Behavior Change and Health-Related Interventions for Heterosexual Risk Reduction Among Drug Users

Abstract

Prevention of heterosexual transmission of HIV between and from drug users is important for controlling the local and global HIV heterosexual epidemic. Sex risk reduction interventions and health-related interventions are important for reducing the sex risk behaviors of drug users. Sex risk reduction interventions address individual-level, peer-level, and structural-level determinants of risk reduction. Health-related interventions include HIV counseling and testing, prevention and treatment of sexually transmitted diseases, and delivery of highly active antiretroviral therapy. It is important to adapt effective interventions implemented in resource-rich countries to the realities of the resourceconstrained settings and to address relevant contextual factors.RESUMEN-Il est important de prévenir la transmission hétérosexuelle du VIH à partir des usagers de drogue pour contrôler l'épidémie hétérosexuelle locale et mondiale de VIH. Des interventions ciblant à la fois la réduction de risque sexuel et la santé des usagers de drogue sont nécessaires. Les interventions de réduction de risque sexuel prennent en compte le niveau individuel, le niveau des pairs et celui des déterminants structurels de la réduction des risques. Les interventions visant l'amélioration de la santé comprennent le conseil et le dépistage du VIH, la prévention et le traitement des infections sexuellement transmissibles et la prescription d'antirétroviraux. Il est important d'adapter les interventions efficaces mises en place dans les pays riches aux réalités des contextes de pays à ressources limitées et de tenir compte des facteurs contextuels pertinents. Keywords global research; HIV; injection drug use; research interventions; sexual risk HIV Infection and Injection Drug UsersInjection drug use continues to complicate the control of the global HIV epidemic (UNAIDS, 2004). In 2003, 136 countries reported injecting drug use and 93 countries reported HIV infection among injection drug users (IDUs) (World Health Organization, 2003). IDUs are at risk for infection with HIV through both multiperson use ("sharing") of drug injection equipment and through unsafe sex behaviors (Aceijas et al., 2004). Although the scope and effectiveness of interventions aimed at reducing HIV infection through drug injection equipment has been well documented in the literature (Des Jarlais et al., 2005;Quan et This review describes sex risk reduction interventions with drug users and their effectiveness in reducing sexual risk behaviors of IDUs and other drug users. We highlight the needs and opportunities for these interventions, discuss the generalizability of the results to resourceconstrained settings, and outline the implications for global research efforts and public health practice. Although our literature review is not comprehensive, it highlights many areas that affect sexual transmission of HIV to and from drug users in both resource-rich and resourceconstrained settings. Efforts to reduce substance abuse and HIV risk associated with injection behav...

Heterosexual HIV and Sexual Partnerships Between Injection Drug Users and Noninjection Drug Users

“…Despite decreases in injection-related HIV risk, many IDU still engage in sexual risk behaviors. 21,22 This is one reason that 8% of New York City heterosexual HIV diagnoses in 2001-2007 were attributed to IDU sex partnerships, according to local surveillance data. 23 Yet there has been little recent attention in the literature describing the dynamics of IDU=non-IDU sex partnerships and their overall contribution to the heterosexual HIV epidemic.…”

The Impact of a Brief Motivational Intervention on Unprotected Sex and Sex While High Among Drug-Positive Emergency Department Patients Who Receive STI/HIV VC/T and Drug Treatment Referral as Standard of Care

“…In this context it is not altogether surprising that the B-MI provided no additional incremental benefit. A protocol for VC/T and referral to substance abuse treatment, if delivered appropriately, is expected to produce major effects [4,6,[29][30][31]. Control group improvements have also been reported in a large number of randomized controlled trials of brief alcohol interventions [32].…”

An assessment of brief group interventions to increase condom use by heterosexual crack smokers living with HIV infection

“…Many non-injecting drug users are at increased risk of HIV transmission by sex because of crack smoking (Friedman et al, 2003;Miller, Kio, Wanger, & Korves, 2008). While knowledge of HIV infection may be sufficient impetus for some heterosexual crack smokers living with HIV infection to decrease some risk behaviors (Desenclos, Papaevangelou, & Ancelle-Park, 1993;Semaan, Des Jarlais, & Malow, 2006), many continue to engage in risky sexual behaviors after learning of their diagnosis (Avants, Warburton, Hawkins, & Margolin, 2000;Deren, Beardsley, Tortu, & Goldstein, 1998;Timpson, Williams, Bowen, & Keel, 2003). However, brief interventions intended to reduce risk of HIV infection among drug users have met with mixed results.…”