RESUMO
OBJECTIVES: To examine factors associated with HIV infection in injecting drug users (IDU), the independent and interactive effects of potential risk factors, and geographic differences in risk factors. METHODS: IDU entering methadone treatment in New York City, Asbury Park and Trenton in New Jersey, Baltimore and Chicago between February 1987 and December 1991 were interviewed using a standard questionnaire and tested for HIV antibodies (n = 4584). Associations of HIV serostatus with race/ethnicity, other demographic characteristics, and injecting and sexual risk behaviors were assessed by logistic regression analyses. RESULTS: African Americans were at increased risk for HIV in four of the five cities, and Puerto Ricans in two cities. Injection in shooting galleries and 'speedball' injection emerged as behavioral variables highly associated with HIV, although interaction of these variables indicates that each variable contributes to HIV risk only in the absence of the other behavior. CONCLUSIONS: Geographic differences in HIV risk factors and the interaction of 'speedball' and shooting gallery use suggest that multiple HIV risk models are needed that reflect seroprevalence rates, variation in risk behaviors, and the social context of risk behaviors. Increased risk among racial/ethnic minorities independent of risk behaviors, suggests the need to examine further potential social and environmental factors, such as the social networks in which injecting and sexual behaviors occur, HIV seroprevalence within these networks, and the locales in which risk behaviors occur.
Assuntos
Infecções por HIV/epidemiologia , Abuso de Substâncias por Via Intravenosa/epidemiologia , Adulto , Negro ou Afro-Americano/estatística & dados numéricos , Baltimore/epidemiologia , Chicago/epidemiologia , Cocaína , Comorbidade , Comportamento Perigoso , Feminino , Infecções por HIV/etnologia , Infecções por HIV/transmissão , Soropositividade para HIV/epidemiologia , Hispânico ou Latino/estatística & dados numéricos , Humanos , Masculino , Americanos Mexicanos/estatística & dados numéricos , Análise Multivariada , Uso Comum de Agulhas e Seringas/estatística & dados numéricos , New Jersey/epidemiologia , Cidade de Nova Iorque/epidemiologia , Razão de Chances , Porto Rico/etnologia , Fatores de Risco , Comportamento Sexual/estatística & dados numéricos , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Estados Unidos/epidemiologia , População UrbanaAssuntos
Síndrome da Imunodeficiência Adquirida/epidemiologia , Comportamento Sexual , Síndrome da Imunodeficiência Adquirida/etnologia , Síndrome da Imunodeficiência Adquirida/transmissão , África , População Negra , Métodos Epidemiológicos , Feminino , Haiti , Humanos , Masculino , Vigilância da População , Parceiros Sexuais , Estados UnidosRESUMO
Homosexual and heterosexual patients with the acquired immunodeficiency syndrome were compared by risk group. Race; diagnoses; history of sexually transmitted diseases, sexual behavior, and drug use; and socioeconomic indicators differed considerably among risk groups, suggesting different risk factors for acquisition of the syndrome. Patients in the homosexual, intravenous drug user, and Haitian risk groups differed in their serologic response to cytomegalovirus and syphilis testing, presumably due to lifestyle-related exposures. Differences in the rate of recovery of cytomegalovirus, serum levels of IgA and IgG, and antibody titers to Epstein-Barr virus were noted among patients with different diagnoses. We conclude that in studies of risk factors for the acquired immunodeficiency syndrome, patients should be analyzed by risk group and diagnoses.
Assuntos
Síndrome da Imunodeficiência Adquirida/etiologia , Homossexualidade , Síndrome da Imunodeficiência Adquirida/imunologia , Adolescente , Adulto , Métodos Epidemiológicos , Feminino , Haiti/etnologia , Hepatite A/complicações , Hepatite B/complicações , Infecções por Herpesviridae/complicações , Humanos , Imunoglobulina A/análise , Imunoglobulina G/análise , Injeções Intravenosas , Entrevistas como Assunto , Masculino , Risco , Transtornos Relacionados ao Uso de Substâncias/complicações , Sífilis/complicaçõesRESUMO
Twenty-one (100%) Haitians and 42 (21.5%) of 192 native black Americans autopsied in a 33-month period at Jackson Memorial Hospital, Miami, were included in this review. All autopsied materials were examined. Among the Haitians autopsied, infectious diseases accounted for 11 (52%) of 21 deaths. Toxoplasma encephalitis was the leading cause of death (five cases). Other infectious causes of death included disseminated cryptococcosis (one), disseminated cytomegalovirus diseases (one), Pneumocystis carinii pneumonia (one), chronic active hepatitis B (two), and bacterial pneumonia (one). Malignant neoplasms were also found to be causes of death and these included a single cases of each of the following: adenocarcinoma of the lung, multiple myeloma, diffuse histiocytic lymphoma, hepatoma, and Kaposi's sarcoma. Deaths of the remaining cases were due to hypertensive cardiovascular diseases (two), rheumatic heart disease (one), glomerulonephritis (one), and intimal fibroplasia of coronary arteries (one). Seven Haitian cases fulfilled the Centers for Disease Control case definition for the acquired immune deficiency syndrome (AIDS). For comparison, autopsies of black Americans were chosen from conditions that would most likely predispose them to opportunistic infections. Among the autopsies on black Americans there were no cases of opportunistic infections or Kaposi's sarcoma that were considered to be consistent with the AIDS.