HIV/AIDS-related behavior change among injecting drug users in different national settings.
OBJECTIVE
To identify factors associated with effective AIDS behavior change among injecting drug users (IDU) in different national settings.


METHODS
Cross-sectional surveys of IDU, with determination of HIV status. Trends in city HIV seroprevalence among IDU also used to validate effectiveness of behavior change.


METHODS
Subjects recruited from drug-use treatment programs and outreach efforts in Bangkok, Thailand (n = 601), Glasgow, Scotland (n = 919), New York City, USA (n = 2539), and Rio de Janeiro, Brazil (n = 466).


RESULTS
Evidence for the effectiveness of self-reported risk reduction was available for all cities. Univariate followed by multiple logistic regression analyses were used to identify factors associated with self-reported AIDS behavior change. Separate analyses were conducted for each city. Talking about AIDS with drug-using friends was significantly associated with behavior change in all four cities. Talking with sex partners about AIDS, educational level, knowing that someone can be HIV-infected and still look healthy, and having been tested previously for HIV were each significantly associated with behavior change in three of the four cities.


CONCLUSIONS
Despite the substantial differences in these national settings, there were common factors associated with effective risk reduction. In particular, risk reduction appears to occur through social processes rather than through individual attitude change. HIV prevention programs need to explicitly incorporate social processes into their work.
Des Jarlais
D C
DC
Chemical Dependency Institute, Beth Israel Medical Center, New York, New York, USA.
Friedman
S R
SR
Friedmann
P
P
Wenston
J
J
Sotheran
J L
JL
Choopanya
K
K
Vanichseni
S
S
Raktham
S
S
Goldberg
D
D
Frischer
M
M
D000163:Acquired Immunodeficiency Syndrome / Q000209:etiology / Q000517:prevention & control / Q000523:psychology*; D000328:Adult; D001519:Behavior; D001938:Brazil; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000209:etiology / Q000517:prevention & control / Q000523:psychology*; D006801:Humans; D008297:Male; D009519:New York City; D012044:Regression Analysis; D012606:Scotland; D012725:Sexual Behavior; D015819:Substance Abuse, Intravenous / Q000523:psychology*; D013785:Thailand