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OCR for page 81
Prevention: The Continuing Challenge
The epidemiological data presented in the first chapter enable researchers
and program planners to identify shifts in the epidemic and in the sub-
populations being affected. Although such data are vital for targeting
programs to populations at nsk, they say little about how to stop the
spread of infection. Given that there is no convincing evidence that
AIDS or HIV infection is abating and that there are no cures or vaccines
on the immediate horizon, the need for effective behavioral intervention
will persist into the second decade of the epidemic. Many intervention
efforts of the first decade were designed and implemented quickly in
response to a new health problem that in some areas took on the char-
acteristics of a crisis. As the United States enters the second decade of
efforts to contain the spread of disease, the committee believes that the
time has come to view behavioral intervention from a more long-term
perspective. This view of AIDS calls for a commitment to the careful and
systematic accrual of information capable of identifying those strategies
that will facilitate change In risk-associated behaviors, maintain safer
behaviors, and thus alter the course of the epidemic.
In its first report, the committee recommended that the Public Health
Service (PHS) support basic research on human sexual behavior and give
high priority to research on the social contexts of IV drug use to provide
the data needed to design efficacious intervention strategies to prevent
the spread of HIV infection. The committee further recommended that
knowledge about the efficacy of intervention programs be built system-
atically through the use of planned variations of key program elements
with subsequent rigorous evaluation. The committee reiterates these rec-
ommendations and notes that the need for well-designed, carefully
81
OCR for page 82
82 ~ AIDS: THE SECOND DECADE
implemented, and thoughtfully evaluated intervention efforts and good
behavioral research continues today. Although there are many projects
currently in place whose goal is to educate people about the threat of
AIDS, few of these programs have been sufficiently well designed to pro-
vide the data needed to assess the eject of their efforts especially their
effects on changing the behaviors associated with transmission. More-
over, as the first decade of the epidemic draws to a close, it is apparent
that, although data have accrued from a range of behavioral research
activities, those data are of varying quality. Consequently, it is often dif-
ficult to draw firm conclusions from such studies or to reach consensus
about the next set of issues to be studied.
The first three sections of this chapter consider intervent~on-related
issues pertaining to gay men (among whom the greatest share of the
burden of disease continues to reside), IV drug users, and women. At
the beginning of the epidemic, interventions to prevent the spread of
HIV infection focused primarily on gay men, the population that showed
the first evidence of disease. However, as evidence accumulated on
the risks associated with other behaviors, intervention efforts began to
expand, encompassing, for example, IV drug users and heterosexuals with
multiple sexual partners. Today, the focus of AIDS prevention requires
expansion once again to accommodate the changing epidemiological
patterns noted in the previous chapter and the changing character of the
disease.
IMPACT OF INTERVENTIONS AMONG GAY MEN
Studies of gay men since the first years of the epidemic have indicated
considerable behavioral change among some members of this popula-
tion, especially men living in large urban areas (e.g., San Francisco, Los
Angeles, New York City) (Becker and Joseph, 1988; Stall, Coates, and
Hoff, 1988; Catania et al., 19894. This change is largely reflected in
the decreased frequency of unprotected anal intercourse and fewer sexual
partners. More recent data from the epicenters or focal points of the epi-
demic have shown Hat gay men are continuing to alter risky behaviors.
1 For example, at recruitment into the AIDS Behavioral Research Project in 1983 and 1984, 45.3 per-
cent of subjects reported practicing unprotected insertive anal intercourse, and 32.8 percent reported
unprotected receptive anal intercourse. However, only 12 percent of the 435 nonmonogamous men
who continue to participate in this longitudinal study reported unprotected anal intercourse at their last
assessment in 1988 (McKusick et al., in press). Similarly, among participants in the San Francisco
Men's Health Study, prevalence rates for insertive and receptive anal intercourse dropped from 37.4
and 33.9 percent in 1985 to 1.7 and 4.2 percent, respectively, in 1988. In 1988 only 8.5 percent of par-
ticipants in this study reported one or more episodes of relapse (i.e., reman to risk-associated behavior
after safer behavior had been initiated) during the previous year (Ekstrand and Coates, in press).
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PREVENTION ~ 83
Similar change has also been reported among gay men from other com-
munities, such as Denver (Judson, Cohn, and Douglas, 1989; O' Reilly
et al., 1989), Long Beach (California) and Dallas (O' Reilly et al., 1989~.
Reports of behavioral change have coincided with stable HIV incidence
rates and stable rates of other sexually transmitted diseases, which sug-
gests that the intervention programs targeting these men have had some
success (Linden et al., 1989~. Despite the encouragement provided by
these data, however, other studies indicate that safer sex practices have
not been universally instituted among gay men, and there appears to be
substantial variation in the degree of behavioral change across geographic
areas and across age and ethnic groups in the gay community (Office of
Technology Assessment, 1988; Coates et al., l98Sa, 1989b; Kelly et al.,
l989c). In particular, reports of unprotected anal intercourse among men
living in low-prevalence cities raise serious concerns about the future
spread of the epidemic in these communities.2
The existing data on behavior change and HIV seroprevalence, al-
though imperfect, are sufficient to provide a sense that a major risk
for new HIV infection still exists among samples of self-identified gay
men, despite the profound behavioral risk reductions that have occurred
since the onset of the AIDS epidemic and despite widespread understand-
ing of health education guidelines for the prevention of HIV infection
(Stall, Coates, and Hoff, 1988~. Especially in the epicenters of the AIDS
epidemic, the high prevalence of infection estimated to exist among ho-
mosexually active men, combined with the increased infectivity believed
to be associated with later stages of ir~fection,3 confers a substantial risk
2For example, about 21 percent of a sample of 270 gay men in Boston who were interviewed in 1987
(McCusker et al., 1988) reported engaging in unprotected anal intercourse in the previous month. In a
study of 127 gay men in Atlanta, a high-incidence city, only 13 percent of the men reported unprotected
anal intercourse in the previous two months; however, 35.4 percent of 163 men in low-prevalence
cities (Birmingham, Alabama, and Tupelo, Mississippi) reported such activity, as did approximately
one-quarter of 355 men interviewed in Hattiesburg and Biloxi, Mississippi, and Monroe, Louisiana
(St. Lawrence et al., 1989; Kelly et al., 1990a). Among a cohort of 249 male sexual partners of HIV-
seropositive men in Toronto, 43 percent reported practicing unprotected insertive anal intercourse,
and 42 percent reported engaging in unprotected receptive anal intercourse in the previous month
(Calzavara et al., 1989). In a study that involved four south Florida counties, half (51 percent) of the
gay and bisexual men who participated (N = 586) had previously sought HIV testing and counseling
(suggesting that they considered themselves to be possibly at risk for infection), but only 25 percent
reported that they always used condoms during anal intercourse (Lieb et al., 1989). For reviews of
changes in sexual behavior among gay men, see Becker and Joseph (1988); Coates, Stall, and Hoff
(1988); Coates and coworkers (1988b); Office of Technology Assessment (1988); and Stall, Coates,
and Hoff (1988).
3In studies of men with hemophilia and their female sexual partners, Goedert and coworkers found
that the probability of HIV infection increased significantly for female partners of men with HIV p24
antigenemia or extreme immune deficiency (Dr. James Goedert, National Cancer Institute, personal
communication, April 23, 1990).
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84 ~ AIDS: THE SECOND DECADE
of disease transmission by any single homosexual contact. Thus, notwith-
standing the number of AIDS prevention programs that have already been
established for gay men, continuing intervention remains a high priority.
Research to understand the distribution and determinants of behav-
ioral change among gay men is currently in progress,4 but certain aspects
of the studies limit their usefulness. Despite the tremendous diversity
among homosexual men, most research to date has involved older, white,
self-identified gay men in urban areas. Relatively little is known about
other subgroups of gay men who may in fact be at highest risk (e.g.,
younger men, black and Hispanic men, men who have sex with other
men but do not self-identify as gay). In addition, piecing together the
findings from different projects presents certain difficulties. First, data are
collected and reported in different ways by different investigators, making
it difficult to compare rates of change and prevalences of high-risk behav-
iors across studies. Second, the results are often reported in a piecemeal
fashion, using a variety of publication channels (e.g., scientific journals,
scientific conferences, government reports, technical reports, personal
communications). It is an arduous and extremely time-consum~ng task
to assemble and collate the entire set of studies to identify any patterns
among the results. Third, behaviors are reported for varying time periods,
ranging from 1 and 2 months to 6 and 12 months. Finally, the frag-
mentation of funding sources provides little opportunity or incentive to
communicate with other investigators whose efforts are being supported
by other funders.
Establishing standards for reporting on at least selected subsets of
data would facilitate comparisons across studies. But quantifying change
does not provide insight into why men alter their behavior. Developing
a more coherent sense of what has been learned from studies of gay
men supported by the PHS requires considerably more effort. Therefore,
the committee recommends that the Public Health Service assemble
and summarize data reported by gay men in PHS-funded studies
regarding seroprevalence, seroconversion, and high-risk behavior
and determine what conclusions can be drawn from the research.
4Studies of behavioral change among gay and bisexual men in San Francisco, Chicago, and New York
are currently being supported by the National Institute of Mental Health. CDC sponsors demonstration
and education projects among gay and bisexual men in six communities: Dallas, Denver, Albany and
New York City, Seanle-King County, Chicago, and Long Beach, California. The National Institute of
Allergy and Infectious Diseases supports research on the epidemiology and natural history of AIDS in
cohorts of homosexual men as well as studies on behavioral and other risk factors associated with the
acquisition of HIV infection. The Multicenter AIDS Cohort Study (MACS) has administered inter-
views and physical examinations to cohorts of homosexual men in Baltimore, Chicago, Los Angeles,
and Pittsburgh. The University of California, Berkeley, also conducts studies of gay men.
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PREVENTION | 85
Such a summary would be extremely useful in formulating a research
agenda that could direct intervention efforts that are likely to be effective
toward gay men who continue to require intensive attention.
One group of particular concern is young gay men. Numerous studies
have found that young gay men engage in higher rates of risk taking than
older gay menS (Joseph et al., 1988; VaIdisem et al., 1988; Ekstrand and
Coates, in press; Kelly et al., 1990b). Indeed, according to data collected
in the San Francisco Men's Health Study, young homosexual men were
significantly more likely than older men to engage in unprotected anal
intercourse and to do so with more partners (Ekstrand and Coates, in
press).6 These results indicate the dynamic nature of the gay population
and highlight the need for continuing intervention and the identification of
particular subgroups whose risk behaviors may warrant increased efforts.
Community-Level and Individual Intervention Efforts
It is clear that behavioral change has been occurring among some groups
of gay males in this country. Yet there is also evidence that some sub-
populations of men who have sex with other men have not initiated or
maintained nsk-reducing behavior. These findings argue for continuing
intervention to prevent further spread of infection among men who en-
gage in same-gender sex. However, which risk reduction strategies are
most likely to be effective remains in doubt. Community-leve} inter-
vention programs have been implemented in several gay communities
to reach a critical mass of individuals with ~nforrnation, motivation, and
skills training and to foster changes in the norms that stipulate appropriate
behavior (Coates and Greenblatt, in press). In its first report, the com-
mittee recognized the importance of this mechanism for reaching many
high-risk groups. However, additional strategies that focus on individual
gay men are also needed.
Community-leve] strategies are based on the assumption that an in-
dividual is much more likely to initiate and maintain healthful behavior
when a variety of avenues are used to inform and motivate, specific
strategies are used to teach skills needed for low-nsk activities, specific
S The ages that constitute the '~young" male population, however, appear to vary across studies and are
rarely defined.
6 Other studies have also reported differential risk taking among younger gay men. In a survey of 526
bar patrons in Seattle, Tampa, and Mobile, young men were more likely than older men to engage in
unprotected anal intercourse (Kelly et al., 1990b). In a 1989 survey of 100 homosexual men between
the ages of 18 and 25 in three West Coast communities (Santa Cruz, Santa Barbara, and Eugene,
Oregon), 43 reported engaging in unprotected anal intercourse in the previous two months (Hays,
Kegeles, and Coates, in press).
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86 i AIDS: THE SECOND DECADE
health-diminishing behaviors become less socially accepted in a commu-
nity, and social sanctions regarding unhealthy behaviors are perceived as
persistent and inescapable (Coates and Greenblatt, in press). Programs
conducted to date reflect a diversity in design and venues for delivery:
educational sessions offered in homes and in bars, antibody testing and
counseling in public health clinics and alternative test sites, newspaper
coverage, pamphlets, and safer-sex videos (Catania et al., 19891. Preven-
tion strategies that seek to influence entire communities have been widely
advocated but less frequently implemented and rarely evaluated. One
such program, the Stop AIDS Project, was developed in San Francisco
and capitalized on community mobilization, using influential members
of the local gay population to provide risk reduction information and
skills to other gay men 7 There are indications that the Stop AIDS Project
met some of its objectives,8 but data to determine its specific impact on
behavior are lacking. The Stop AIDS mode] reportedly has been imple-
mented in areas other than San Francisco (Becker and Rose, 1989; Miller
et al., 1989) and in one case has shown encouraging results (Miller et
al., 1989~. Without rigorous evaluation, however, conclusions about the
effectiveness of this strategy cannot be drawn.
Activities for gay men in a variety of communities around the country
are exploring variations of community-level interventions. For example,
researchers at the University of Mississippi are recruiting groups of so-
cially influential gay males in each of three medium-sized cities for a
series of training sessions. The sessions provide detailed educational
materials on HIV transmission and social skills training to teach partic-
ipants how to communicate risk reduction information to others (Kelly
et al., 1989b). A second project at the University of Califomia, San
Francisco, plans to implement and evaluate a peer-led, community-level
intervention in three medium-sized West Coast cities to assist young ho-
mosexual men to reduce AIDS-related high-risk behaviors (S. Kegeles,
University of California, San Francisco, personal communication, lan-
uary 19901. The project's community mobilization strategy will include
7 Initial analyses by the originators of this project (Puckett and Bye, 1987) indicated that gay men felt
helplessly caught between the growing enormity of the AIDS epidemic and the sexual values and ex-
pectations of the gay community. The Stop AIDS program used a variety of strategies to elicit personal
commitments to safer sex, encourage participation in intervention activities, empower individuals to
take appropriate action, hasten the adoption of safer sex as a community norm, build peer support
for safer sex activities, and create peer pressure against activities that would spread the virus. For a
detailed description of this project, see Turner, Miller, and Moses ( 1989:Chapter 4).
8Following its fourth survey (in 1986) of gay men in San Francisco, Communication Technologies
(1987) reported that 51 percent (as compared with 27 percent in 1985) said that they had heard of the
project, and 20 percent said that they had attended a meeting. Stop AIDS records showed that more
than 7,000 men in San Francisco attended at least one meeting.
OCR for page 87
PREVENTION I 87
three central elements: a system of peer outreach in formal and infor-
mal settings to communicate the need for safer sex; peer-led HIV risk
reduction workshops to discuss and overcome barriers to safer sex; and
an ongoing publicity campaign about the intervention program within the
gay community to establish the legitimacy of intervention activities for
this subpopulation and provide a continual reminder of the norms for
safer sex.
New research directions for AIDS prevention strategies that target
individual gay men include the use of clinical interventions. Clinical
interventions are multisession, face-to-face strategies for individuals who
require more intensive attention than can be afforded by community-level
programs to achieve or sustain behavioral change. These interventions
attempt to help gay men evaluate their personal risk for AIDS, gener-
ate group norms supportive of safer behaviors, and provide information,
skills, and feedback on how well recommended behaviors are performed.
Clinical interventions can be delivered in small group or individual ses-
sions and have been employed in a variety of settings, including health
care establishments, worksites, and drug treatment centers.
Several researchers have reported on promising variations of clini-
cal interventions in samples of gay men. Kelly and coworkers (1989b,
1989c) recruited and randomized 104 homosexual men with a history
of frequent high-nsk behavior into experimental or wait-list control
groups. The experimental intervention consisted of 12 weekly group
sessions that provided AIDS risk education, cognitive behavioral self-
management training that focused on refusing coercion (self-management
and assertiveness training), and steady and self-affirming social supports.
Participants in the expenmental group reported fewer episodes of un-
protected anal intercourse and higher rates of condom use than control
subjects at a follow-up assessment.9 An intervention conducted by Coates
and colleagues (1989a) also showed risk reduction following an eight-
week program. The intervention consisted of weekly meetings plus one
retreat emphasizing meditation, relaxation, positive health habits, and
9 after four months, men in the experimental group reported a mean of only 0.2 episodes of unprotected
anal intercourse (compared with 1.2 at baseline) in the previous month. The control group reported a
mean of 1.2 (compared with 0.9 at baseline). In addition, experimental subjects at follow-up reported
using condoms in 70 percent of sexual contacts that involved intercourse, compared with 40 percent
at baseline. Comparable rates for control subjects were 20 percent at follow-up and 32 percent at
baseline.
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88 ~ AIDS: THE SECOND DECADE
coping with the stress of being seropositive.~° In addition, a peer-led in-
tervention effort by VaIdise~n and coworkers (1989a) reported increased
condom use following a skills training components
The results presented above point to a possible role for clinical
interventions in AIDS prevention efforts for gay men. Additional research
is needed, however, to determine whether clinical interventions can be
modified for wider dissemination through different avenues (e.g., the
media) and for other populations (e.g., minorities, IV drug users).
The Impact of Drug Use on Behavior Change
The disturbing finding that gay men who use drugs (including alcohol) are
more likely to report unprotected sexual behaviors than those who do not
use drugs has important implications for the development of intervention
programs. Men who combine drugs with sex are less likely than those
who do not to have changed the frequency of engaging in unsafe anal
intercourse and more likely to engage in sexual behaviors that cany
a high risk of HIV transmission (Stall et al., 1986; Communication
Technologies, 1987; Beeker and Zielinski, 1988; Robertson and Plant,
1988; Valdisem et al., 1988; Stall and Ostrow, 1989; Martin, 1990;
Martin and Hasin, in press).~3 Moreover, the use of noninfected drugs
10The 64 men recruited by Coates and colleagues (1989a) were evenly divided into an experimental
group and a wait-list control group to study the effects of stress management on behavior and immune
function. At posttreatment, the experimental group reported a mean of 0.5 sexual partners in the pre-
vious month (compared with 1.41 at baseline), whereas the control group reported 2.29 partners in the
previous month compared with 1.09 at baseline.
11Valdiserri and coworkers (1989a) randomized participants to one of two peer-led interventions. The
intervention that provided a skills training component to discuss and rehearse the art of negotiating safer
sex resulted in more condom use at 6- and 12-month follow-ups than the intervention that provided
information only.
12KeIly and coworkers (199Ob) surveyed bar patrons in three cities (Seattle, Tampa, and Mobile) and
found that 37 percent had engaged in unprotected anal intercourse at least once in the past three months.
In addition, Stall and colleagues (in press) described the sexual risks for HIV infection reported by a
convenience sample of 1,344 homosexual male and heterosexual male and female bar patrons in San
Francisco. More than one-third (37.3 percent) of the homosexual males in the sample (N = 593) had
engaged in unprotected intercourse in the previous month, but approximately twice as many hetero-
sexuals (61 percent of 314 heterosexual males and 63.8 percent of 437 heterosexual females) reported
intercourse without a condom during the same time period. The rates in this study are much higher
than those found in other samples of convenience (McKusick et al., in press) or in population-based
samples (Ekstrand and Coates, in press).
13A longitudinal study of 604 gay men from New York City (Martin, in press) found that the strength
of the association between drug use and high-risk sex has diminished over the course of the epidemic.
Nevertheless, cessation of drug use was associated with lower rates of both receptive and insertive anal
Intercourse.
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PREVENTION ~ 89
ultimately may confer greater risk for gay men than IV drug use (Stall
and Ostrow, 19891.
Several studies are currently under way in San Francisco to investi-
gate the impact of drug use on risk-associated behaviors among gay men.
The intervention strategies being used are designed to be implemented in
bars and to deal with both drug use and sexual risk taking among adult
gay men. These activities may provide much-needed insight into the
connection between drug use and risk taking, as well as the connection
between drug use and relapse.
INTERVENTIONS FOR INTRAVENOUS DRUG USERS
HIV infection has been present among IV drug users in the United States
for more than a decade now (Des JarIais et al., 1989a), and the number of
studies investigating behavioral change in this population has increased
greatly since the early years of the epidemic. Knowledge regarding the
manifestation and spread of the infection within this population has been
advancing incrementally. A nationwide program to reduce the spread of
the virus among drug users has been in place over the past several years,
arid there is a general consensus among researchers in this area that IV
drug users as a group have reduced their risk of acquiring HIV and AIDS
by adopting safer injection practices. Indeed, recent studies presented in
June 1989 at the Fifth International Conference on AIDS in Montreali4
confirmed many of the conclusions offered by this committee in its first
report:
· many IV drug users (usually a majority of those studied
in any particular research project) have reported changes in
their behavior to reduce their risk of contracting AIDS;
· behavioral change among IV drug users usually reflects risk
reduction rather than complete risk elimination;
· there is no single "best" method for facilitating AIDS risk
reduction among IV drug users, and consequently it is nec-
essary to provide the means both to reduce drug use and to
increase the use of"safer" injection practices; and
· more drug users report changes in drug injection behavior
than changes in sexual behavior.
It does not appear likely that these conclusions will be contradicted
by new research findings in the near future. Yet as the AIDS epidemic
i4See, for example, Connors and Lewis (1989), Corby, Rhodes, and Wolitski (1989), Skidmore and
Robertson ( 1989), Sunita and coworkers ( 1989), Vlahov et al. ( 1989), and Wolfe and colleagues ( 1989).
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90 ~ AIDS: THE SECOND DECADE
enters its second decade within the population of IV drug users, a shift in
perspective is required. There is still great geographic variation in the ex-
tent to which HIV has spread among drug injectors in local communities.
This variation affords both the hope of preventing a more widespread
problem in communities that currently report low seroprevalence rates
and the need for new approaches in communities that already have sig-
nificant infection rates. Some populations in the United States appear to
have moved beyond the immediate crisis phase of the AIDS epidemic to
a longer term endemic phase. Because neither a vaccine nor a cure for
HIV infection appears likely in the near future, planning is needed for the
long term to limit the spread of HIV among drug injectors, their sexual
partners, and their potential offspring. The conclusions noted above point
to the need for a two-pronged approach to intervention: (~) reduce drug
use in general, including preventing the initiation of injection, and (2)
facilitate risk reduction behavior in both injection and sexual practices.
In designing programs to implement such a strategy, the knowledge
gained from past efforts must be combined with new approaches geared
to present needs. Many injectors have received basic information about
AIDS and HIV infection, but there are indications that risk-associated be-
haviors in this population are not affected by information alone, nor can
much change be expected to occur in response to a single intervention
episode (Des JarIais, Friedman, and Stoneburner, 19881. Rather, nsk-
associated behaviors are dynamic and are affected by a variety of factors,
including new information from within the IV drug-using community,
changing social norms regarding risky behaviors, and accessibility of the
means for risk reduction (e.g., sterile injection equipment, drug treatment
programs). Findings of past behavioral research would predict that indi-
viduals who have begun new, lower risk behavior would be less likely
to revert to previous high-nsk patterns if He means for risk reduction
were readily available and were believed to be effective by the targeted
population.~5
Whereas most interventions (with the possible exception of"infor-
mation-only" programs) have been associated with self-reported behav-
ioral change among IV Hug users, methadone maintenance treatment
programs have been associated with reduced levels of HIV infection
(Abdul-Quader et al., 1987; Blix and Gronbladh, 1988; Brown et al.,
1989; Novick et al., 1989; Truman et al., 1989; and Schoenbaum et al.,
i5 Beliefs about effectiveness may serve as important cognitive reinforcement for AIDS risk reduction
messages. In a study of street-recruited IV drug users in New York City (Des Jarlais et al., l989b),
an individual's belief that behavior change would successfully protect against HIV infection was one
of the strongest predictors of maintaining risk-reducing behaviors. The importance of other beliefs in
AIDS risk reduction is not as clear.
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PREVENTION | 91
19891. Individuals who enter and stay in methadone treatment programs
are less likely to be seropositive than those who have not chosen to seek
treatment or those who sought treatment but were unable to find it. This
finding points to the importance of reducing drug use as a way of curbing
the spread of the epidemic.
Eliminating drug use among those who already inject drugs has so
far proved very difficult. A more pragmatic and immediate approach
raises another possibility for halting the spread of HIV: decrease the
number of new drug injectors. Clearly, if HIV is present among IV
drug users in a community, then it becomes critically important to reduce
the number of new persons who might start injecting drugs, for it is
during the initial period of use that individuals are most likely to share
injection equipment (see the discussion on the progression of drug use in
Chapter 31. Some have thought that the threat of AIDS In and of itself
would be sufficient to deter individuals from using drugs, but the limited
number of AIDS-era studies of persons beginning illicit drug injection
suggest that fear of AIDS has not had any large-scale effect on whether
individuals become IV drug users. This finding would be consistent with
the limited effectiveness of fear arousal during drug prevention and safer
injection campaigns of the past (Des lariats and Friedman, 1987; Ghodse,
Tregenza, and Li, 19871.
In fact, the United States and most other nations have given relatively
little attention to new injectors or potential injectors, an oversight that
may be attributable in part to the need to address simultaneously the
multitude of other health and social problems associated with injecting
illicit drugs. Recent data from a survey of 256 IV drug users in New
York City, however, have shown infection to be less frequent among
those who have been injecting for less than five years than among drug
users who have been injecting for longer periods (Friedman et al., 19891.
Targeting new injectors for intervention thus appears to be a reasonable
strategy for preventing further spread of HIV infection.
AIDS prevention efforts related to the initiation of injection have
been stymied in some instances by political barriers. Much attention
has focused on vague fears of creating new injectors through the infor-
mation and services offered in HTV prevention strategies (e.g., syringe
exchanges), and untested hypotheses linking these services to new drug
use have been used to oppose innovative approaches. Yet there is no
evidence that any form of "safer injection" program is associated with an
increase in the number of new drug injectors. Considering the importance
of the research and public health aspects of these issues, the development
of strategies to reduce the number of persons who start injecting illicit
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136 ~ AIDS: THE SECOND DECADE
Kaback, M. M., Nathan, T. J., and Greenwald, S. (1977) Tay-Sachs disease: Heterozy-
gote screening and prenatal diagnosis- U.S. experience and world perspective. In
M. M. Kaback, ea., Tay-Sachs Disease: Screening and Prevention. New York:
Alan Liss.
Kamenga, M., Jihgu, K., Hassig, S., Ndilu, M., Behets. F., et al. (1989) Condom use
and associated seroconversion following intensive HIV counseling of 122 mamed
couples in Zaire with discordant HIV serology. Presented at the Fifth International
Conference on AIDS, Montreal, June =9.
Kamps' B. S., Niese, D., Brackmann, H. H., Euler, P., van Loo, B., and Kamradt,
T. (1989) No more seroconversions among spouses of patients of the Bonn
hemophiliac cohort study. Presented at the Fifth Intemational Conference on
AIDS, Montreal, June =9.
Kanoff, A. B., Kietner, B., and Gordon, B. (1962) The impact of infantile amaurotic
idiocy (ray-Sachs disease) on the family. Pediatrics 9:37~6.
Kaplan, M. H., Farber, B., Hall, W. H., Mallow, C., O'Keefe, C., and Harper, R.
G. (1989) Pregnancy arising in HIV infected women while being repetitively
counseled about `'safe sex." Presented at the Fifth International Conference on
AIDS, Montreal, June =9.
Kaunitz' A. M., Brewer, J. L., Paryani, S. G., de Sausure, L., Sanchez-Ramos, L., and
Harrington, P. (1987) Prenatal care and lIIV screening. Journal of the American
Medical Association 258:2693.
Kegeles, S. M., Coates, T. J;, Lo, B., and Catania, J. A. (1989) Mandatory reporting of
HIV testing would deter men from being tested (letter). Journal of the American
Medical Association 261:1275-1276.
Kelly, J. A.' St. Lawrence, J. S., Smith, S., Hood, H. V., and Cook, D. J. (1987)
Stigmatization of AIDS patients by physicians. American Journal of Public Health
77:789-79 1.
Kelly, J. A., St. Lawrence, J. S., Hood, H. V., and Brasfield, T. L. (1989a) Behavioral
intervention to reduce AIDS risk activities. Journal of Consulting and Clinical
Psychology 57:60 67.
Kelly, J. A., St. Lawrence, J. S., Stevenson, Y. L., Diaz, Y. E., Brasfield, T. L.,
and Hauth, A. C. (1989b) Changing peer norms to promote AIDS precautionary
behavior: Training popular people to impact on the knowledge, attitudes, and
behavior of their acquaintances. Presented at a symposium on Factors Influencing
AIDS-Risk Behavior Reduction: Implications for Primary Prevention at the Annual
Meeting of the Association for the Advancement of Behavior Therapy, Washington,
D.C., November. '
Kelly, J. A., St. Lawrence, J. S., Brasfield, T. L., and Hood, H. V. (1989c) Group
intervention to reduce AIDS risic behaviors in gay men: Applications of behavioral
principles. In V. M. Mays, G. W. Albee, and S. F. Schneider, eds., Primary
Prevention of AIDS: Psychological Approaches. Newbury Park, Calif.: Sage
Publications.
Kelly, J. A., St. Lawrence, J. S., Brasfield, T. L., Stevenson, L. Y., Diaz, Y. Y.,
and Hauth, A. C. (199Oa) AIDS risk behavior patterns among gay men in small
southern cities. American Journal of Public Health 80:416 418.
Kelly, J. A., St. Lawrence, J. S., Brasfield, T. L., Lemke, A., Amidei T., et al. (1990b)
Psychological factors that predict AIDS high-nsk versus AIDS precautionary
behavior. Journal of Consulting and Clinical Psychology 58:117-120.
OCR for page 137
PREVENTION ~ 137
Kenen, R. H., and Schmidt, R. M. (1978) Stigmatization of carrier status: Social
implications of heterozygote genetic screening programs. American Journal of
Public Health 68:111~1120.
Kirp, D. L. (1989) Learning by Heart: AIDS and Schoolchildren in America's Commu-
nities. New Brunswick, N.J.: Rutgers University Press.
Kotler, P., and Roberto, E. L. (1989) Social Marketing: Strategies for Changing Public
Behavior. New York: The Free Press.
Krasinski, K., Borkowsky, W., Bebenroth, D., and Moore, T. (1988) Failure of voluntary
testing for human immunodeficiency virus to identify infected parturient women
in a high-risk population. New England Journal of Medicine 318:185.
Landesman, S. H., Minkoff, H. L., and Willoughby, A. (1989) HIV disease in
reproductive age women: A problem of the present. Journal of the American
Medical Association 261:132~1327.
Lappe, M., Gustafson, J. M., and Roblin, R. (1972) Ethical and social issues in
screening for genetic disease. New England Journal of Medicine 286:1129-1132.
Leonard, C. O., Chase, G. A., and Childs, B. (1972) Genetic counseling: A consumer's
view. New England Journal of Medicine 287:433~39.
Lewis, C., and Freeman, H. (1987) The sexual history-taking in counseling practices of
primary care physicians. Western Journal of Medicine 147:165-167.
Lieb, S., Zimmerman, R. S., Kuechler, M., Langer, L. M., Sims, J., and Witte,
J. J. (1989) Trends in AIDS knowledge, attitudes and behaviors (KAB) in
heterogeneous, high-nsk groups, Florida. Presented at the Fifth International
Conference on AIDS, Montreal, June =9.
Lifson, A., O'Malley, P. M., Hessol, N. A., Doll, L. S., Cannon, L., and Rutherford,
G. W. (1989) Recent HIV seroconverters (SC) in a San Francisco cohort of
homosexual/bisexual men: Risk factors for new infection. Presented at the Fifth
International Conference on AIDS, Montreal, June =9.
Lindan, C., Rutherford, G.W., Payne, S., Hearst, N., and Lemp, G. (1989) Decline in
rate of new AIDS cases among homosexual and bisexual men in San Francisco.
Presented at the Fifth International Conference on AIDS, Montreal, June =9.
Ljungberg, B., Andersson, B., Christensson, B., Hugo-Persson, M., Tunving, K., and
Ursing, B. (1988) Distribution of sterile equipment to IV drug abusers as part of
an HIV prevention program. Presented at the Fourth International Conference on
AIDS, Stockholm, June 12-16.
Lowden, J. A., and Davidson, J. (1977) Tay-Sachs screening and prevention: The
Canadian experience. In M. M. Kaback, ea., Tay-Sachs Disease: Screening and
Prevention. New York: Alan Liss.
Magura, S., Shapiro, J. L., Siddiqi, Q., and Lipton, D. S. (1989) Variables influencing
condom use among intravenous drug users. Presented at the Fifth International
Conference on AIDS, Montreal, June =9.
Marin, B. V. (1990) AIDS prevention for non-Puerto Rican Hispanics. In C. G.
Leukefeld, R. J. Battjes, and Z. Amsel, eds., AIDS and Intravenous Drug Use:
Future Directions for Community-Based Prevention Research. NIDA Research
Monograph 93. Rockville, Md.: National Institute on Drug Abuse.
Marin, B., and Marin, G. (1990) Effects of acculturation on knowledge of AIDS and
HIV among Hispanics. Hispanic Journal of Behavioral Sciences 12:11~121.
Marin, G. (1989) AIDS prevention among Hispanics: Needs, risk behaviors, and
cultural values. Public Health Reports 104:411~1S.
OCR for page 138
138 ~ AIDS: THE SECOND DECADE
Marin, G., and Mann, B. V. (In press) Perceived credibility of channels and sources of
AIDS information among Hispanics. AIDS Education and Prevention.
Marrnor, M., Fnedman-Kien, A. E., Laubenstein, L., Byrum, R. D., William, D. C.,
et al. (1982) Risk factors for Kaposi's sarcoma in homosexual men. Lancet
1: 1083-1087.
Marsh, J. C, and Miller, N. A. (1985) Female clients in substance abuse treatment.
International Journal of the Addictions 20:995-1019.
Martin, J. L (1987) The impact of AIDS on gay male sexual behavior patterns in New
York City. American Journal of Public [Iealth 77:578-581.
Martin, J. L. (1990) Drug use and unprotected anal intercourse among gay men. Health
Psychology 9:45~65.
Martin, J. L. (In press) Drug use and unprotected anal intercourse among gay men.
Health Psychology.
Martin, J. L., and Hasin, D. (In press) Alcohol use and sexual behavior in a cohort of
New York City gay men. IDrugs and Society.
Mastroianni, L., Donaldson, P., and Kane, T., eds. (1990) Developing New Contra-
ceptives: Obstacles and Opportunities. Washington, D.C.: National Academy
Press.
May, R. M., and Anderson, R. M. (1987) Transmission dynamics of HIV infection.
Nature 326:137-142.
Mays, V. M., and Cochran, S. D. (1988) Issues in the perception of AIDS risk and risk
reduction activities by black and Hispanic/Latina women. American Psychologist
43:949-957.
McCrae, W. M., Cult, A. M., Burton, L., and Dodge, J. (1973) Cystic Fibrosis: Parents'
response to the genetic basis of the disease. Lancet 2:141-143.
McCusker, J., Stoddard, A. M., Mayer, K. H., Zapka, J., Momson, C., and Saltzman,
S. P. (1988) Effects of antibody test knowledge on subsequent sexual behaviors
in a cohort of homosexually active men. American Journal of Public Health
78:462~67.
McFarland, L., Dean, H., Trahan, B., and Muirhead, L. (1989) HIV infection in
pregnant women at a public hospital in New Orleans, Louisiana. Presented at the
Fifth International Conference on AIDS, Montreal, June ~9.
McKusick, L., Conant, M., and Coates, T. J. (1985) The AIDS epidemic: A model
for developing intervention strategies for reducing, high-risk behavior in gay men.
Sexually Transmitted Diseases 12:229-234.
McKusick, L., Coates, T. J., Monn, S., Pollack, L., and Hoff, C. (In press) Longitudinal
predictors of unprotected anal intercourse in San Francisco gay men 198~1988:
The AIDS Behavioral Research Project. American Journal of Public Health.
Mechanic, D., and Aiken, L. (1989) Lessons from the past: Responding to the AIDS
crisis. Health Affairs Fall: 17-32.
Michigan Department of Public Health. (1988) Perinatal AIDS in Michigan. A report
of the Maternal and Infant Task Force, June.
Miller, T., Booraem, C., Flowers, J., and Iversen, I. (1989) Short- and long-term results
of an AIDS prevention program. Presented at the Fifth International Conference
on AIDS, Montreal, June =9.
OCR for page 139
PREVENTION | 139
Minkoff, H. L., and Landesman, S. H. (1988) The case for routinely offering prenatal
testing for human immunodeficiency virus. American Journal of Obstetrics and
Gynecology 159:793-796.
Moatti, J. P., Tavares, J., Durbec, J. P., Bajos, N., Menard, C., and Serrand, L. (1989)
Modifications of sexual behavior due to AIDS in French heterosexual "at risk"
population. Presented at the Fifth International Conference on AIDS, Montreal,
June =9.
Mondanaro, J. (1989) Chemically Dependent Women: Assessment and Treatment.
Lexington, Mass.: Lexington Press.
Moody, R., Foss, L. A., Parker, J., Callan, W., and Williamson, D. (1989) Seroprevalence
of antibodies to the human immunodeficiency virus (HIV) in applicants for
marriage licenses in Alabama. Presented at the Fifth International Conference on
AIDS, Montreal, June =9.
Murray, R. F., Chamberlain, N., Fletcher, J., Hopkins, E., Jackson, R., King, P. A.,
and Powledge, T. M. (1980) Special considerations for minority participation in
prenatal diagnosis. Journal of the American Medical Association 243:125~1256.
Neal-Cooper, F., and Scott, R.B. (1988) Genetic counseling in sickle cell anemia:
Experiences with couples at risk. Public Health Reports 103:17~178.
New York City Department of Health. (1989) The Pilot Needle Exchange Study in
New York City: A Bridge to Treatment. Department of Health, New York City.
New York State Department of Health. (1989) AIDS in New York State Through 1988.
Public Affairs Group, New York State Department of Health, Albany, N.Y.
Nichols, E. K. (1989) Mobilizing Against AIDS. Cambridge, Mass.: Harvard University
Press.
NOVA Research Company. (1989) Conference Proceedings: NIDA Conference on
AIDS Intervention Strategies for Female Sexual Partners. Vol. 1. Berkeley, Calif.,
March 19-22.
Novick, D. M., Joseph, H., Croxson, T. S., Salsitz, E. A., Wang, G., et al. (1989)
Absence of antibody to HIV in long-term, socially rehabilitated methadone mainte-
nance patients. Presented at the Fifth International Conference on AIDS, Montreal,
June ~9.
Nzila, N., Laga, M., Kivuvu, M., Mokwa' K., Manoka, A. T., et al. (1989) Evaluation of
condom utilization and acceptability of spennicides among prostitutes in Kinshasa,
Zaire. Presented at the Fifth International Conference on AIDS, Montreal, June
=9.
Getting, L. A., and Steele, M. W. (1982) A controlled retrospective follow-up study of
the impact of genetic counseling on parental reproduction following the birth of a
Down syndrome child. Clinical Genetics 21:7-13.
Office of Technology Assessment (OTA). (1988) How Effective is AIDS Education?
Washington, D.C.: Office of Technology Assessment.
O'Reilly, K., Higgins, D. L., Galavotti, C., Sheridan, J., Wood, R., and Cohn, D. (1989)
Perceived community noIms and risk reduction: Behavior change in a cohort of
gay men. Photocopied materials distributed at the Fifth International Conference
on AIDS, Montreal, June =9.
Padian, N., Marquis, L., Francis, 13. P., Anderson, R. E., Rutherford, G. W., et al.
(1987) Male-to-female transmission of human immunodeficiency virus. Journal
of the American Medical Association 258:788-790.
OCR for page 140
140 ~ AIDS: THE SECOND DECADE
Parish, K. L., Mandel, J., Thomas, J., and Gomperts, E. (1989) Prediction of safer
sex practice and psychosocial distress in adults with hemophilia at risk for AIDS.
Presented at the Fifth International Conference on AIDS, Montreal, June =9.
Parmet, W. E. (1987) AIDS and the limits of discrimination law. Law, Medicine &
Health Care 15:61-72.
Paul, J., Stall, R., and Davis, F. (1989) Sexual risk for HIV transmission in a gay male
substance-abusing population. Presented at the Fifth International Conference on
AIDS, Montreal, June =9.
Peterson, J. L., and Marin, G. (1988) Issues in the prevention of AIDS among Black
and Hispanic men. American Psychologist 43:871-877.
Peterson, J. L., Fullilove, R. E., Catania, J. A., and Coates, T. J. (1989) Close encounters
of an unsafe kind: Risky sexual behaviors and predictors among black gay and
bisexual men. Presented at the Fifth International Conference on AIDS, Montreal,
June ~9.
Pindyck, J. (1988) Transfusion-associated HIV infection: Epidemiology, prevention,
and public policy (editorial review). AIDS 2:239-248.
Potterat, J. J., Spencer, N. E., Woodhouse, D. E. and Muth, J. B. (1989) Partner
notification in the control of human immunodeficiency virus infection. American
Journal of Public Health 79:87~876.
Powledge, T. M., and Fletcher, J. (1979) Guidelines for the ethical, social, and legal
issues in prenatal diagnosis: A report from the Genetics Research Group of the
Hastings Center, Institute of Society, Ethics, and the Life Sciences. New England
Journal of Medicine 300:168-172.
Presidential Commission on the Human Immunodeficiency Virus Epidemic. (1988)
Final Report of the Presidential Commission on the Human Immunodeficiency
Virus Epidemic. Washington, D.C.: Government Printing Office.
Price, W., Merigan, T., and Peterman, T. (1989) Condom usage reported by female
sexual partners of asymptomatic HIV seropositive hemophiliac men. Presented at
the Fifth International Conference on AIDS, Montreal, June 4-9.
Puckett, S. B., and Bye, L. L. (1987) The stop AIDS project: An interpersonal
AIDS-prevention program. The Stop AIDS Project, Inc., San Francisco, Calif.
Reed, B. G. (1987) Intervention strategies for drug dependent women: An introduction.
In G. M. Beschner, B. G. Reed, and J. Mondanaro, eds., Treatment Services for
Drug Dependent Women. Vol. 1. Rockville, Md.: National Institute on Drug
Abuse.
Reed, B. G., Lovach, J., Bellows, N., and Mosie, R. (1981) The many faces of addicted
women: Implications for treatment and future research. In A. J. Schecter, ea.,
Drug Dependence and Alcoholism, Vol. 1. New York: Plenum Press.
Remafedi, G. (1987~. Homosexual youth: A challenge to contemporaIy society. Journal
of the American Medical Association 258:222-225.
Remien, R., Rabkin, J., Williams, J., Gorman, J., and Ehrhardt, A. A. (1989~. Cessation
of alcohol and drug use disorders ~n an HIV~ sample Presented at the Fifth
International Conference on AIDS, Montreal, June =9.
Rhame, F. S., and Maki' D. G. (1989) The case for wider 1lse of testing for HIV
infection. New England Journal of Medicine 320:1248-1254.
Robertson, J. A., and Plant, M. A. (1988) Alcohol, sex and risks of HIV infection.
Drug and Alcohol Dependence 22:75-78.
OCR for page 141
PREVENTION ~ 141
Rowe, M., and 13ridgham, B. (1989) Executive Summary and Analysis: AIDS and
Discrimination Review of State Laws That Affect HIV Infection (1983 to
1988). Washington, D.C.:
Health Policy Project.
George Washington University Intergovernmental
Rubinstein, A., Sicklick, M., Gupta, A., Bernstein, L., Klein, N., et al. (1983) Acquired
immunodeficiency with reversed T4/T8 ratios in infants born to promiscuous and
drug-addicted mothers. Journal of the American Medical Association 249:235
2356.
Rucknagel, D. L. (1983) A decade of screening in the hemoglobinopathies: Is a
national program to prevent sickle cell anemia possible? The American Journal
of Pediatric Hematology and Oncology 5:373-377.
Russell, L. B. (1986) Is Prevention Better Than Cure? Washington, D.C.: The
Brookings Institute.
Rutherford, G. W., Oliva, G. E., Grossman, M., Green, J. R., Wara, D. W., et al. (1987)
Guidelines for the control of perinatally transmitted HIV infection and care of
infected mothers, infants, and children. Western Journal of Medicine 147:10~108.
Sachs, B. P., Tuomala, R., and Frigoletto, F. (1987) AIDS: Suggested protocol for
counseling and screening in pregnancy. Obstetrics and Gynecology 70:408~11.
Saint Cyr-Delpe, M. (1989) Update to the community response on women and AIDS.
Presented at the Fifth International Conference on AIDS, Montreal, June ~9.
Sakondhavat, C. (1990) The female condom (letter). American Journal of Public Health
80:498~99.
Saltzman, S., Stoddard, A., McCusker, J., and Mayer, K. (1989) Factors associated with
recurrence of unsafe sexual practices in a cohort of gay men previously engaging
In "safer" sexual practices. Presented at the Fifth International Conference on
AIDS, Montreal, June =9.
San Francisco AIDS Foundation. (1987) Designing an Effective AIDS Risk Prevention
Campaign Strategy for San Francisco: Resultsirom the Fourth Probability Sample
of an Urban Gay Male Community. San Francisco, Cal~f.: Research and Decision
Corporation, Communication Technologies.
Schechter, M. T., Craib, K. J. P., Willoughby, B., Douglas, B., McLeod, W. A., et al.
(1988) Patterns of sexual behavior and condom use in a cohort of homosexual
men. American Journal of Public Health 78:1535-1538.
Schild, S. (1964) Parents of children with phenylketonuria. Children 11:92-96.
Schilling, R. F., Schinke, S. P. Nichols, S. E., Zayas, L. H., Muller, S. O., et al. (1989)
Developing strategies for AIDS prevention research with black and Hispanic drug
users. Public Health Reports 104:2-11.
Schmidt, K. W., Krasnik, A., Bendstrup, E., Zoffman, H., and Larson, S. O. (1989)
Occurrence of sexual behavior related to the risk of HIV-infection. Danish Medical
Bulletin 36:8~88.
Schneck, M., Goode, L., Connor, E., Holland, B., Oxtoby, M., and Oleske, J. (1989)
Reproductive history (HX) of HIV antibody positive (HIV+) women followed in a
prospective study in Newark, N.J. Presented at the Fifth International Conference
on AIDS, Montreal, June =9.
Schneider, B. E. (1988) Gender and AIDS. In R. Kulstad, ea., AIDS 1988: AAAS
Symposia Papers. Washington, D.C.: American Association for the Advancement
of Science.
OCR for page 142
142 ~ AIDS: THE SECOND DECADE
Schoenbaum, E. E., Hartel, D., Selwyn, P. A., Klein, R. S., Davenny, K., et al. (1989)
Risk factors for human immunodeficiency virus infection in intravenous drug
users. New England Journal of Medicine 321:87~879.
Seidlin, M., Dugan, T., Vogler, M., Bebenroth, D., Krasinski, K., and Holzman, R.
(1989) Risk factors for HIV transmission in steady heterosexual couples. Presented
at the Fifth International Conference on AIDS, Montreal, June =9.
Selwyn, P. A., Feiner, C., Cox, C. P., Lipshutz, C., and Cohen, R. L. (1987) Knowledge
about AIDS and high-risk behavior among intravenous drug users in New York
City. AIDS 1:247-254.
Selwyn, P. A., Schoenbaum, E. E., Davenny, K., Robertson, V. J., Feingold, A. R.,
et al. (1989) Prospective study of human immunodeficiency virus infection and
pregnancy outcomes in intravenous drug users. Journal of the American Medical
Association 261: 1289-1294.
Serrano, Y., and Goldsmith, D. (1989) Street outreach strategies for intravenous drug
and crack users, their sexual partners, and addicted prostitutes at risk for AIDS.
Presented at the Fifth International Conference on AIDS, Montreal, June =9.
Serrano, Y., and Johnson, P. (1989) Women injection drug users: Issues and strategies,
experiences in New York City and ADAPT. Presented at the Fifth International
Conference on AIDS, Montreal, June =9.
Shaw, M. W. (1987) Invited editorial comment: Testing for the Huntington gene: A
right to know, a right not to know, or a duty to know. American Journal of
Medical Genetics 26:243-246.
Shaw, N., and Paleo, L. (1986) Women and AIDS. In L. McKusick, ea., What To Do
About AIDS. Berkeley, Calif.: University of California Press.
Skidmore, C., and Robertson, J. R. (1989) Long term follow-up and assessment of HIV
serostatus and risk taking in a cohort of 203 intravenous drug users. Presented at
the Fifth International Conference on AIDS, Montreal, June =9.
Smiley, M. L.' White, G. C. II, Becherer, P., Macik, G., Matthews? T. J.' et al. (1988)
Transmission of human immunodeficiency virus to sexual partners of hemophiliacs.
American Journal of Hematology 28:27-32.
Soloick, R. (1978) Sexual responsiveness, age and change: Facts and potentials. In R.
Solnick, ea., Sexuality and Aging. Los Angeles, Calif.: University of Southern
Califomia Press.
Soluick, R., and Birren, J. (1977) Age and male erectile response and sexual behavior.
Archives of Sexual Behavior 6:1-9.
Solomon, M. Z., and DeJong, W. (1986) Recent sexually transmitted disease prevention
efforts and their implications for AIDS health education. Health Education
Quarterly 13:31~3 16.
Solomon, M. Z., and DeJong, W. (1989) Preventing AIDS and other STDs through
condom promotion: A patient education intervention. American Journal of Public
Health 179:453~58.
Sorenson, J., Gibson, D., Heitzmann, C., Calvillo, A., Dumontet, R., et al. (1988)
Pilot trial of small group AIDS education with intravenous drug abusers (abstract).
In L. S. Harris, ea., Problems of Drug Dependence, 1988: Proceedings of the
Committee on the Problems of Drug Dependence. National Institute on Drug
Abuse Research Monograph 90. Washington, D.C.: U.S. Government Printing
Office.
OCR for page 143
PREVENTION I 143
Sotheran, J. L., Fnedman, S. R., Des Jarlais, D. C., Engel, S. D., Weber, J., et al.
(1989) Condom use among heterosexual male IV drug users is affected by the
nature of the social relationships. Presented at the Fifth International Conference
on AIDS, Montreal, June 4-9.
Sowder, B., Weissman, G., and Young, P. (1989) Working with women at risk in a
national AIDS prevention program. Photocopied materials distributed at the Fifth
International Conference on AIDS, Montreal, June =9.
St. Lawrence, J. S., Hood, H. V., Brasfield, T. L., and Kelly, J. A. (1988) Patterns
and predictors of risk knowledge and risk behavior across high-, medium-, and
low-AIDS prevalence cities. Presented at the Fourth International Conference on
AIDS, Stockholm, June 12-16.
St. Lawrence, J. S., Hood, H. V., Brasfield, T. L., and Kelly, J. A. (1989) Differences
in gay men's AIDS risk knowledge and behavior patterns in high and low AIDS
prevalence cities. Public Health Reports 104:391-395.
Stall, R. D., and Ostrow, D. (1989) Intravenous drug use, the combination of drugs
and sexual activity and HIV infection among gay and bisexual men: The San
Francisco Men's Health Study. Journal of Drug Issues 19:57-73.
Stall, R. D., Catania, I., and Pollack, L. (1988) AIDS as an age-defined epidemic.
Report to the National Institute of Aging, April.
Stall, R. D., Coates, T. J., and Hoff, C. (1988) Behavioral risk reduction for HIV
infection among gay and bisexual men: A review of results from the United
States. American Psychologist 43:878-885.
Stall, R. D., McKusick, L., Wiley, J., Coates, T. J., and Ostrow, D. G. (1986) Alcohol
and drug use during sexual activity and compliance with safe sex guidelines
for AIDS: The AIDS Behavioral Research Project. Health Education Quarterly
13:359-371.
Stall, R. D., McKusick, L., Hoff, C., Lang, S., and Coates, T. J. (1989) Sexual risk
for HIV infection among bar patrons in San Francisco. Presented at the Fifth
International Conference on AIDS, Montreal, June 4-9.
Stall, R. D., Ekstrand, M., Pollack, L., McKusick, L., and Coates, T. J. (1990) Relapse
from safer sex: The next challenge for AIDS prevention efforts. Unpublished
manuscript. Center for AIDS Prevention Studies, University of California, San
Francisco.
Stall, R. D., Heurtun-Roberts, S., McKusick, L., Hoff, C., and Lange, S. (In press)
Sexual risk for HIV transmission among singles-bar patrons in San Francisco.
Medical Anthropology Quarterly.
Steele, M. W. (1980) Lessons from the American Tay-Sachs experience. Lancet 2:914.
Stein, Z. (1990) HIV prevention: The need for methods women can use (commentary).
American Journal of Public Health 80:46~462.
Sterk, C. E., Friedman, S. R., Sufian, M., Stepherson, B., and Des Jarlais, D. C. (1989)
Barriers to AIDS interventions among sexual partners of IV drug users. Presented
at the Fifth International Conference on AIDS, Montreal, June =9.
Stevens, R., Wethers, J., Berns, D., and Pass, K. (1989) Human immunodeficiency (HIV)
and human T-lymphotropic (HTLV-1/2) viruses in childbearing women: Tests of
24,569 consecutive newboms. Presented at the Fifth International Conference on
AIDS, Montreal, June ~9.
Stimson, G. V. (1988) Injecting equipment exchange schemes: Final report. London:
Monitoring Research Group, Sociology Department, Goldsmith's College.
OCR for page 144
144 ~ AIDS: THE SECOND DECADE
Stimson, G. V. (1989) Syringe exchange programmes for injecting drug users. AIDS
3:253-260.
Stryker, J. (1989) IV drug use and AIDS: Public policy and dirty needles. Journal of
Health Politics, Policy and Law 14:719-740.
Sundet, J. M., Kvalem, I. L., Magnus, P., Gronnesby, J. K., Stigum, H., and Baklceteig,
L. S. (1989) The relationship between condom use and sexual behavior. Presented
at the Fifth International Conference on AIDS, Montreal, June =9.
Sunita, J., Flynn, N., Bailey, V., Sweha, A., Ding, D., and Sloan, W. (1989) IVDU and
AIDS: More resistance to changing their sexual than their needle-shanng practices.
Presented at the Fifth International Conference on AIDS, Montreal, June ~9.
Sweeney, P., Allan, D., and Onorato, I., and State and Local Health Departments.
(1989) HIV infection among women attending women's health clinics in the
United States, 1988-1989. Presented at the Fifth International Conference on
AIDS, Montreal, June =9.
Tafoya, T. (1989) Pulling coyote's tale: Native Amencan sexuality and AIDS. In V.
M. Mays, G. W. Albee, and S. F. Schneider, eds., Primary Prevention of AIDS:
Psychological Approaches. Newbury Park, Calif.: Sage Publications.
Tanner, W. M., and Pollack, R. H. (1988) The effect of condom use and erotic
instructions on attitudes towards condoms. The Journal of Sex Research 25:537-
541.
Traeen, B., Rise, J. and Kraft, P. (1989) Condom behavior in 17, 18, and 19 year-old
Norwegians. Presented at the Fifth International Conference on AIDS, Montreal,
June =9.
Truman B., Lehman, J. S., Brown, L., Peyser, N., Peters, D., et al. (1989) HIV
infection among intravenous drug users (IVDUs) in NYC. Presented at the Fifth
International Conference on AIDS, Montreal, June i9.
Turner, C. (1989) Research on sexual behaviors that transmit HIV: Progress and
problems. AIDS 3:S63-S70.
Turner, C. F., Miller, H. G., and Moses, L. M., eds. (1989) AIDS, Sexual Behavior,
and Intravenous Drug Use. Washington, D.C.: National Academy Press.
Tu~nock, B. J., and Kelly, C. I. (1989) Premantal testing for human immunodeficiency
virus. Journal of the American Medical Association 261:3415-3418.
U.S. Conference of Mayors. (1989) AIDS/HIV anti-discrimination initiatives. AIDS
Information Exchange 6:2.
Valdisem, R. O. (1989) Preventing AIDS: The Design of Effective Programs. New
Brunswick, N.J.: Rutgers University Press.
Valdiserri, R., Lyter, D., Callahan, C., Kingsley, L., and Rinaldo, C. (1987) Condom
use in a cohort of gay and bisexual men. Presented at the Third International
Conference on AIDS, Washington, D.C., June 1-5.
Valdisem, R., Lyter, D., Leviton, L. C., Callahan, C. M., Kingsley, L. A., et al. (1988)
Variables influencing condom use in a cohort of gay and bisexual men. American
Journal of Public Health 78:801-805.
Valdiserri, R. O., Lyter, D. W., Leviton, L. C., Callahan, C. M., Kingsley, L A., and
Rinaldo, C. R. (1989a) AIDS prevention in homosexual and bisexual men: Results
of a randomized trial evaluating two risk reduction interventions. AIDS 3:21-26.
OCR for page 145
PREVENTION | 145
Valdisem, R. O., Arena, V. C., Proctor, D., and Bonati, F. A. (1989b) The relationship
between women's attitudes about condoms and their use: Implications for condom
promotion programs. American Journal of Public Health 79:499-501.
van den Hoek, J. A. R., Coutinho, R. A., van Haastrecht, H. J. A., van Zadelhoff, A.
W., and Goudsmit, J. (1988) Prevalence and risk factors of HIV infections among
drug users and drug-using prostitutes in Amsterdam. AIDS 2:55~0.
van den Hoek, J. A. R., van Haastrecht, H. J. A., and Coutinho, R. A. (1989) Risk
reduction among intravenous drug users in Amsterdam under the influence of
AIDS. American Journal of Public Health 79:1355-1357.
VanRaden, M., Kaslow, R., Kingsley, L., Detels, R., Jacobson, L., et al. (1988)
Incidence and nonsexual risk factors for recent HIV risk infection in homosexual
men. Presented at the Fourth International Conference on AIDS, Stockholm, June
12-16.
Vlahov, D., Anthony, J. C., Celentano, D. D., Solomon, L., Choudhury, N., and
Mandell, W. (1989) Trends of risk reduction among initiates into intravenous
drug use 1982-1987. Presented at the Fifth International Conference on AIDS,
Montreal, June =9.
Watters, J. K. (1987) Preventing human immunodeficiency virus contagion among
intravenous drug users: The impact of street-based education on risk-behavior.
Presented at the 3rd International Conference on AIDS, Washington, D.C., June
1 - 5.
Weiss, R., and Thier, S. O. (1988) HIV testing is the answer What's the question?
New England Journal of Medicine 319:101~1012.
Wells, J., Wilensky, G. R., Valleron, A. J., Bond, G., Sell, R. L., and DeFilippes, P.
(1989) Population prevalence of AIDS high risk behaviors in France, the United
Kingdom and the United States. Presented at the Fifth International Conference
on AIDS, Montreal, June =9.
Williams, A. B. (1989) Educational needs assessment for women at risk for HIV
through intravenous drug abuse. Presented at the Fifth International Conference
on AIDS? Montreal, June i9.
Williamson, M., Dobson, J.C., and Koch, R. (1977) Collaborative study of children
treated for phenylketonuria: Study design. Pediatrics 60:815-821.
Willoughby, B., Schechter, M. T., Douglas, B., Craib, K. J. P., Constance, P., et al.
(1989) Self-reported sexual behavior in a cohort of homosexual men: Cross-
sectional analysis at six years. Presented at the Fifth International Conference on
AIDS, Montreal, June =9.
Wiznia, A., Bueti, C., Douglas, C., Cabat, T., and Rubinstein, A. (1989) Factors
influencing maternal decision making regarding pregnancy outcome in HIV infected
women. Presented at the Fifth International Conference on AIDS, Montreal, June
=9.
Wolfe, H., Keffelew, A., Bacchetti, P., Meakin, R., Brodie, B., and Moss, A. R. (1989)
HIV infection in female intravenous drug users in San Francisco. Presented at the
Fifth International Conference on AIDS, Montreal, June =9.
World Health Organization (WHO). (1988) AIDS: Avoidance of discrimination in
relation to HIV-infected people and people with AIDS. Forty-first World Health
Assembly, World Health Organization, Geneva, May.
Worth, D., and Rodriguez, R. (1987) Latina women and AIDS. Siecus Report January-
February:5-7.
OCR for page 146
146 ~ AIDS: THE SECOND DECADE
Zeugin, P., Dubois-Arber, F., Hausser, D., and Lehmann, Ph. (1989) Sexual behavior
of young adults and the effects of AIDS-prevention campaigns in Switzerland.
Presented at the Fifth International Conference on AIDS, Montreal, June =9.
Representative terms from entire chapter:
hiv infection
