If you have issues viewing or accessing this file contact us at NCJRS.gov. National Institute on Drug - Abuse MONOGRAPH SERIES AIDS and Intravenous Drug Use: Ire Directions ~ ~ lmunity-Based -...... 'ention earch , U. S. D., .... '._.' _.. _ .. ___ ....._ .. _._ ... SERVICES • Puhllc Health Service • Alcohol, Drug Abuse, and Mental Health Administration 121134 U.S. Department of Justice National Institute of Justice This document has been reproduced exactly as received from the person or organization originating it. Points of view or opinions stated in this document are those of the authors and do not necessarily represent the official position or pOlicies of the National Institute of Justice. Permission to reproduce this a ",*",material has been granted by - Public ~omain/National Institute on ~rug Abuse to the National Criminal Justice Reference Service (NCJRS). Further reproduction outside of the NCJRS system requires permis­ sion of the ~ owner. I z. / IJ ("1 v ~-"I AIDS, and Intravenous Drug Use: Future Directions for Community­ Based Prevention Research L Editors: C.G. Leukefeld, D.S.W. R.J. Balljes, D.S.W. Z. Amsel, Sc.D. Division of Clinical Research National Institute on Drug Abuse NIDA Research Monograph 93 1990 f~CJRS 8 1990 ~ UAN "\ "; ACQUISITIONS ,.. U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Public Healih Service Alcohol, Drug Abuse, and Mental Health Administration National Institute on Drug Abuse 5600 Fishers Lane Rockville, MD 20857 For sale by the Superintendent of Documente, U.S. Government Printing Office W Bshington, DC 20402 NIDA Research Monographs are prepared by the research divisions of the National Institute on Drug Abuse and published by its Office of Science. The primary objective of the series is to provide critical reviews of research problem areas and techniques. ·the content of state-of-the-art conferences. and integrative research reviews. Its dual publication emphasis is rapid. and targeted dissemination to the scientific and professional community. Editorial Advisors MARTIN W. ADLER. Ph.D. MARY L. JACOBSON Temple University School of Medicine National Federation of Parents for Philadelphia, Pennsylvania Drug·Free Youth Omaha, Nebraska SYDNEY ARCHER. Ph.D, Rensselaer Polytechnic Institute Troy, New York REESE T. JONES. M.D. Langley Porter Neuropsychiatric Institute RICHARD E. BELLEVILLE. Ph.D. San FrancIsco, California N B Associates, Health Sciences Rockville, Maryland KARST J. BESTEMAN DENISE KANDEL. Ph.D. College of Physicians and Surgeons of Alcohol and Drug Problems Association Columbia University of North America New York, New York Washington, D.C. GILBERT J. BOTVIN. Ph.D. Cornell University Medical College HERBERT KLEBER. M.D. New York, New York 'rale University School of MediCine New Hayen, Connecticut JOSEPH V. BRADY. Ph.D. The Johns Hopkins University' School of Medicine . RICHARD RUSSO Baltimore, Maryland New Jersey State Department of Health Trenton, New Jersey THEODORE J. CICERO. Ph.D. Washington University School of Medicine St. Louis, Missouri NIDA Research Monograph Series CHARLES R. SCHUSTER. PhD. Director, NIDA THEODORE M. PINKERT. MD., J.D. Acting Associate Director for Sci€!nce, N,I D~ Parklawn Building, 5600 Fishers Lane, Rockville, Maryland 20857 AIDS and Intravenous Drug Use: Future Directions for Community­ Based Prevention Research ACKNOWLEDGMENT This monograph is based upon papers and discussion from a technical review on AIDS and intravenous drug abuse that took place on February 25 and 26, 1988, in Rockville, MD. The review meeting was sponsored by the Division of Clinical Research, National Institute on Drug Abuse. COPYRIGHT STATUS The National Institute on Drug Abuse has obtained permission from the copyright holders to reproduce certain previously published material as noted in the text. Further reproduction of this copyrighted material is permitted only as part of a reprinting of the entire publication or chapter. For any other use, the copyright holder's permission is required. All other material in this volume except quoted passages from copyrighted sources is in the public domain and may be used or reproduced without permission from the Institute or the authors. Citation of the source is appreciated. Opinions expressed in this volume are those of the authors and do not necessarily reflect the opinions or official policy of the National Institute on Drug Abuse or any other part of the U.S. Department of Health and Human Services. The U.S. Government does not endorse or favor any specific commercial product or company. Trade, proprietary, or company names appearing in this publication are used only because they are considered essential in the context of the studies reported herein. DHHS publication number (ADM) 90-1627 Printed 1990 NIDA Research Monographs are indexed in the Index Medicus. They are selectively included in the coverage of American Statistics Index, BioSciences Information Service, Chemical Abstracts, Current Contents, Psychological Abstracts, and Psychopharmacology Abstracts. iv Contents Introducing the Concept "Community Prevention" . • . vii ZiliAmsel Communication and Health Education Research: Potential Sources for Education for Prevention of Drug Use . • • • . • . 1 Nathan Maccoby The Puerto Rican Intravenous Drug User. • . 24 Yolanda Serrano AIDS Prevention for Non-Puerto Rican Hispanics . • . 35 Barbara V. Marin Black Intravenous Drug Users: Prospects For Intervening in the Transmission of Human Immunodeficiency Virus Infection • . • . • . 53 Lawrence S. Brown, Jr. CommlJnity-Based AIDS Prevention Interventions: Special Issues of Women Intravenous Drug Users. 68 Josette Mondanaro Preventing AIDS: Prospects for Change in White Male Intravenous Drug Users . 83 James L. Sorensen Sexual Minority Needle Users. • . 108 A. Billy S. Jones v Risk Behavior of Intravenous Cocaine Users: Implications for Intervention. • . 120 Dale D. Chitwood, Clyde B. McCoy, and Mary Comerford An Ethnographic Approach to Understanding HIV High-Risk Behaviors: Prostitution and Drug Abuse. 134 Michele G. Shedlin The Role of Schools in Community-Based Approaches to Prevention of AIDS and Intravenous Drug Use. • . 150 Lewayne D. Gilchrist The Role of Drug Abuse Treatment Programs in AIDS Prevention and Education Programs for Intravenous Drug Users: The New Jersey Experience • •. ..... 167 Joyce F. Jackson, Leslie G. Rotkiewicz, and Robert C. Baxter Lost Opportunity to Combat AIDS: Drug Abusers in the Criminal Justice System . • . .. .... 187 Eric D. Wish, Joyce O'Neil, and Virginia Baldau The Homeless Intravenous Drug Abuser and the AIDS Epidemic. " ....... 210 Herman Joseph and Hilda Roman-Nay HIV-Related Disorders, Needle Users, and the Social Services. • . 254 Lawrence C. Shulman, Joanne E. Mantell, Charles Eaton, and Stephan Sorrell Accessing Intravenous Drug Users via the Health Care System. • . 277 Patricia E. Evans Community Prevention Efforts to Reduce the Spread of AIDS Associated With Intravenous Drug Abuse ..... 288 Robert J. Battjes, Carl G. Leukefeld, and Ziti Amsel List of NIDA Research Monographs. 300 vi Introducing the Concept l IICommunity Prevention • Zili Amse/, SC.D. The impact of the acquired immunodeficiency syndrome (AIDS) on intravenous (IV) drug abusers is only beginning to be assessed. According to the surveillance system of the Centers for Disease Control (CDC), over 25 percent of all reported adult and adolescent cases of AIDS in the United States are attributed to IV drug abuse, and the percentage is growing (Centers for Disease Control 1988). However, the effect of AIDS on IV drug abusers has been even greater than indicated by AIDS case data. Many IV drug abusers have died of AIDS-related conditions. AIDS among heterosexual IV drug abusers has been reported in all 50 States, the District of Columbia, and Puerto Rico, and is heavily concentrated along the East Coast. For women with AIDS, IV drug abuse is the primary risk factor, accounting for 52 percent of adult and adolescent female cases. Finally, 11 percent of gay AIDS cases also have IV drug abuse as a risk factor. Ethnic groups, overrepresented among IV drug abusers, are also overrepresented among heterosexual IV drug abusers with AIDS. Whereas blacks account for 12 percent of the U.S. population, blacks make up 51 percent of heterosexual IV drug abusers with AIDS. Similarly, while 6 percent of the general population are Hispanic, over 30 percent of the heterosexual IV drug abusers with AIDS are Hispanic. According to reports from the National Institute on Drug Abuse (NIDA), there are an estimated 1.1 to 1.3 million IV drug abusers in the United States (Centers for Disease Control 1987). Various studies (Lange et al. 1988; Des Jarlais et al. 1988a) report that between 70 percent and nearly 100 percent of IV drug abusers share the use vii of injection equipment, with resulting high risk for contracting and transmitting AIDS. The effects of AIDS are not limited to IV drug abusers, but extend also to their sexual partners and children. About 70 percent of those born in the United States and reported to the CDC as having AIDS attribute their infection to heterosexual contact with an IV drug abuser. About 75 percent of perinatal transmission (from mother to child during pregnancy or childbirth) has been attributed to children of IV-drug-using women or to women who were the sexual partners of IV drug abusers (Chamberland et al. 1987; Oxtoby, personal communication, 1987). Preventing the AIDS epidemic associated with IV drug abuse requires a broad program that includes multiple