Thesis (Ph. D.)--University of Texas at Austin, 2003. / Vita. Includes bibliographical references. Available also from UMI Company.

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INTRODUCTION: Human Immunodeficiency Virus (HIV) infection remains prevalent among the minority and drug using population in the United States. Testing for HIV is an important and cost effective way to reduce HIV prevalence. OBJECTIVE: To assess the HIV testing behavior of people who use non-injected drugs (PWND) and compare it to that of people who use injected drugs (PWID), in order to determine which factors, in terms of social context as well as individual risks, predict HIV testing among the PWND. METHOD: A cross-sectional study of HIV testing behavior of PWND compared to PWID was conducted and the data was analyzed by applying negative binomial regression models. Then, a negative binomial regression using generalized estimating equation (GEE) was employed in order to identify the predictive factors for HIV testing among PWND over a 2-year period. RESULTS: Individuals who reported using injected drugs tended to undergo HIV tests more often compared to those who used non-injected drugs, PR (95% CI) = 1.24 (1.02, 1.51), p = 0.03. The interaction term between injection status and emotional support in relation to HIV testing was significant, 0.75 (0.59, 0.97), p = 0.03. PWID that had access to greater emotional support on average tended to test for HIV less frequently than did PWID with less emotional support. In stratified analyses, emotional support was negatively associated with testing among PWID and positively associated among PWND, though both relationships were borderline significant. HIV testing among users of illicit drugs was dependent on emotional support. According to the GEE models examining the factors predicting HIV testing among PWND, sexually transmitted infections, non-injected heroin use, being in drug treatment, engagement in sexual transactions, and instability in drug networks were the main factors contributing to being HIV tested, as well as frequency of testing. The positive influence of emotional support on these variables was borderline significant. CONCLUSION: People who use non-injected drugs are less likely to test for HIV compared to those who use injected drugs, though they may share similar risk factors for HIV transmission and acquisition. To exert a greater impact on the HIV epidemic, interventions and policies encouraging HIV testing in this subpopulation, which remains under-recognized by both researchers and health practitioners in terms of the potential risks for contracting the HIV, are warranted.

Despite increased involvement in the criminal justice system among populations of migrants, people who inject drugs, and drug-involved men in community corrections, few studies investigate associations between involvement in the criminal justice system and sexual and injection drug risks among these key-affected populations and their intimate partners. To address these gaps the following dissertation study investigated the association between exposures to the criminal justice system and sexual and injection drug risks among three key affected populations: 1) male labor migrants in Almaty, Kazakhstan, 2) people who inject drugs and their intimate partners in Almaty, Kazakhstan, and 3) drug-involved men in community corrections in New York City, NY in the United States. Using the three-paper model, the following dissertation sheds new insights into how exposures to the risk environment shape sexual and injection HIV risks to inform HIV prevention research and practice with populations disproportionately involved in criminal justice systems.

The problem of the study was to determine the status of bloodborne pathogen education for injection drug users in Indiana hospital emergency departments. The study was designed to answer the following research questions: (a) Do Indiana hospital emergency departments have written policies on bloodborne pathogen education for injection drug users? (b) To what extent do Indiana hospital emergency departments provide bloodborne pathogen education for injection drug users? and (c) What are the major barriers for Indiana hospital emergency departments in providing bloodborne pathogen education for injection drug users?A valid instrument was developed and sent to 110 Indiana hospital emergency department nurse managers. Forty-six instruments were returned for a response rate of 43.8%.The results indicated only three (7.1 %) responding hospital emergency departments had written bloodborne pathogen educational policies. Ten (20.8%) emergency departments provided some form of bloodborne pathogen education for injection drug users. Major barriers indicated for not providing patient education consisted of insufficient monetary resources, injection drug users denying a drug history, and emergency department nurses being unable to identify injection drug usage. / Department of Physiology and Health Science

Source: Masters Abstracts International, Volume: 46-04, page: 2054. Adviser: Jan M. H. Risser. Includes bibliographical references.

Thesis (Ph.D.)--University of Alberta, 2009. / A thesis submitted to the Faculty of Graduate Studies and Research in partial fulfillment of the requirements for the degree of Doctor of Philosophy, Department of Public Health Sciences. Title from pdf file main screen (viewed on September 20, 2009). Includes bibliographical references.

Research on the determinants of injection drug use behavior has traditionally concentrated on factors operating at the individual level. However, more recent studies have found that behaviors surrounding injection drug use are shaped, not only by individual-level characteristics, but also by the environment in which they occur. The risk environment paradigm, proposed by Rhodes and colleagues, describes how factors exogenous to the individual influence high-risk injection behavior and blood borne virus (BBV) transmission among people who inject drugs (PWID). To date, few elements of the risk environment have been evaluated as potential determinants of high-risk injection behavior. The purpose of this dissertation was to study the influence of two elements of the risk environment on unsafe injection practices among PWID – neighborhood socioeconomic disadvantage and social discomfort surrounding the acquisition of sterile syringes from syringe exchange programs (SEPs) and pharmacies. To this end, a systematic literature review was conducted on the relation between neighborhood context and injection drug use behavior. Research gaps and methodological challenges identified in this review were used to design analyses exploring relations among neighborhood disadvantage, social discomfort, and high-risk injection behavior. These analyses were conducted using data collected from 484 PWID enrolled in the Pharmacists as Resources Making Links to Community Services (PHARM-Link) study, combined with data from the American Community Survey. Poisson regression with robust error variance was used to estimate associations between measures of neighborhood socioeconomic disadvantage and high-risk injection behavior. SEP accessibility and drug-related police activity were evaluated as potential modifiers of these relations. Similar methods were used to estimate associations between measures of social discomfort and high-risk injection behavior, including neighborhood socioeconomic disadvantage as a potential effect modifier. The systematic literature review on neighborhood context and injection drug use behavior identified few articles pertaining to this relation (n=22). Selected studies primarily investigated the influence of structural aspects of the neighborhood environment on behaviors surrounding injection drug use, while aspects of the social environment and potential modifiers of neighborhood-behavior relations were understudied. Subsequent quantitative analyses revealed that neighborhood socioeconomic disadvantage was associated with safer injection behaviors among PWID. Injectors in disadvantaged neighborhoods reported less receptive syringe sharing and less unsterile syringe use than their counterparts in relatively better off neighborhoods. Drug-related police activity attenuated associations between neighborhood disadvantage and unsterile syringe use, while the direction of associations between neighborhood disadvantage and the use of unsafe syringe sources varied with levels of SEP accessibility. In neighborhoods with high SEP accessibility, neighborhood disadvantage was associated with decreased use of unsafe syringe sources, while in neighborhoods with low SEP accessibility, neighborhood disadvantage was associated with increased use of unsafe syringe sources. Social discomfort was not associated with high-risk injection behavior, but effect modification was detected between neighborhood disadvantage and two items measuring the quality of relationships between participants and syringe staff: “Pharmacists care about my health and well-being” and “The staff at syringe exchange programs seems to care about my health and well-being.” In disadvantaged neighborhoods, participants who reported positive relationships with syringe staff were less likely to engage in receptive syringe sharing. However, in relatively better off neighborhoods, positive relationships with syringe staff were associated with increased receptive syringe sharing. Overall, the results of this dissertation support the validity of the risk environment paradigm in shaping high-risk injection behavior among PWID. Future studies should continue to investigate contextual factors as determinants of behavior surrounding injection drug use. Understanding how aspects of local-area environments influence injection risk behavior will be essential to eliminating the transmission of BBVs among PWID.

Conclusions. The "bridging effect" for HIV transmission is evident. Variables predicting condom use during commercial sex are multidimensional. Integrative programs are hence required. Methadone clinics may offer a platform for offering such services to IDU-FSWs. The performance of the TPB could be enhanced by addition of external variables; its applicability varies according to the wellbeing status of the IDU-FSWs. Future randomized control studies are warranted to design effective evidence-based programs targeting IDU-FSWs. / Introduction. Injecting drug users (IDUs) drive the HIV epidemic in China. Female injecting drug users who are sex workers (IDU-FSWs) is a strategic "bridge population" for HIV transmission from the IDU to non-IDU populations. Background characteristics, health behavioral theories (e.g. the Theory of Planned Behavior, TPB), drug dependence, economic pressure, psychological problems, social support and gender power are potential predictors of condom use during commercial sex among IDU-FSWs. Most of these associations have not been investigated in China or elsewhere, and the TPB has not been applied to HIV-vulnerable populations in China. A knowledge gap exists. / Objectives. This study validated two instruments measuring severity of drug dependence. The prevalence of inconsistent condom use among IDU-FSWs and its associations with the aforementioned variables were investigated. The hypotheses that different blocks of variables would have independent effects on condom use during commercial sex, and the effects of TPB-related variables on condom use would be moderated by some external variables (e.g. severity of drug dependence) were tested. / Results. The Opiate Addiction Severity Inventory-Revised (OASI-R) was fully validated in the Study I. Around 6.8% of IDU-FSWs were HIV positive and respectively 48% and 64% of them practiced needle sharing and unprotected commercial sex (last six months). After adjusting for significant background variables, the five TPB-related variables (AOR=0.43 to 1.92, p<0.001), severity of drug dependence (AOR=1.05, p<0.01), economic pressure (AOR=1.07, p<0.05) and all studied psychosocial variables (e.g. depression, social support and gender power; AOR=0.70 to 1.67, p<0.05) were significantly associated with condom use during commercial sex. / Subjects and methods. Two cross-sectional studies were conducted. In Study I, 178 non-institutionalized drug users were interviewed in Dazhou, Sichuan. In Study II, 281 non-institutionalized IDU-FSWs were interviewed in Dazhou, Sichuan and Hengyang, Hunan, using snowballing method and face-to-face interviews. Statistical methods such as hierarchical and interaction modeling, stratification analysis, ROC method were used in this study. / The final hierarchical model predicting condom use during commercial sex included variables coming from four blocks of independent variables, with ROC area = 94% and sensitivity/specificity = 0.84/0.91. A "Wellbeing Status Index" moderated the associations between some of the TPB-related variables and condom use during commercial sex. / Gu, Jing. / Adviser: Joseph T. F. Lau. / Source: Dissertation Abstracts International, Volume: 70-06, Section: B, page: 3462. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2008. / Includes bibliographical references (leaves 228-246). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstracts in English and Chinese. / School code: 1307.

Conclusion. The significance of risk perception in predicting behavioral intention, hence actual future behaviors, is therefore evident. Conditional measures need to be used. HIV prevention can employ conditional risk perception approaches. Health behavioral theories can be strengthened by using such conditional measures on risk perceptions. The results add to this new and growing area of risk behavior research. / Introduction. Risk perception, a core element of key health behavioral theories and health interventions, is assumed to motivate people to avoid risk behaviors. Mixed findings however prevail in the literature due to methodological issues. Many of such studies are cross-sectional, using global risk perception measures that do not condition on type of risk behavior or partnership which may affect the level of risk. / Male injecting drug users (IDU) are driving the HIV epidemic in China and bridge HIV transmission to non-IDU female populations; they may be at risk of both unprotected sex and syringe sharing. HIV prevention targeting male IDU is greatly warranted and would benefit from understanding of the relationships between risk perceptions and behaviors, in the context of health behavioral theories such as the Health Action Process Approach (HAPA) model, which had not been applied to studies targeting IDU. / Objectives. This study refined the concepts and measures of HIV-related risk perception, conditioning on different types of behaviors and partners, and extended it to include others-directed risk perceptions. The relationship between such conditional risk perception measures and both prior risk behaviors and behavioral intention to avoid sex-related and drug-related risk behaviors in the future were investigated and were compared to those involving global unconditional risk perception measures. The nature of the aforementioned relationships, being motivational or reflective was investigated. A longitudinal component validated the predictive power of behavioral intention over actual future behaviors. / Results. Almost 90% of the respondents had had unprotected sex though <20% shared syringes with others in the last 6 months. Prior syringe sharing but not unprotected sex in the last 6 months was significantly associated with global unconditional risk perception measures. The picture is totally different when risk perception measures conditioned on type of sex partner and unprotected sex or syringe sharing were used instead of the global measures---higher levels of the conditional risk perception measures were significantly associated with higher levels of behavioral intention for consistent condom use and avoidance of syringe sharing, thus supporting the motivational hypothesis. Conditional others-directed risk perceptions (perceived risk of transmitting HIV to others via unprotected sex and syringe sharing) were also associated with the aforementioned behavioral intentions to avoid risk behaviors. A pilot longitudinal study showed that behavioral intentions strongly predict actual future behaviors. Other HAPA-based variables such as self-efficacy and outcome expectancies had predictive effects on behavioral intentions, independent from those of risk perceptions. / Subjects and methods. A total of 456 sexually active male IDU were recruited from Dazhou, Sichuan and Hengyang, Hunan, via snowball sampling. With informed consent, anonymous face-to-face interviews were conducted by trained and experienced staff of the local CDC in privacy settings. / Tsui, Hi Yi. / Adviser: Joseph Lau. / Source: Dissertation Abstracts International, Volume: 72-04, Section: B, page: . / Thesis (Ph.D.)--Chinese University of Hong Kong, 2010. / Includes bibliographical references (leaves 118-130). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. Ann Arbor, MI : ProQuest Information and Learning Company, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract also in Chinese; appendix in Chinese.