Antiretroviral therapy adherence and the use of condoms among African American HIV-positive crack cocaine users

Safer sex practices, such as consistent condom use, are essential to reduce HIV transmission. Determining causes and/or co-variants related to the likelihood of participating in high-risk sexual behaviors may allow the content of interventions and treatments to minimize HIV transmission to be tailored more effectively. The goal of this study was to examine whether a relationship exists between consistent condom use among African American HIV-positive crack cocaine users and both (1) the use of antiretroviral therapy, and (2) adherence to antiretroviral therapy regimens. The study population consisted of 390 participants. They were at least 18 years old, African American, HIV-positive, and had used crack cocaine within a month prior to an interview conducted sometime between April, 2004, and September, 2007. Bivariate associations were examined using contingency tables and χ2-statistics. The Mantel-Haenszel method was used to control for confounding. This study found neither a significant relationship between use of antiretroviral therapy and consistent condom use (Odds ratio (OR) = 1.38; 95% Confidence interval (95%CI) = 0.86–2.22), nor an association between antiretroviral therapy adherence and consistent condom use (OR = 1.02, 95%CI = 0.60–1.75). The exception was more consistent condom use when sex was traded for money or drugs in those on antiretroviral therapy, compared to those not on such therapy (OR = 2.28, 95%CI = 1.08–4.85). Further studies examining condom use and HIV treatment adherence are recommended. ^

Hepatitis C and human immunodeficiency virus infections in injecting drug users in drug treatment centers in Vietnam

Background. Injecting drug users (IDUs) are at risk of infection with Hepatitis C Virus (HCV) and Human Immunodeficiency Virus (HIV). Independently, each of these viruses is a serious threat to health, with HIV ravaging the body’s immune system, and HCV causing cirrhosis, liver cancer and liver failure. Co-infection with HIV/HCV weakens the response to antiretroviral therapy in HIV patients. IDUs with HIV/HCV co-infection are at a 20 times higher risk of having liver-related morbidity and mortality than IDUs with HIV alone. In Vietnam, studies to ascertain the prevalence of HIV have found high rates, but little is known about their HCV status. ^ Purpose. To measure the prevalence of HCV and HIV infection and identify factors associated with these viruses among IDUs at drug treatment centers in northern Vietnam. ^ Methods. A cross-sectional study was conducted from November 2007 to February 2008 with 455 injecting drug users aged 18 to 39 years, admitted no more than two months earlier to one of four treatment centers in Northern Vietnam (Hatay Province) (response rate=95%). Participants, all of whom had completed detoxification and provided informed consent, completed a risk assessment questionnaire and had their blood drawn to test for the presence of antibody-HCV and antibody-HIV with enzyme immuno assays. Univariate and multivariable logistic regression models were utilized to explore the strength of association using HIV, HCV infections and HIV/HCV co-infection as outcomes and demographic characteristics, drug use and sexual behaviors as factors associated with these outcomes. Unadjusted and adjusted odds ratios and 95% confidence intervals were calculated. ^ Results. Among all IDU study participants, the prevalence of HCV alone was 76.9%, HIV alone was 19.8%. The prevalence of HIV/HCV co-infection was 92.2% of HIV-positive and 23.7% of HCV-positive respondents. No sexual risk behaviors for lifetime, six months or 30 days prior to admission were significantly associated with HCV or HIV infection among these IDUs. Only duration of injection drug use was independently associated with HCV and HIV infection, respectively. Longer duration was associated with higher prevalence. Nevertheless, while HCV infection among IDUs who reported being in their first year of injecting drugs were lower than longer time injectors, their rates were still substantial, 67.5%. ^ Compared with either HCV mono-infection or HIV/HCV non-infection, HIV/HCV co-infection was associated with the length of drug injection history but was not associated with sexual behaviors. Higher education was associated with a lower prevalence of HIV/HCV co-infection. When compared with HIV/HCV non-infection, current marriage was associated with a lower prevalence of HIV/HCV co-infection. ^ Conclusions. HCV was prevalent among IDUs from 18 to 39 years old at four drug treatment centers in northern Vietnam. Co-infection with HCV was predominant among HIV-positive IDUs. HCV and HIV co-infection were closely associated with the length of injection drug history. Further research regarding HCV/HIV co-infection should include non-injecting drug users to assess the magnitude of sexual risk behaviors on HIV and HCV infection. (At these treatment centers non-IDUs constituted 10-20% of the population.) High prevalence of HCV prevalence among IDUs, especially among HIV-infected IDUs, suggests that drug treatment centers serving IDUs should include not only HIV prevention education but they should also include the prevention of viral hepatitis. In addition, IDUs who are HIV-positive need to be tested for HCV to receive the best course of therapy and achieve the best response to HIV treatment. These data also suggest that because many IDUs get infected with HCV in the first year of their injection drug career, and because they also engaged in high risk sexual behaviors, outreach programs should focus on harm reduction, safer drug use and sexual practices to prevent infection among drug users who have not yet begun injecting drugs and to prevent further spread of HCV, HIV and co-infection. ^

Sex, drugs, and STIs: Syphilis infection and hepatitis B vaccine compliance among illicit drug users in Houston

Although the association between syphilis infection status and compliance with the hepatitis B virus vaccine has been the focus of investigation, there is a lack of data regarding the association between syphilis infection and HBV vaccine compliance. The author investigated the association between the exposure of syphilis infection and the outcome of HBV vaccine completion, defined as degree of constancy and accuracy with which a patient follows a prescribed regimen. A cohort design was employed using interview and serological data from the Drugs, AIDS, STDs, Hepatitis (DASH) Research Project; analysis was restricted to HIV and HBV seronegative (at baseline), illicit drug users residing in Harris County. Syphilis negative and syphilis positive infection status was determined from the serological data while covariates and outcome information were determined from the DASH Project Questionnaire; enrolled subjects (n=1160) were selected from the data. Association between exposure and outcome was assessed with logistic regression adjusted for data-based confounders. ^ A prevalence of 7% and 71% was found for syphilis and HBV vaccine compliance, respectively. When measuring the actual association between syphilis infection status and HBV vaccine compliance, an odds ratio of 1.49 (95% CI: 0.86, 2.72) was obtained. There was a non-significant association between these two variables. 78% of the study population was syphilis positive and completed the vaccine series compared to 70% of the population that was syphilis negative and received all three doses. This finding confirms that there is a difference between syphilis positive and negative drug users with respect to HBV vaccine compliance. The fact that differences were found in these drug users with respect to vaccine schedule supports the idea that sub-group differences may exist and thus merits further investigation. If these differences are confirmed, it is recommended that STI interventions identify community characteristics of their samples and target populations based on practices specific to that community. ^

Gender differences in life circumstances, monthly income, risky sexual and drug behaviors among injection drug users in Dar es Salaam, Tanzania

This study investigated the gender difference between male and female injection drug users’ (IDUs) life circumstances, income and risky sexual and drug behaviors. The study sample comprised of 318 male and 249 female injection drug users in Dar es Salaam, Tanzania. There were gender differences between male and female IDUs in terms of life circumstances and sexual behaviors. There were no differences in the drug behaviors among the two sexes. Women were more likely to be 21-25 years of age, have had more sexual partners in the last 30 days, traded sex for money, and have been sexually abused as a child. On the other hand, the males were more likely to be 26-30 years of age and have never used a condom during sex in the last 30 days. Regardless of the differences in sexual risk behaviors by gender, both male and female injection drug users in Dar es Salaam are at risk of HIV/AIDS, blood borne and other sexually transmitted diseases associated with drug use.^

Examining seasonal variations in physical activity among low-income Hispanic walk-trail users living in the Cameron Park Colonia

This study examines variations in physical activity by season, and within seasons by age and gender among park users living in the Cameron Park Colonia, a low-income Hispanic community along the Texas-Mexico border. This is the first study of its kind to evaluate seasonal variations by physical activity among a Hispanic population. We hypothesized that (1) there are no differences in overall physical activity by season; (2) youth engage in more sport-related physical activity compared to adults, (3) males engage in more physical activity than females, and (4) there are differences in physical activity between walk-trail users compared to non walk-trail users in the park.^ Physical activity behavioral data was collected (males n=2,093; females n=1,014) at two time periods (winter 2007; summer 2007) via direct observations and assessed park use, walking trail use, and physical activity (moderate-to-vigorous physical activity (MVPA) by seasons. Frequencies for physical activities were calculated for gender, age groups, and season. Separate Pearson's chi-square analyses were used to address variations in physical activity, age, gender, intensity level of physical activity by season, between walk-trails users and non walk-trail users.^ People visiting the park engaged in more sedentary behavior in winter than summer and a higher percentage engaged in MVPA in the summer than winter (p<.05). More females engaged in light activity compared to males (p<.05). Walk-trail users consisted mostly of females and engaged in more light activity than non walk-trail users (p<.05) who participated in more MVPA.^ Increasing access to parks and walk-trails may be an intervention strategy to increase physical activity among Hispanics. More research is needed to assess promoting trail use and determining long-term effects on physical activity among minority/ethnic groups at greater risk of a sedentary lifestyle and reasons for trail use and non-use. Future studies should focus on the types of activities Hispanics engage in at different parks particularly between men and women. As a result of this study city officials and planners may use this information to build and design parks that cater to the types of activities that Hispanics engage in and may use to meet physical activity guidelines.^

Factors associated with needle sharing among Black male injection drug users in Harris County, Texas

Background. Injection drug users (IDUs) are at increased risk for HIV transmission due to unique risk behaviors, such as sharing needles. In Houston, IDUs account for 18% of all HIV/AIDS cases among Black males. ^ Objectives. This analysis compared demographic, behavioral, and psychosocial characteristics of needle sharing and non-sharing IDUs in a population of Black males in Harris County, Texas. ^ Methods. Data used for this analysis were from the second IDU cycle of the National HIV Behavioral Surveillance System. This dataset included a sample of 288 Black male IDUs. Univariate and multivariate statistical analysis were performed to determine statistically significant associations of needle sharing in this population and to create a functional model to inform local HIV prevention programs. ^ Results. Half of the participants in this analysis shared needles in the past 12 months. Compared to non-sharers, sharers were more likely to be homeless (OR=3.70, p<0.01) or arrested in the past year (OR=2.31, p<0.01), inject cocaine (OR=2.07, p<0.01), report male-to-male sex in the past year (OR=6.97, p<0.01), and to exchange sex for money or drugs. Sharers were less likely than non-sharers to graduate high school (OR=0.36, p<0.01), earn $5,000 or more a year (OR=1.15, p=0.05), get needles from a medical source (OR=0.59, p=0.03), and ever test for HIV (OR=0.17, p<0.01). Sharers were more likely to report depressive symptoms (OR=3.49, p<0.01), lower scores on the family support scale (mean difference 0.41, p=0.01) and decision-making confidence scale (mean difference 0.38, p<0.01), and greater risk-taking (mean difference -0.49, p<0.01) than non-sharers. In a multivariable logistic regression, sharers were less likely to have graduated high school (OR=0.33, p<0.01) and have been tested for HIV (OR=0.12, p<0.01) and were more likely to have been arrested in the past year (OR=2.3, p<0.01), get needles from a street source (OR=3.87, p<0.01), report male-to-male sex (OR=7.01, p<0.01), and have depressive symptoms (OR=2.36, p=0.02) and increased risk-taking (OR=1.78, p=0.01). ^ Conclusions. IDUs that shared needles are different from those that did not, reporting lower socioeconomic status, increased sexual and risk behaviors, increased depressive symptoms and increased risk-taking. These findings suggest that intervention programs that also address these demographic, behavioral, and psychosocial factors may be more successful in decreasing needle sharing among this population.^

HIV prevalence and contextual risk-factors among injection drug users in Harris County, Texas

Injection drug use is the third most frequent risk factor for new HIV infections in the United States. A dual mode of exposure: unsafe drug using practices and risky sexual behaviors underlies injection drug users' (IDUs) risk for HIV infection. This research study aims to characterize patterns of drug use and sexual behaviors and to examine the social contexts associated with risk behaviors among a sample of injection drug users. ^ This cross-sectional study includes 523 eligible injection drug users from Houston, Texas, recruited into the 2009 National HIV Behavioral Surveillance project. Three separate set of analyses were carried out. First, using latent class analysis (LCA) and maximum likelihood we identified classes of behavior describing levels of HIV risk, from nine drug and sexual behaviors. Second, eight separate multivariable regression models were built to examine the odds of reporting a given risk behavior. We constructed the most parsimonious multivariable model using a manual backward stepwise process. Third, we examined whether HIV serostatus knowledge (self-reported positive, negative, or unknown serostatus) is associated with drug use and sexual HIV risk behaviors. ^ Participants were mostly male, older, and non-Hispanic Black. Forty-two percent of our sample had behaviors putting them at high risk, 25% at moderate risk, and 33% at low risk for HIV infection. Individuals in the High-risk group had the highest probability of risky behaviors, categorized as almost always sharing needles (0.93), seldom using condoms (0.10), reporting recent exchange sex partners (0.90), and practicing anal sex (0.34). We observed that unsafe injecting practices were associated with high risk sexual behaviors. IDUs who shared needles had higher odds of having anal sex (OR=2.89, 95%CI: 1.69-4.92) and unprotected sex (OR=2.66, 95%CI: 1.38-5.10) at last sex. Additionally, homelessness was associated with needle sharing (OR=2.24, 95% CI: 1.34-3.76) and cocaine use was associated with multiple sex partners (OR=1.82, 95% CI: 1.07-3.11). Furthermore, twenty-one percent of the sample was unaware of their HIV serostatus. The three groups were not different from each other in terms of drug-use behaviors: always using a new sterile needle, or in sharing needles or drug preparation equipment. However, IDUs unaware of their HIV serostatus were 33% more likely to report having more than three sexual partners in the past 12 months; 45% more likely to report to have unprotected sex and 85% more likely to use drug and or alcohol during or before at last sex compared to HIV-positive IDUs. ^ This analysis underscores the merit of LCA approach to empirically categorize injection drug users into distinct classes and identify their risk pattern using multiple indicators and our results show considerable overlap of high risk sexual and drug use behaviors among the high-risk class members. The observed clustering pattern of drug and sexual risk behavior among this population confirms that injection drug users do not represent a homogeneous population in terms of HIV risk. These findings will help develop tailored prevention programs.^

A comparison of health behaviors of African -American male and female illicit drug users: Implications for community health practice

Prevalence of drug use, HIV, syphilis, and other STDs is particularly high in African-American populations. Although some studies have documented protective changes in health behaviors relevant to these outcomes, other research indicates that risky health behaviors are still widespread. Moreover, little is known about how African-American men and women have differed in their responses to calls to adopt protective behaviors. The study reported in this dissertation investigates gender differences in health risk behavior in a sample of 482 African American chronic, frequent injection drug and crack cocaine users residing in Houston, Texas. It uses baseline and 9 month follow-up data collected on this sample. Four major research questions are addressed. These questions are: Research question 1. What was the overall pattern of reduction in drug use for subjects in the sample? In particular, did subjects who reported a recent (30 day) reduction in drug use and needle sharing risk at baseline also report a reduction at follow-up? Research question 2. Is gender significantly associated with the overall pattern of risk reduction in drug injection observed in the two waves of the study? Research question 3. Is gender significantly associated with the overall pattern of reduction in the number of sexual partners observed in the two waves of the study? Research question 4. Is gender significantly associated with the overall pattern of increase in the use of barrier contraceptives in the two waves of the study? ^

Tabulation of multiple responses

Although multiple response questions are quite common in survey research, Stata's official release does not provide much possibility for an effective analysis of multiple response variables. For example, in a study on drug addiction an interview question might be, "Which substances did you consume during the last four weeks?" The respondents just list all the drugs they took if any, e.g., an answer could be "cannabis, cocaine, heroin" or "ecstasy, cannabis" or "none", etc. Usually, the responses to such questions are held as a set of variables and, therefore, cannot be easily tabulated. I will address this issue and present a new module to compute one- and two-way tables of multiple responses. The module supports several types of data structure, provides significance tests, and offers various options to control the computation and display of the results.

Time series distances measures to analyze in-air signatures to authenticate users on mobile phones

Improving the security of mobile phones is one of the crucial points required to assure the personal information and the operations that can be performed from them. This article presents an authentication procedure consisting of verifying the identity of people by making a signature in the air while holding the mobile phone. Different temporal distance algorithms have been proposed and evaluated through a database of 50 people making their signatures in the air and 6 people trying to forge each of them by studying their records. Approaches based on DTW have obtained better EER results than those based on LCS (2.80% against 3.34%). Besides, different signal normalization methods have been evaluated not finding any with better EER results that when no normalization has carried out.

Workflow reuse in practice: a study of neuroimaging pipeline users

Workflow reuse is a major benefit of workflow systems and shared workflow repositories, but there are barely any studies that quantify the degree of reuse of workflows or the practical barriers that may stand in the way of successful reuse. In our own work, we hypothesize that defining workflow fragments improves reuse, since end-to-end workflows may be very specific and only partially reusable by others. This paper reports on a study of the current use of workflows and workflow fragments in labs that use the LONI Pipeline, a popular workflow system used mainly for neuroimaging research that enables users to define and reuse workflow fragments. We present an overview of the benefits of workflows and workflow fragments reported by users in informal discussions. We also report on a survey of researchers in a lab that has the LONI Pipeline installed, asking them about their experiences with reuse of workflow fragments and the actual benefits they perceive. This leads to quantifiable indicators of the reuse of workflows and workflow fragments in practice. Finally, we discuss barriers to further adoption of workflow fragments and workflow reuse that motivate further work.

Exploring users inter-temporal preferences for measuring transport social equity effects

There exist different ways for defining a welfare function. Traditionally, welfare economic theory foundation is based on the Net Present Value (NPV) calculation where the time dependent preferences of considered agents are taken into account. However, the time preferences, remains a controversial subject. Currently, the traditional approach employs a unique discount rate for various agents. Nevertheless, this way of discounting appears inconsistent with sustainable development. New research work suggests that the discount rate may not be a homogeneous value. The discount rates may change following the individual’s preferences. A significant body of evidence suggests that people do not behave following a constant discount rate. In fact, UK Government has quickly recognized the power of the arguments for time-varying rates, as it has done in its official guidance to Ministries on the appraisal of investments and policies. Other authors deal with not just time preference but with uncertainty about future income (precautionary saving). In a situation in which economic growth rates are similar across time periods, the rationale for declining social optimal discount rates is driven by the preferences of the individuals in the economy, rather than expectations of growth. However, these approaches have been mainly focused on long-term policies where intergenerational risks may appear. The traditional cost-benefit analysis (CBA) uses a unique discount rate derived from market interest rates or investment rates of return for discounting the costs and benefits of all social agents included in the CBA. However, recent literature showed that a more adequate measure of social benefit is possible by using different discount rates including inter-temporal preferences rate of users, private investment discount rate and intertemporal preferences rate of government. Actually, the costs of opportunity may differ amongst individuals, firms, governments, or society in general, as do the returns on savings. In general, the firms or operators require an investment rate linked to the current return on savings, while the discount rate of consumers-users depends on their time preferences with respect of the current and the future consumption, as well as society can take into account the intergenerational well-being, adopting a lower discount rate for today’s generation. Time discount rate of social actors (users, operators, government and society) places a lower value in a future gain, but the uncertainty about future income strongly determines the individual preferences. These time and uncertainty depends on preferences and should be integrated into a transport policy formulation that may have significant social impacts. The discount rate of a user cannot be the same than the operator’s discount rate. The preferences of both are different. In addition, another school of thought suggests that people, such as a social group, may have different attitudes towards future costs and benefits. Particularly, the users have different discount rates related to their income. Some research work tried to modify user discount rates using a compensating weight which represents the inverse of household income level. The inter-temporal preferences are a proxy of the willingness to pay during the time. Its consideration is important in order to make acceptable or not a policy or investment

Characterising social media users by gender and place of residence

Characterising users through demographic attributes is a necessary step before conducting opinion surveys from information published by such users in social media. In this paper, we describe, compare and evaluate different techniques for the identification of the attributes "gender"' and "place of residence" by mining the metadata associated to the users, the content published and shared by themselves, and their friendship networks. The results obtained show that the social network is a valuable source of information for obtaining the sociodemographic attributes of single users.

A personal data framework for exchanging knowledge about users in new financial services

Personal data is a key asset for many companies, since this is the essence in providing personalized services. Not all companies, and specifically new entrants to the markets, have the opportunity to access the data they need to run their business. In this paper, we describe a comprehensive personal data framework that allows service providers to share and exchange personal data and knowledge about users, while facilitating users to decide who can access which data and why. We analyze the challenges related to personal data collection, integration, retrieval, and identity and privacy management, and present the framework architecture that addresses them. We also include the validation of the framework in a banking scenario, where social and financial data is collected and properly combined to generate new socio-economic knowledge about users that is then used by a personal lending service.

Assessment methodology to make urban transport interchanges attractive for users

En las ciudades europeas, los patrones de movilidad son cada vez más complejos debido fundamentalmente a un crecimiento sostenido de la población así como a la tendencia de dispersión de los núcleos urbanos. En consecuencia, muchos de los usuarios del transporte público se ven obligados a combinar varios modos o servicios de transporte para completar sus viajes diarios. Por tanto, el mayor reto de las ciudades es conseguir una mejora e incremento en la movilidad mientras que al mismo tiempo se reducen problemas como la congestión, los accidentes y la contaminación (COM, 2006). Un principio básico para lograr una movilidad sostenible es reducir los inconvenientes y molestias derivados de la transferencia o ruptura del viaje. En este sentido, los intercambiadores de transporte público juegan un papel fundamental como nodos de la red urbana de transporte y la calidad del servicio prestado en ellos tiene una influencia directa sobre la experiencia diaria de los viajeros. Como señaló Terzis and Last (2002), un intercambiador de transportes urbano eficiente debe ser competitivo y al mismo tiempo, debe ser atractivo para los usuarios dado que sus experiencias físicas y sus reacciones psicológicas se ven influenciadas de manera significativa por el diseño y operación del intercambiador. Sin embargo, todavía no existen standards o normativas a nivel europeo que especifiquen como deberían ser estos intercambiadores. Esta tesis doctoral proporciona conocimientos y herramientas de análisis dirigidas a planificadores y gestores de los propios intercambiadores con el fin de entender mejor el funcionamiento de los intercambiadores y gestionar así los recursos disponibles. Así mismo, esta tesis identifica los factores clave en el diseño y operación de intercambiadores urbanos de transporte y proporciona algunas guías generales de planificación en base a ellos. Dado que las percepciones de los usuarios son particularmente importantes para definir políticas adecuadas para intercambiadores, se diseñó y se llevó a cabo en 2013 una encuesta de satisfacción al viajero en tres intercambiadores de transporte urbano europeos: Moncloa (Madrid, España), Kamppi (Helsinki, Finlandia) e Ilford Railway Station ( Londres, Reino Unido). En resumen, esta tesis pone de relieve la naturaleza ambivalente de los intercambiadores urbanos de transporte, es decir, como nodos de la red de transporte y como lugares en sí mismos donde los usuarios pasan tiempo dentro de ellos y propone algunas recomendaciones para hacer más atractivos los intercambiadores a los usuarios. Travel patterns in European urban areas are becoming increasingly complex due to a sustained increase in the urban population and the trend towards urban sprawl. Consequently, many public transport users need to combine several modes or transport services to complete their daily trips. Therefore, the challenge facing all major cities is how to increase mobility while at the same time reducing congestion, accididents and pollution (COM, 2006). Reducing the inconvenience inherent in transferring between modes is a basic principle for achieving sustainable mobility. In this regard, transport interchanges play a key role as urban transport network nodes, and the quality of the service provided in them has a direct influence on travellers' daily experience. As noted by Terzis and Last (2000), an efficient urban transport interchange must be competitive and, at the same time, be attractive for users given that their physical experiences and psychological reactions are significantly influenced by the design and operation of the interchange. However, yet there are no standards or regulations specifying the form these interchanges should take in Europe. This doctoral thesis provides knowledge and analysis tools addressed to developers and managers in order to understand better the performance of an urban transport interchange and manage the available resources properly. Likewise, key factors of the design and operation of urban transport interchanges are identified and some 'Planning guidelines' are proposed on the basis on them. Since the users' perceptions of their experience are particularly important for achieving the most appropriate policy measures for interchanges, an ad‐hoc travellers' satisfaction survey was designed and carried out in 2013 at three European transport interchanges: Moncloa (Madrid, Spain), Kamppi (Helsinki, Finland) and Ilford Railway Station (London, United Kingdom) In summary, this thesis highlights the ambivalent nature of the urban transport interchanges, i.e. as nodes within the transport network and as places where users spending time and proposes some policy recommendations in order to make urban transport interchanges attractive for users.