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Subjects for this study were 1,478 community-recruited women sexual partners of male injection drug users who were participants in the National Institute on Drug Abuse (NIDA)-supported Women Helping to Empower and Enhance Lives (WHEEL) project. This study assessed the association between child/adolescent sexual abuse--including specific type of abuse and perpetrator of abuse--and lifetime crack use in this sample of women. About 64% of sample women had ever used crack; 56% had been sexually abused by age 18. In logistic regression analyses, any sexual abuse in childhood, penetrative sexual abuse in childhood, and sexual abuse by a family member in childhood were significantly associated with lifetime crack use. Sexual abuse in adolescence was indirectly associated with lifetime crack use through running away from home and rape in adulthood. Given that many of these subjects reported drug treatment experience, such programs may provide the best setting for helping women with both substance use and sexual abuse issues.

This study: 1) examined the rate and correlates of human immunodeficiency virus (HIV) seropositivity; and 2) assessed whether self-selection in HIV testing influenced the rate and correlates of HIV seropositivity in a group of out-of-treatment drug users. Data were collected from 856 out-of-treatment drug users in Philadelphia between January 1993 and August 1994. Seventy-four percent of the sample elected to take an HIV test that was included in the project in which the drug users were enrolled, and of these, 11% were HIV positive. Multivariate analyses indicated that those who were younger, those who had an injection-drug-using sex partner, and those who reported no recent sexual activity were more likely to be HIV positive. An examination of the multivariate correlates of HIV testing indicated that subjects who took an HIV test had higher rates of participation in some risk behaviors than did subjects who did not take an HIV test, but lower rates for other risk behaviors. None of the correlates of HIV seropositivity were correlates of HIV testing. Although the generalizability of the HIV seroprevalence rate is unclear, it is probable that the correlates of HIV seropositivity are generalizable to the total sample. The results of this study indicate the importance of interventions that target sexual risk behavior among out-of-treatment drug users, and of assessing the impact of self-selection bias whenever the rate and correlates of HIV seropositivity are examined.

The objective of this study was (1) to assess the validity of self-report measures of opiate and cocaine use for a sample of out-of-treatment drug users by comparing self-reports to urinalysis results, and (2) to examine the correlates of valid self-reports. Baseline data were collected from 1,015 out-of-treatment drug users in Philadelphia as part of an HIV risk reduction intervention project funded by the National Institute on Drug Abuse. Agreement rates, sensitivity, and specificity measurements were high, and kappa values were good indicating that out-of-treatment drug users provided moderately valid self-reported drug use. The multivariate analysis revealed that women and younger persons were more likely to validly report opiate use and those who were younger and more educated were more likely to give valid reports of cocaine use. Additional research is needed to better understand differences in the validity of self-reports of opiate and cocaine use and the role that urinalysis plays in influencing the validity of self-reported data.

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