RESUMEN
The purpose of the analysis described here was to classify not-in-treatment drug users participating in the National Institute on Drug Abuse (NIDA)-sponsored Cooperative Agreement study into several "homogeneous" HIV risk groups using cluster analysis. Data for this analysis (N=17,778) were collected at 19 study sites in the United States and Puerto Rico. Measures selected for the cluster analysis were limited to (a) current drug use and HIV risk behaviors, (b) mutually exclusive behaviors, (c) behaviors directly related to HIV risk, and (d) behaviors that were not statistically rare. Eight homogeneous HIV risk clusters were produced. Crack cocaine use was the most distinguishing feature of three clusters. Another three clusters were distinguishable by drug injection and needle use practices. Two additional clusters could not be grouped with either the crack- or the injection-dominant clusters. Prostitution was the most distinguishing risk behavior of one of these clusters, and extremely high drug injection frequencies and relative rates of risky needle use characterized the other. Composition of the clusters varied significantly by gender, race/ethnicity, educational attainment, and drug use characteristics. In addition, perceptions and behaviors initiated to reduce the chances of becoming infected with HIV varied by cluster. Subjects in the crack-predominant clusters reported low perceptions of the chances of getting AIDS. Perceptions of the chances of becoming infected with HIV among subjects in the injection-predominant clusters were strongly related to injection frequency. Seroprevalence was also related to cluster. Higher rates of HIV infection were evident among the injection-predominant clusters, and higher rates were related to frequency of injection and the rate of risky needle use. Among the crack-predominant clusters, the relationship between drug use and sexual behaviors and HIV infection was less clear.
Asunto(s)
Infecciones por VIH/epidemiología , Trastornos Relacionados con Sustancias/epidemiología , Síndrome de Inmunodeficiencia Adquirida/epidemiología , Síndrome de Inmunodeficiencia Adquirida/etiología , Síndrome de Inmunodeficiencia Adquirida/prevención & control , Actitud Frente a la Salud , Brasil/epidemiología , Análisis por Conglomerados , Trastornos Relacionados con Cocaína/epidemiología , Trastornos Relacionados con Cocaína/prevención & control , Cocaína Crack , Femenino , Infecciones por VIH/etiología , Infecciones por VIH/prevención & control , Humanos , Cooperación Internacional , Masculino , Puerto Rico/epidemiología , Asunción de Riesgos , Trabajo Sexual/estadística & datos numéricos , Abuso de Sustancias por Vía Intravenosa/epidemiología , Trastornos Relacionados con Sustancias/complicaciones , Trastornos Relacionados con Sustancias/prevención & controlRESUMEN
This study examines the relationship between the patterns of use of alcohol and heroin by narcotics addicts, and evaluates the hypothesis--frequently reported during methadone maintenance--that this form of treatment can be causally implicated in an increased consumption of alcohol. Data were obtained on lifetime patterns of alcohol and heroin use of 375 Anglo and Chicano male addicts sampled from two treatment sources: the nonmethadone (drug-free) California Civil Addict Program (CAP) and several Southern California Methadone Maintenance (MM) programs. Repeated-measures MANOVAs revealed that alcohol and heroin consumption were inversely related throughout the addicts' careers. This pattern was evident in the addiction, treatment, and postdischarge stages of Anglo and Chicano addict careers, in both the CAP and MM samples. Consequently, the authors reject the hypothesis that increased alcohol consumption is caused solely by addicts' participation in methadone maintenance treatment. Rather, the findings suggest that addicts' alcohol use during methadone treatment reflects a lifetime pattern of increased alcohol use following any decline in heroin intake.