Shiela M Strauss

Abstract

Drug treatment programs are sites of opportunity for the delivery of hepatitis C (HCV) prevention and care services to drug users. Using data collected from a random nationwide sample (N = 595) of drug treatment programs in the United States, this study compares the provision of HCV services by drug-free and methadone maintenance treatment programs (MMTPs). It then examines and compares perceived inadequacies in this service provision from the perspective of the managers in these two types of programs. Findings indicate that MMTPs are providing more HCV services to their patients, and that a greater proportion of MMTPs are dissatisfied with their current level of HCV service provision. Managers of drug-free programs would like to be offering patients more HCV education, while MMTP managers would like to be providing more HCV testing to their patients, and more support and care for patients who are HCV+.

Abstract

Objective. Residential drug treatment units are uniquely situated to provide HIV testing and counseling to their patients. This article examines the extent to which residential drug treatment units in the United States provide HIV testing on-site, and identifies organizational and institutional characteristics that differentiate units in which on-site HIV testing is available from those in which it is not. Methods. The analyses use data collected in telephone interviews with unit managers from a random nationwide sample (N=138) of residential drug treatment units in 2001. Results. About half (48.6%) of the residential drug treatment units made HIV testing available to their patients on-site. Residential units were significantly more likely to make on-site testing available if they were larger (i.e., had a greater number of patients treated each month or had a greater number of staff that provided direct patient services) and if they were publicly rather than privately owned. Provision of on-site HIV testing was significantly correlated with having a medical orientation, i.e., with being operated by a hospital, with the unit viewing itself as patients' primary medical provider, or with providing medical care to the patients either on-site or at another part of the same treatment agency. Conclusion. In view of the critical importance of HIV testing for individuals who use illicit drugs and the existence of a simplified testing protocol involving saliva samples (eliminating the need for phlebotomy), units that do not have a medical orientation should be encouraged to make HIV testing available on-site.

Abstract

Hepatitis C virus (HCV) has reached epidemic proportions among drug users, and drug programs are in a unique position to provide each of their patients with HCV education. Using a nationwide sample (N= 434) of drug treatment programs, we report the results of a logistic regression analysis that differentiates programs providing HCV education to all of their patients versus programs that do not. Fifty-four percent of the programs provide HCV education to all of their patients. Programs are about four and a half times as likely to provide HCV education to all patients if they dispense methadone; almost four times as likely to provide this service if they educate most of their staff about HCV; twice as likely if they are residential; and almost twice as likely if they conduct HIV testing on-site. Our findings indicate that there is a need to increase HCV educational services in drug treatment programs.

Abstract

The social networks of substance-using women consist of people who provide constructive social support, individuals who enable their drug use, and those who do both. Women's success in recovery may be attenuated because some of the people who are most likely to provide them with social support after drug treatment previously enabled their drug use. This article examines the social support systems of women offenders (N=100) who were mandated to four therapeutic communities in New York City. The women had an average of nine supporters (four males and five females). Although most of the women had partners who provided them with constructive social support, many of their partners also enabled their drug use. Some of the women indicated that their partners did not provide constructive support but were among their main enablers, while half of the women said that their partners actually encouraged them to stop using drugs. The majority of the women also received support from their parents, siblings, other kin, and friends. Some of these supporters also enabled their drug use while others encouraged them to stop using drugs and enter drug treatment.

Abstract

Many HIV positive drug users are unaware that they have the virus, either because they never obtained testing for HIV or because they submitted a biological specimen for testing but never returned to obtain the result of the test. Using data collected from a large multi-site sample of out-of-treatment HIV positive drug users (N=1, 544), we identify a variety of socio-demographic characteristics and drug use and sexual risk behaviors that differentiate HIV-positive individuals who had obtained HIV testing in the past and those who had not and, among those who had been tested, what differentiates individuals who had returned to obtain their HIV test results and those who had failed to return. Results of the analyses suggest that there is a need to target different subgroups of high risk drug users for interventions to obtain HIV testing as compared with those that need encouragement to obtain the results of this testing.

Abstract

Drug treatment programs are a site of opportunity for the delivery of primary and secondary hepatitis C (HCV) prevention services to drug users, a population at great risk for contracting and transmitting the virus. Using data collected from a random nationwide sample (N = 439) of drug treatment programs in the United States, this study examines the extent to which various types of HCV services are provided to their patients. Findings indicate that the majority of drug treatment programs educate at least some of their patients about HCV, and provide some type of support for patients who are infected with the virus. Only 29 of the programs in the sample test all of their patients for HCV, however, and 99 programs test none of them. For the most part, residential treatment programs offer more HCV related services than outpatient drug-free programs.

Abstract

This study investigates the relationship between substance use and partner abuse among women (N = 1,025) who entered drug-treatment programs through the criminal justice systems in New York City and Portland, Oregon. Self-report data on substance use and partner abuse indicate that although the rate of partner abuse in both cities is well above the national average, the less substance-involved women in Portland reported more abuse than their New York counterparts. Our analyses suggest that the relationship between partner abuse and substance use during conflicts varies within the population of women offenders who are heavily drug-involved, with women in Portland reporting a greater direct link between partner abuse and substance use. The findings indicate that there is a need for drug-treatment providers to understand their clients' victimization histories and the relationship between partner abuse and substance use in order to engage clients in the treatment process and help them learn how to avoid being victimized in the future.

Abstract

This study examines the concurrence of drug users' self-reports of current HIV status with serotest results. The analyses are based on data obtained from face-to-face interviews with 7,256 out-of-treatment injection drug and/or crack users in 10 sites that participated in the Cooperative Agreement for AIDS Community-Based Outreach/Intervention Research Program (funded by the U.S. National Institute on Drug Abuse). Although the degree of concurrence between HIV-negative individuals' self-reports of their current HIV status and their serotest results was high (specificity, 99%), this was not the situation for individuals who tested positive for HIV (sensitivity, 44%).