Thesis (Ph. D.)--University of Arizona, 1993. / Also issued in print.

Thesis (Ph. D.)--University of Washington, 1997. / Vita. Includes bibliographical references (leaves [42]-49).

Thesis (Ph. D.)--University of Arizona, 1993.

This ethnography of intravenous (IV) drug users challenges popular representations of a "junkie" subculture and stereotypes of users as rejecting the dominant cultural values of mainstream society. Users attempts to construct and maintain a moral identity are examined. Beyond "war stories" ennobling street life and survival, life narratives were constructed through a juxtaposition of voices and images establishing moral worth in opposition to others. Moral identity is a central concern for IV drug users, one influencing their response to risk. Social relations, responsibility, and an ethic of care were found to underlay the moral codes developed by users, codes socially-embedded and to some degree gender specific. Men tended to adopt a "tough guy," "independence" voice in which responsibility was largely framed around status and image as a role model. Women tended to see responsibility and morality within a web of interdependence and care. Social responsibility was a measure of moral goodness. The desire to be defined by mainstream values was strongly evident among women users who were mothers. Motherhood was a core symbol representing inherent goodness, a marker of moral identity, and a means toward achieving a socially acceptable identity. The identities of "junkie" and "mother" placed women in a state of perpetual tension and conflict as manifested in issues of child custody and welfare. Maintaining relationship with their children was central to the women's moral identity, be it based in daily interaction or visitations inspiring hopes for a future. This ethnography suggests that IV drug users, while chemically dependent, maintain a sense of agency. Contrary to stereotypes of irresponsibility, users are reflexive about their habit's control and their use of drugs to block suffering, social responsibility, and the pain they cause others. Displays of agency and exercises of control proved critical in identity construction, particularly for women users diagnosed HIV positive. Documented was the process whereby they redefined their "health" and moral identity in the company of others who assisted in constructing identities in contrast to the negative stereotypes of AIDS. Through discourse within these "life narrative groups" a positive diagnosis was transposed into a positive identity.

<p>Syftet med studien var att öka kunskapen om och förståelsen för hiv-smittade narkomaner i kriminalvård. Den övergripande frågeställningen löd; Hur beskriver ett mindre urval av hiv-smittade narkomaner i föremål för kriminalvård sina tankar och känslor kring sin sjukdom och sin livssituation? Studien var av kvalitativ design och den vetenskapliga positionen av hermeneutisk karaktär. Det empiriska materialet bestod av intervjuer med fem hiv-smittade narkomaner i kriminalvård. Tre teman var grundläggande i intervjuerna; Tankar, känslor och reaktioner kring hiv-diagnosen, Existentiella frågor, drivkraft och copingstrategier samt Bemötande i och utanför kriminalvården. Studiens teoretiska perspektiv; kristeori, existentialistisk teori, upplevelseteori och hälsoteori, valdes i syfte att nå en ökad förståelse för intervjupersonernas upplevelse av sin livssituation. Studiens resultat och analys visade att hiv-smittan fått olika konsekvenser för de intervjuade. För tre personer blev livet bättre genom sjukdomen; två av dem menade att de annars skulle varit döda. För de övriga två innebar sjukdomen i stället att döden kommit närmare och grusat alla förhoppningar om ett bättre liv. Tolkningen visade att en möjlig förklaring till de olika förhållningssätten kunde bero på skillnader i vilken inre privat betydelse sjukdomen haft för de intervjuade, samt i vilken mån de lyckats komma igenom krisen.</p>

Syftet med studien var att öka kunskapen om och förståelsen för hiv-smittade narkomaner i kriminalvård. Den övergripande frågeställningen löd; Hur beskriver ett mindre urval av hiv-smittade narkomaner i föremål för kriminalvård sina tankar och känslor kring sin sjukdom och sin livssituation? Studien var av kvalitativ design och den vetenskapliga positionen av hermeneutisk karaktär. Det empiriska materialet bestod av intervjuer med fem hiv-smittade narkomaner i kriminalvård. Tre teman var grundläggande i intervjuerna; Tankar, känslor och reaktioner kring hiv-diagnosen, Existentiella frågor, drivkraft och copingstrategier samt Bemötande i och utanför kriminalvården. Studiens teoretiska perspektiv; kristeori, existentialistisk teori, upplevelseteori och hälsoteori, valdes i syfte att nå en ökad förståelse för intervjupersonernas upplevelse av sin livssituation. Studiens resultat och analys visade att hiv-smittan fått olika konsekvenser för de intervjuade. För tre personer blev livet bättre genom sjukdomen; två av dem menade att de annars skulle varit döda. För de övriga två innebar sjukdomen i stället att döden kommit närmare och grusat alla förhoppningar om ett bättre liv. Tolkningen visade att en möjlig förklaring till de olika förhållningssätten kunde bero på skillnader i vilken inre privat betydelse sjukdomen haft för de intervjuade, samt i vilken mån de lyckats komma igenom krisen.

Injection drug users (IDUs) account for an estimated 44% of people living with HIV/AIDS in China and are the major driving force behind the expanding epidemic. Developing effective antiretroviral therapy (ART) adherence interventions in the Chinese IDU population is a major challenge. In conjunction with ART scale-up in Yunnan province, our goal was to gather patient perspectives on ART and ideas for feasible adherence support. Between December 2005 and March 2006, eight focus groups with a total of 55 HIV positive IDUs were conducted at three sites in Yunnan to ascertain ART knowledge, barriers to adherence, and acceptable adherence support methods. Focus groups included ART experienced and naïve participants, and HIV positive IDUs in methadone maintenance clinics. Discussions were audiotaped, notes were transcribed and coded for analyses. All participants were former or current IDUs and 31 were from the rural countryside (59.6%), and 19 (36.5%) resided in a small city. ART was viewed positively but the principal barriers for urban IDUs were stigma and discrimination, while geography was the main problem for rural IDUs. Major themes were stratified between four components: knowledge, motivation, cues to action, and access to care. Adherence tools that were spontaneously endorsed included watches, pill boxes, and diaries. Directly observed therapy (DOT) within methadone programs was acceptable but community-based DOT would need to address stigma issues in urban areas. Two separate HIV epidemics exist within IDUs in China, stratified between small-city urban and rural populations. No single model for adherence will work and interventions must be broad-based. This study provides an expanded conceptual framework for ART adherence in the HIV positive IDU population, which includes the unique barriers posed by the ecological context surrounding this doubly-discriminated population.

No description available.

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&lt;0.001), severity of drug dependence (AOR=1.05, p&lt;0.01), economic pressure (AOR=1.07, p&lt;0.05) and all studied psychosocial variables (e.g. depression, social support and gender power; AOR=0.70 to 1.67, p&lt;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 &lt;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.