to these social events are not simple and are most certainly not defined by these particular data.(ABSTRACT TRUNCATED AT 400 WORDS)
NIDA Res Monogr 1990
PMID:The operational styles of crack houses in Detroit. 209 93

Blastocystis hominis (B. hominis) is a protozoan that may inhabit the human gastrointestinal tract. In our study we reviewed the signs and symptoms of patients at Wilford Hall with stool specimens positive for B. hominis. These patients fell into four groups, HIV-positive adults, foreign nationals, children, and adults not known to be HIV positive. B. hominis caused an acute self-limited diarrheal illness, or chronic gastroenteritis with nausea, abdominal pain, and mild diarrhea. Metronidazole effectively relieved the symptoms and cleared the organism in some but not all patients.
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PMID:Blastocystis hominis infection: signs and symptoms in patients at Wilford Hall Medical Center. 212 Jun 22

This paper has surveyed the laws restricting the use of hypodermic needles and syringes for injection of illegal drugs. It has reviewed the constitutional basis for these laws and concluded that they are on sound footing. There is a new Federal law regulating needles and syringes in interstate commerce, but it is too early to tell how expansively it will be implemented. A large majority of States have drug paraphernalia laws that govern needles and syringes, and a smaller number have laws that require prescriptions for the sale and possession of needles and syringes. Some local jurisdictions also have laws, but these were not specifically reviewed. Altogether, a breadth of relevant laws govern the manufacture, sale, use or possession, advertisement, and interstate commerce of needles and syringes intended for use with illegal drugs. Any attempt by scientists or public health officials to accurately study the effect of these legal restrictions on the HIV infection rates in differing jurisdictions must comprehensively consider the applicable laws. Likewise, attempts at legislative change must also identify each law that would apply. Prosecutorial discretion has been discussed as it relates to the decision not to prosecute offenses involving the illegal use of needles and syringes. While prosecutorial discretion is most likely to be used by prosecutors in individual cases, it provides a legally sound approach for a prosecutor who decides not to enforce the needle and syringe laws across the board as part of an HIV infection control program. Although this approach has not yet been adopted in this country, a prosecutor's decision not to enforce these laws might allow the establishment of an experimental program, such as one for needle exchange, that could serve as a laboratory for legislative initiatives.
NIDA Res Monogr 1988
PMID:Intravenous drug abuse and AIDS transmission: Federal and State laws regulating needle availability. 313 38

In summary, the conference focused on one means of HIV transmission among intravenous drug abusers: exposure through the sharing of drug injection equipment. The participants emphasized the urgency of the AIDS epidemic among intravenous drug abusers. A massive effort is needed now to prevent further spread of the disease. The prevention of AIDS requires a multipronged approach to reach intravenous drug abusers, with various motivations for behavior change: Communities across the United States should quickly implement programs to educate addicts regarding their risk for AIDS and how they may reduce their risk. Aggressive outreach is a key educational tool. Drug abuse treatment is an important means of combating the AIDS epidemic among intravenous drug abusers who wish to quit using drugs and are willing to enter treatment. Resources need to be expanded so that drug abuse treatment is readily available. Since a substantial number of intravenous drug abusers will continue to inject drugs, an effective AIDS prevention strategy must encourage these individuals not to share injection equipment and must provide clear and explicit information on how they can clean their injection equipment to decrease the likelihood of HIV transmission if they continue to share. Public policies that restrict the availability of needles and thereby encourage needle sharing should be reexamined. As part of this reexamination, research should be conducted to determine the effectiveness of needle exchange programs that provide intravenous drug abusers with sterile needles in exchange for used needles.
NIDA Res Monogr 1988
PMID:Needle sharing among intravenous drug abusers: future directions. 313 42

AIDS is a serious public health problem for IVDAs in the United States and Europe. Although AIDS and HIV infection are concentrated in New York and New Jersey in the United States, and in Italy and Spain in Europe, AIDS has been diagnosed and reported among IVDAs in all 50 States of the United States and 16 countries in Europe. It is quite apparent that, once HIV is introduced into a group of IVDAs, it can spread readily between IVDAs, to their sexual partners, and to their children in utero. Unfortunately, one can only expect HIV seroprevalence rates and AIDS cases to continue to increase among IVDAs worldwide for at least the next several years. Concerted efforts to develop, implement, and evaluate potential prevention strategies among IVDAs are urgently needed.
NIDA Res Monogr 1988
PMID:HIV infection among intravenous drug abusers in the United States and Europe. 313 47

In 1987 the UK government launched experimental schemes for distributing injecting equipment to injecting drug users in order to help prevent the spread of Human Immunodeficiency Virus. This paper reports on the first few months of the schemes, and provides some initial evidence of changes in clients' risk behaviours. The schemes have been reasonably successful in attracting clients, but are less successful in retaining them. Schemes have demonstrated that equipment can be distributed to clients on an exchange basis. Schemes have reached new groups of clients, including many without previous or current treatment contact or other help for their drug problems. The baseline assessment of clients found that most had accurate knowledge of the risk of infection from sharing injecting equipment. Most thought that they were at low risk of infection. Syringe sharing in the last four weeks was reported by 36%. A minority engaged in multiple sharing. Most clients were sexually active and many had partners who did not inject drugs. The main reason for attendance was worry about AIDS, and a majority of clients reported that they had already made changes in their injecting practices because of AIDS. Some reported changes in sexual behaviour. A sample of clients followed-up at 2-4 months indicates a reduction in syringe sharing.
NIDA Res Monogr 1988
PMID:Preventing the spread of HIV in injecting drug users--the experience of syringe-exchange schemes in England and Scotland. 315 32

Drug treatment on demand, appropriate and affordable drug treatment for injection drug users who are "ready" to enter a program, is a humane approach to drug treatment services and an important mechanism to halt the spread of HIV. However, drug treatment on demand is not a reality in the United States. In fact, due to funding cuts at federal, state, and local levels, entry into drug treatment programs has become increasingly more difficult over the past decade. In a NIDA-funded ethnographic study of methadone maintenance, i.v. drug use and AIDS, 70 heroin addicts who were out of treatment and actively seeking methadone maintenance were interviewed. In life-history interviews, the drug users described barriers to treatment, waiting-list experiences, and the impact of these experiences on their drug use, drug-using behavior, and emotional well-being. Respondents used many mechanisms to cope with the lack of availability of drug treatment slots, some of which have increased their risk of exposure to and spread of HIV. These findings indicate the need for an increase in the availability of subsidized methadone maintenance treatment slots "on demand" if individuals are to decrease their drug use and their high-risk behaviors. Drug treatment on demand is more than politically correct rhetoric. It is a necessary ingredient in reducing the harm caused by the use of illegal drugs.
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PMID:Drug treatment on demand--not. 802 2


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