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Try out PMC Labs and tell us what you think. Learn More. To identify ethnic differences in HIV risk behaviors among cocaine using women receiving methadone maintenance for opioid dependence, and to evaluate the efficacy of contingency management CM for cocaine use disorders in reducing HIV risk behaviors.
They completed the HIV Risk Behavior Scale HRBS indicating frequency of drug use and sexual behaviors across the lifetime, in the month before baseline, and in the 3 months following clinical trial participation.
Ethnic group differences and the effect of CM on change in HIV risk behaviors between baseline and follow-up were evaluated. White women reported ificantly higher lifetime rates of risky drug use and sexual behaviors on the HRBS than African American women; neither group differed ificantly from Hispanic women. No ethnic group differences in HIV risk behaviors were identified in the month prior to baseline. At follow-up, African American women reported fewer high-risk drug use behaviors than White or Hispanic women, and Hispanic women reported more high-risk sexual behaviors than White or African American women.
CM was associated with reduction in high-risk drug use behaviors regardless of ethnicity, but did not affect high-risk sexual behaviors. White women receiving methadone maintenance engage in more lifetime HIV risk behaviors than African American women. CM for cocaine use reduces risky drug use behaviors, but certain ethnic groups may benefit from additional targeted HIV prevention efforts.
Engagement in behaviors that increase HIV risk, such as anal sex, injecting drugs, sex with an injection drug user, or not using condoms, varies by ethnicity Johnson et al. Studies of ethnic differences in HIV risk behaviors among female methadone maintenance clients yield mixed.
Among women receiving methadone maintenance treatment in the early s, African American women reported less frequent condom use during sex and were less likely to report changing their sexual practices to reduce HIV risk than White or Hispanic women Schilling et al. Other studies from the same period examining women considered to be at high-risk for HIV infection found that White women were ificantly more likely than African American or Hispanic women to use intravenous drugs, to have primary sex partners with a history of injection drug use, and to use dirty needles when injecting drugs Harrison et al.
African American women were more likely than White or Hispanic women to be diagnosed with syphilis and to have primary sex partners who were HIV positive Quadagno et al. Among a group of African American, Hispanic, and White women entering methadone maintenance treatment, a substantial proportion of whom were sex workers, White women were the least likely and Hispanic women the most likely to report more than two sex partners in the last 12 months, whereas African American women had intermediate rates Grella et al.
Hispanic women in the same study were most likely to report sharing injection equipment Grella et al. The studies cited above suggest that White women receiving methadone maintenance may increase their relative risk of HIV infection through injection drug use behaviors, including injecting drugs and using dirty needles.
African American women have elevated risk through high-risk sexual behaviors, such as having sex without condoms and having sex with HIV positive partners. Findings are less consistent for Hispanic women, whose rates of high-risk drug use and sexual behaviors relative to African American and White women vary across studies. These studies were conducted in three different regions of the United States New York, Florida, and California, respectivelywhich could contribute to some of the differing associations of risk with ethnicity. Further, all of these studies are over a decade old.
We know of no studies examining ethnic differences in HIV risk among female drug users conducted since the introduction of highly active antiretroviral treatment in Methadone maintenance treatment can be effective in reducing or eliminating use of illegal opioids and in turn reducing the frequency of HIV risk behaviors, particularly those related to injection drug use Kwiatkowski and Booth, ; Sorensen and Copeland, ; Thiede et al. Research on methadone maintained clients has shown that higher methadone doses are associated with decreased HIV transmission rates, most likely because adequate methadone dosing le to decreased opioid use with an accompanying reduction in high-risk behaviors Hartel and Schoenbaum, Even methadone maintenance clients who continue to inject drugs show reductions in risky behaviors such as sharing syringes and other injection equipment Millson et al.
Cocaine use is a common problem among patients receiving methadone treatment for opioid use disorders Condelli et al. Cocaine use is associated with increased likelihood of engaging in high-risk drug use Buchanan et al.
Many methadone maintenance clients Sex Challacombe women and black men continue to use cocaine and engage in behaviors that increase risk of exposure to the HIV virus Condelli et al. Contingency management CM treatments have been effectively applied to reducing cocaine use among cocaine dependent methadone maintenance clients Peirce et al.
CM interventions provide tangible reinforcement for target behaviors, most often for submitting negative urine toxicology specimens. Studies conducted in methadone clinics indicate that clients ased to receive standard treatment plus CM have longer durations of continuous cocaine abstinence and submit a higher proportion of cocaine-free urine samples than clients receiving standard treatment alone Peirce et al. There are currently no published studies specifically examining associations between ethnicity and CM treatment outcomes. A recent study examining predictors of CM outcomes included ethnicity as a covariate and showed no ificant effect of ethnicity on treatment retention and drug use outcomes Stitzer et al.
Lifetime and past-month behaviors were examined at the start of clinical trials evaluating CM treatment interventions for cocaine use. Based on prior research with drug dependent women, we predicted that White women would report more injection drug use related risk behaviors than African American or Hispanic women, that African American women would report the most high-risk sexual behaviors, and that Hispanic women would lie somewhere between White and African American women for both types of high-risk behaviors at baseline.
We also examined prospective effects of CM treatments on HIV risk behaviors of women of different ethnicities. Because cocaine use among methadone maintenance clients is associated with more high-risk drug use and sexual behaviors, we expect CM, which has proven to be effective in reducing cocaine use, to reduce behaviors that increase risk for contracting HIV.
A recent study finds that CM treatments are associated with reductions in HIV risk behaviors, especially drug use risks, in a sample of men and women Hanson et al. We predicted that women receiving CM would show greater reductions in HIV risk behaviors than women who did not receive CM, and we examined whether this effect varied by ethnicity.
For instance, research suggests that White drug treatment clients have more psychiatric disorders than their African American counterparts Kendall et al. African American women receiving methadone maintenance are more likely to use crack cocaine both at the start of treatment and 18—24 months later Grella et al. Such characteristics that vary by ethnicity could affect the efficacy of CM treatments for reducing cocaine use and in turn reducing HIV risk behaviors. Participants were drawn from a sample of women enrolled in one of three CM clinical trials conducted at a methadone maintenance clinic in Hartford, CT between and Petry and Martin, ; Petry et al.
Clinical trial participants were recruited via counselor referrals or when they responded to flyers advertising the research. Counselors were asked to refer any clients who used cocaine. Only female clinical trial participants were included in the present study. Exclusion criteria were cognitive impairment identified by the Mini Mental State Examination Folstein et al.
The latter exclusion criterion was included because the prize intervention, like gambling, involves an element of chance, although no association between prize CM and increased gambling has been observed in studies Petry et al. The majority of participants belonged to one of three ethnic groups: African American, Hispanic, or White. Figure 1 shows the ethnic group breakdown for each specific clinical trial included in this study.
Demographics and responses to the lifetime and past-month intake versions of the HRBS did not differ ificantly between women who completed the HRBS at both intake and 6-month follow-up and those who completed it only at intake, with all p values greater than 0. Flow chart of participants in each clinical trial and asment to treatment condition by ethnicity. After providing informed consent, participants met with a research assistant to complete a 2-hour baseline interview consisting of several questionnaires.
Research staff also obtained information about demographic characteristics and substance use patterns. Participants submitted breath samples that were screened for alcohol using an Alco-sensor IV Alcometer Intoximeters, St. The HRBS is divided into two sections. Six questions ask about drug use behaviors, and five ask about sexual behaviors associated with increased risk for HIV.
It is administered as a structured interview, and takes about 10 minutes to complete. Each item is scored on a 0—5 scale; higher scores are associated with more risky behaviors. An overall summary score 0—55 can be computed by summing responses to all questions. In addition, separate subscores for Drug Use 0—30 and Sexual Behavior 0—25 can be obtained by summing the scores for these sections separately. Research by HRBS developers suggests that drug use and sexual risk-taking behaviors can occur independently Darke et al.
Internal consistency reliability was. Test-retest reliability was. Test-retest reliability of. Sexual partners of substance abusers asked Sex Challacombe women and black men respond on their behalf show high agreement with the substance users themselves to questions about drug use and sexual behaviors Darke et al.
In the current study, the HRBS was administered at intake and at the 6-month follow-up interview 3 months after end of clinical trial. At intake, two versions of the HRBS were administered. Participants were first asked to respond to the questions referring to lifetime activities. They were then asked to limit their responses to behaviors in the past month. At the 6-month follow-up, participants were asked to respond while considering behavior over the prior three months time since end of clinical trial. The HRBS was also administered 3 months after intake end of clinical trialbut time frames for the 3-month administration varied across the CM clinical trials.
Three-month were therefore not included in the current analysis. Participants were randomly ased to treatment conditions using a computerized urn randomization program Stout et al. Additional stratification variables, including age Petry and Martin, ; Petry et al. Treatment conditions included standard methadone treatment, or standard methadone treatment combined with a CM intervention. The active treatment phase lasted 3 months, and participants continued on standard methadone treatment after the clinical trial ended.
In addition, participants submitted urine samples on 2 to 3 days per week for 3 months. Research staff tested samples for cocaine and opioids using the on-site procedure described above. Participants in the CM conditions received the standard treatment and submitted urine samples as described above. In the voucher CM condition, participants earned vouchers with monetary value that could be accumulated and exchanged for items of equivalent value. In the prize CM conditions, participants earned draws from a bowl, with some proportion of Sex Challacombe women and black men resulting in prizes, again depending on the specific clinical trial and condition.
In one clinical trial Petry and Martin,participants earned draws for each cocaine-negative and opioid-negative sample submitted, with bonus draws when all samples in a single week were negative.Sex Challacombe women and black men
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