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Substance Abuse Research Development Program for Underserved Populations

"Service Utilization Patterns among HIV+ Drug Users:
The HIV Wellness Project"

Dorie Gilbert, Ph.D., Principal Investigator

Compared to other HIV-positive groups, drug users tend to have poorer outcomes with utilization of AIDS services, including successful retention in antiretroviral therapy (ART) services (Kaplan, et al., 1999), and are susceptible to continued drug use without effective treatment.  This is of great concern because inconsistent use of ART medications and continued drug use may lead to rapid progression of HIV disease, reduced life expectancy, and potentially to the development and transmission of resistant strains of HIV (Sorensen, et al., 1998).  Given that an estimated 50% of HIV-positive drug users are receiving ART (Celentano, et al., 1998) with various levels of success (Broers, et al., 1994; Elred, et al., 1996) the above statistics underscore the importance of:  (1) linking HIV-positive drug users to a range of health and social services to improve HIV-therapy outcomes, and (2) assessing a person's readiness for ART medical services.  It is particularly important to improve retention among African American and Mexican American populations, who are disproportionately impacted by the AIDS pandemic (CDCP, 1999). 

The Transtheoretical Model ([TTM], (Prochaska, DiClemente, & Norcross, 1992) helps to explain the cognitive and behavioral processes individuals experience while changing their behavior, and presents a useful model for assessing a person's readiness for ART adherence.  The major goal of this research, therefore, is to develop a Stage of Change measure for ART adherence using a TTM template, and to elicit responses about ART adherence from African American, Latino, and White drug users to investigate cultural differences in decisional balance and self-efficacy constructs.  A second goal is to determine the relationship between stage of change and a set of background factors hypothesized to impact readiness for ART adherence.  Specifically, enabling factors (receipt of a continuum of services), ethnic-related factors (race/ethnicity and mistrust), disabling factors (continued drug use, hepatitis co-infection) and demographic factors will be explored as predictors of stages of change.

Literature Cited:

Broers, B., Morabia, A., and Hirschel, B.  (1994).  A cohort study of drug users' compliance with zidovudine treatment.  Archives of Internal Medicine, 154, 1121-1127.

Celantano, D.D., Vlahov, D., Cohn, S., Shadle, V.M., Obasanjo, O., and Moore, R.D.  (1998).  Self-reported antiretroviral therapy in injection users.  Journal of the American Medical Association, 280 (6), 544-546.

Centers for Disease Control and Prevention (1999).  HIV/AIDS Surveillance Report.  Atlanta, GA.  Year-End Edition, 11 (2). 

Kaplan, J.E., Parham, E.L., Soto-Torres, L., VanDyck, K., Greabes, J.A., Rauch, K., Ellis, B., and Amandus, J.E.  (1999).  Adherence to guidelines for ART and for preventing opportunistic infection in HIV infected adults in adolescence in Ryan White funded facilities in the United states.  Journal of Acquired Immune Deficiency Syndromes and Human Retro Virology, 21 (3), 228-235.

Sorenson, J.L., Mascovich, A., Wall, T.L., DePhilippis, D., Batki, S.L., and Chesney, M.  (1998).  Medication adherence strategies for drug abusers with HIV/AIDS.  AIDS Care, 10 (3), 297-312.

Prochaska, J.O., DiClemente, C.C., and Norcross, J.C.  (1992).  In search of how people change:  Applications to addictive behaviors.  American Psychologist, 47 (9), 1102-1114.


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