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.

Examining the correlates of aftercare participation is critical to program development and successful relapse prevention. This study assesses retention in an aftercare program of case management and peer support for formerly homeless recovering mothers. Length of residential drug treatment, length of sobriety, strong support networks, and concerns about housing and parenting predicted completion of the case management component. Emotional instability and the severity of problems were found to be correlated with participation in the peer support group. Sociodemographic characteristics were not related to program retention. The findings illustrate the need to tailor aftercare services to the level of clients' recovery and the need for female-only aftercare groups where women can safely discuss physical and sexual abuse issues related to their misuse of drugs.

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.

Attrition impacts the effectiveness of preventive interventions as well as the external validity of efficacy analyses. This paper examines attrition from the intervention and from the research data collection in an HIV prevention program for out-of-treatment drug users. Of the 1,115 respondents, 87% completed the two-session HIV prevention intervention and of these 69% completed the 6-month data collection. Factors related to completing the intervention were different from those related to completing the 6-month interview. Completing the intervention was associated with HIV risk behaviors and with having a negative result on the project's HIV test, whereas research completion was related to indicators of a stable lifestyle. Individuals at highest risk were less likely to complete the data collection and so were under-represented in the assessment of intervention efficacy. These results have implications for program planners and evaluators.

This study compared the baseline sociodemographic characteristics and HIV risk behaviors of two groups of out-of-treatment injection drug users (IDUs): 366 who concurrently smoked crack (smoking IDUs) and 212 who did not smoke crack (IDUs) in the past 30 days. Temporal trends in recent risk behaviors were also assessed for each drug user group over an 18-month period, January 1992 through June 1994. Baseline data were collected in South Philadelphia before the implementation of a multisite HIV intervention research project funded by the National Institute on Drug Abuse. For the temporal trend analysis, the sample was grouped into four intake periods based on the date of the baseline interview. The results indicated that although both groups were economically disadvantaged and at high risk of HIV infection and transmission, smoking injectors had fewer economic resources and were at a moderately greater risk because of higher levels of sexual risk behaviors. Analysis of temporal trends revealed few reductions in drug risk behaviors and none in sexual risk behaviors. This study points to the need for examining differences between types of drug users, developing appropriate multidrug treatment programs and assessing the characteristics of communities so that theory-based interventions can be tailored for maximum effectiveness.